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Ageing patients in forensic psychiatric settings: a review of the literature
- Authors:
- DI LORITO Claudio, VOLLM Birgit, DENING Tom
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(12), 2018, pp.1548-1555.
- Publisher:
- Wiley
Objectives: The prevalence of ageing patients in forensic psychiatric settings is increasing. However, limited research has reported around this population. The aim of this scoping review is to synthesise the current evidence around ageing forensic psychiatric patients. Methods: The literature was searched through four databases and Google searches. The identified outputs were screened for suitability and assessed for quality. Quantitative data were extracted and analysed on SPSS; qualitative data were extracted and analysed onto NVivo. Results: Seven studies were included in the review. Quantitative results reported around demographics, service contact, offending patterns, mental, and physical health of ageing patients. Qualitative findings focused on age‐friendliness of services, staff‐patient rapport, activities, security issues, and discharge planning. Conclusions: Ageing forensic psychiatric patients present with complex and unique needs in relation to treatment, activities, mental, physical, and support. Further research looking at individual patients' needs is paramount to inform policy development and good practice in this area. (Edited publisher abstract)
Ways of integrating care that better coordinate services may benefit patients
- Author:
- NATIONAL INSTITUTE FOR HEALTH RESEARCH. Dissemination Centre
- Publisher:
- National Institute for Health Research
- Publication year:
- 2018
- Place of publication:
- London
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. This NIHR Signal focuses on an NIHR-funded review which looked at the international literature to understand how new integrated care models may affect patients, providers and systems. It included a qualitative review of attitudes, barriers and enablers of integration. Nearly half of the 267 studies came from the UK. Most investigated integrated care pathways, often as part of a multicomponent intervention including multidisciplinary teams and some form of case management. Most studies focused on older people. The review finds some positives in relation to improved patient satisfaction and perceived quality of care, but overall highlights the complexity of implementing and assessing new models of care. NIHR Signals highlight examples of important research and explain why the study was needed, what the study found and the implications of the findings. They include commentary from experts, researchers and those working in practice. (Edited publisher abstract)
Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: a narrative review. Don’t we need a value-based approach?
- Authors:
- MARINO Marta, et al
- Journal article citation:
- International Journal of Care Coordination, 21(4), 2018, pp.120-129.
- Publisher:
- Sage
Introduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centredness of care. The authors conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. They reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilisation outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilisation rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalised on a large scale. Discussion: The authors found out a favourable impact of integrated care models/methods on health outcomes, care utilisation and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. A value-based framework for the evaluation of these services is proposed. (Edited publisher abstract)
Hospital outcomes of older people with cognitive impairment: an integrative review
- Authors:
- FOGG Carole, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(9), 2018, pp.1177-1197.
- Publisher:
- Wiley
Objectives: To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. Methods: Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. Results: One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all‐cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. Conclusions: Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes. (Edited publisher abstract)
Cognitive functioning, cognitive reserve, and residential care placement in patients with Alzheimer's and related dementias
- Authors:
- KADLEC Helena, et al
- Journal article citation:
- Aging and Mental Health, 22(1), 2018, pp.19-25.
- Publisher:
- Taylor and Francis
Objective: To test the hypothesis that patients with mild to moderate dementia with higher initial cognitive reserve (higher education levels exhibit faster cognitive decline at later stages of disease progression as they approach residential care (RC) placement. Method: Two provincial administrative databases were used. One contained individuals' scores of cognitive functioning (assessed at 6- to 12-month intervals using the Standardized Mini-Mental State Examination, SMMSE, 2007–2014) and education level; the second (BC Ministry of Health Home and Community Care database, 2001–2014) contained individuals' RC placement; N = 10531. Results: During 2.5–0.5 years prior to placement, SMMSE scores of patients with 0–8 years of education dropped slightly (M D 20.6 to 20.0), while patients with 9–12 years and 13+ years of education started higher (M D 21.8 and 21.4), but decreased faster and ended up lower (M D 19.5 and 18.8). Six-months prior to placement, SMMSE scores of all groups dropped almost 2 points. Conclusions: Once cognitive reserve of more highly educated dementia patients is depleted and they approach RC placement, their cognitive functioning deteriorates faster. Finding effective interventions that maintain or enhance cognitive reserve may increase the time in the community for dementia patients. (Publisher abstract)
An evaluation of a near real-time survey for improving patients' experiences of the relational aspects of care: a mixed-methods evaluation
- Authors:
- GRAHAM C., et al
- Journal article citation:
- Health and Social Care Delivery Research, 6(15), 2018, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: The Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements. Objectives: To develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care. Design: The research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites. Setting: The research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments. Participants: The 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data. Interventions: A patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care. Main outcome measures: The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff. Results: A small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients. Limitations: Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging. Conclusions: Near real-time feedback offers an effective approach for monitoring and improving relational aspects of care. (Edited publisher abstract)