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Guided care for multimorbid older adults
- Authors:
- BOYD Cynthia M., et al
- Journal article citation:
- Gerontologist, 47(5), October 2007, pp.697-704.
- Publisher:
- Oxford University Press
The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity in the United States. Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an Action Plan for the patient and caregiver. Based in the primary care office, the nurse then regularly monitors the patient's chronic conditions, coaches the patient in self-management, coordinates the efforts of all involved health care professionals, smoothes the patient's transitions between sites of care, provides education and support for family caregivers, and facilitates access to community resources. A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers.
Development and implementation of nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families in a multiracial primary care setting.
- Authors:
- AUSTROM Mary Guerriero, et al
- Journal article citation:
- Gerontologist, 44(4), August 2004, pp.548-553.
- Publisher:
- Oxford University Press
Most patients and families with dementia are cared for in primary care clinics. These clinics are seldom designed to provide the necessary comprehensive care. The purpose of this article is to describe nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families that are administered as part of a multifaceted care-management intervention program in a multiracial primary care clinic. The nonpharmacologic component for the integrated program of collaborative care was developed based on a literature review and previous clinical experience. The care is coordinated by a geriatric nurse practitioner who meets with patients, families, and the primary care physicians. The nonpharmacologic protocols included general educational guidelines about Alzheimer's disease. Specific protocols to treat the common behavioral disturbances associated with Alzheimer's disease also were developed. A major component of the intervention is a monthly psychoeducational support group for caregivers. The intervention has been well accepted by patients, families, and physicians. Approximately one-half of the treatment group has participated in the support group regularly. The integration of behavioural interventions and team care within the primary care environment has been successful.
Identification of psychological morbidity in older people in primary care by practice nurses
- Authors:
- CAPE J., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.446-451.
- Publisher:
- Taylor and Francis
Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.
Managing the depression in the older person
- Authors:
- WALKER Kathie, SEWELL Keith
- Journal article citation:
- Community Nurse, 4(9), October 1998, pp.30-31.
- Publisher:
- Emap Healthcare
Nurses are well placed to identify signs of depression in older people. This article explains the different approaches to its effective management in primary care.
A nurse-coordinated educational initiative addressing primary care professionals' attitudes to and problem-solving in depression in older people - a pilot study
- Authors:
- LIVINGSTON Gill, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(5), May 2000, pp.401-405.
- Publisher:
- Wiley
This study assessed the feasibility and efficacy of an intervention focusing on primary care professionals' attitudes to, problem-solving in and practice relating to depression in old age before and after a nurse-implemented educational intervention. The results of the study do not indicate that the evaluation of nurse-led educational interventions in primary care is feasible in the field of depression in old age. The belief that all that is needed is the provision of accessible education of professionals by experts in the field to change attitudes and practice has not been reinforced. The high refusal rate suggests that such interventions are unlikely in any case to be generally acceptable.
Rehabilitation of older people: a handbook for the multidisciplinary team
- Editor:
- SQUIRES Amanda J.
- Publisher:
- Chapman and Hall
- Publication year:
- 1996
- Pagination:
- 314p.,bibliogs.
- Place of publication:
- London
Includes chapters on: disease and disability in older people - prospects for intervention; rehabilitation and older people from minority ethnic groups; psychological approaches with older people; assessment, goal setting and outcomes in rehabilitation; mental state and physical performance; communication problems of older people; the role of the nurse in the rehabilitation of older people; feet and footwear; the potential of social work in the rehabilitation of older people; physiotherapy with older people; occupational therapy; and the role of the GP in primary care led rehabilitation.