Search results for ‘Subject term:"very old people"’ Sort:
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Improving quality and value in healthcare for frail older people
- Authors:
- GEORGE James, et al
- Journal article citation:
- Quality in Ageing, 8(4), December 2007, pp.4-9.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
This article reports an important multi-centre practice-based review that identifies good practice and an ideal pathway for the healthcare of frail older people, which, if replicated nationally, could result in improved quality of care and better value for money for the NHS. Data on healthcare resource groups (HRGs) in England were examined as a marker for the management of elderly people though the healthcare system. Care pathways in several different NHS trusts were explored via staff interviews. A high variation in treatment outcomes across centres were found. Principles of best practice were identified and included: comprehensive geriatric assessment; the availability of specialist geriatric teams and wards; and shared assessment and co-ordination between care agencies.
Preconditions to implementation of an integrated care process programme
- Authors:
- BANGSBO Angela, et al
- Journal article citation:
- Journal of Integrated Care, 30(1), 2022, pp.66-76.
- Publisher:
- Emerald
Purpose: The purpose of this study was to investigate the preconditions of a full-scale implementation of an integrated care process programme for frail older people from the staff's understanding, commitment and ability to change their work procedures with comparisons over time and between organisations. Design/methodology/approach: A repeated cross-sectional study was conducted in a hospital, municipal health and social care setting. Findings: Staff commitment decreased to the importance of a permanent municipal contact from baseline compared to the 12-months follow-up (p = 0.02) and the six- and 12-months follow-up (p = 0.05), to the information transfer from emergency department from the six- to the 12-months follow-up (p = 0.04), to discharge planning at the hospital at six- and 12-months follow-up (p = 0.04) and towards discharge planning at home from baseline to the six-month follow-up (p = 0.04). Significant differences occurred between the organisations about information transfer from the emergency department (p = 0.01) and discharge planning at home (p = 0.03). The hospital staff were the most committed. Practical implications: The results can guide the implementation of complex interventions in organisations with high-employee turnover and heavy workload. Originality/value: The study design, allowing the comparison of implementation results over time and between organisations in a later phase, gives this study a unique perspective. (Edited publisher abstract)
Consequences of ‘conversations not had’: insights into failures in communication affecting delays in hospital discharge for older people living with frailty
- Authors:
- REDWOOD Sabi, et al
- Journal article citation:
- Journal of Health Services Research and Policy, 25(4), 2020, pp.213-219.
- Publisher:
- Sage
- Place of publication:
- London
Older people living with frailty (OPLWF) are often unable to leave hospital even if they no longer need acute care. The aim of this study was to elicit the views of health care professionals in England on the barriers to effective discharge of OPLWF. Methods: The researchers conducted semi-structured interviews with hospital-based doctors and nurses with responsibility for discharging OPLWF from one large urban acute care hospital in England. The data were analysed using the constant comparative method. Results: Researchers conducted interviews with 17 doctors (12 senior doctors or consultants and 5 doctors in training) and six senior nurses. Some of their findings reflect well-known barriers to hospital discharge including service fragmentation, requiring skilled coordination that was often not available due to high volumes of work, and poor communication between staff from different organizations. Participants’ accounts also referred to less frequently documented factors that affect decision making and the organization of patient discharges. These raised uncomfortable emotions and tensions that were often ignored or avoided. One participant referred to ‘conversations not had’, or failures in communication, because difficult topics about resuscitation, escalation of treatment and end-of-life care for OPLWF were not addressed. Conclusions: The consequences of not initiating important conversations about decisions relating to the end of life are potentially far reaching not only regarding reduced efficiency due to delayed discharges but also for patients’ quality of life and care. As the population of older people is rising, this becomes a key priority for all practitioners in health and social care. Evidence to support practitioners, OPLWF and their families is needed to ensure that these vital conversations take place so that care at the end of life is humane and compassionate. (Edited publisher abstract)
Frailty and healthcare costs - longitudinal results of a prospective cohort study
- Authors:
- HAJEK Andre, et al
- Journal article citation:
- Age and Ageing, 47(2), 2018, pp.233-241.
- Publisher:
- Oxford University Press
Objective: to investigate how frailty and frailty symptoms affect healthcare costs in older age longitudinally. Methods: data were gathered from a prospective cohort study in Saarland, Germany (two waves with 3-year interval, n = 1,636 aged 57–84 years at baseline). Frailty was assessed by the five Fried frailty criteria. Frailty was defined as having at least three criteria, the presence of 1–2 criteria as ‘pre-frail’. Healthcare costs were quantified based on self-reported healthcare use in the sectors of inpatient treatment, outpatient treatment, professional nursing care and informal care as well as the provision of pharmaceuticals, medical supplies and dental prostheses. Results: while the onset of pre-frailty did not increase (log) total healthcare costs after adjusting for potential confounders including comorbidity, progression from non-frailty to frailty was associated with an increase in total healthcare costs (for example, costs increased by ~54 and 101% if 3 and 4 or 5 symptoms were present, respectively). This association of frailty onset with increased healthcare costs was in particular observed in the inpatient sector and for informal nursing care. Among the frailty symptoms, the onset of exhaustion was associated with an increase in total healthcare costs, whereas changes in slowness, weakness, weight loss and low-physical activity were not significantly associated with an increase in total healthcare costs. Conclusions: our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs. (Publisher abstract)
Health-related quality of life and activities of daily living in 85-year-olds in Sweden
- Authors:
- ANDERSSON Lena B., MARCUSSON Jan, WRESSLE Ewa
- Journal article citation:
- Health and Social Care in the Community, 22(4), 2014, pp.368-374.
- Publisher:
- Wiley
Abstract Few studies have examined health-related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85-year-olds' reported HRQoL in relation to social support, perceived health, chronic diseases, healthcare use and instrumental activities of daily living (IADL). Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview. HRQoL was assessed using the EQ-5D-3L. For the items in the EQ-5D-3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common. Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases and more problems with IADL. Healthcare use and healthcare costs were correlated with lower HRQoL. HRQoL is of importance to healthcare providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals. (Publisher abstract)
Your push to improve older people's care
- Author:
- MOORE Alison
- Journal article citation:
- Health Service Journal, 124(6393), 4 April 2014, pp.20-23.
- Publisher:
- Emap Healthcare
This article presents some readers suggestions for improving the care of frail older people. Areas covered include service structure and funding, workforce and staffing, ensuring the dignity of older people. (Original abstract)
Improving later life: understanding the oldest old
- Author:
- AGE UK
- Publisher:
- Age UK
- Publication year:
- 2013
- Pagination:
- 92
- Place of publication:
- London
This book provides insights from various contributors into key points for professionals making decisions about those aged 85 and over. Messages include: the oldest old are more diverse in health than the younger old and cannot all be treated the same; chronological age is a weak predictor of life expectancy and response to treatments; and many illnesses associated with age can be treated or avoided, especially if the oldest old receive good co-ordination across services and specialities to offer the best treatment. (Edited publisher abstract)
Clinical issues in old age: the challenges of geriatric medicine
- Author:
- BAYER Anthony
- Journal article citation:
- Quality in Ageing and Older Adults, 12(1), March 2011, pp.44-49.
- Publisher:
- Emerald
Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut-off in chronological age, it recognises that most older people, especially the ‘young-old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients – those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old-old’. This population is characterised by non-specific presentation of illness, functional dependency and a need for a multi-disciplinary approach to care and cautious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlights the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.
Access to healthcare services makes a difference in healthy longevity among older Chinese adults
- Authors:
- GU Danan, ZHANG Zhenmei, ZENG Yi
- Journal article citation:
- Social Science and Medicine, 68(2), January 2009, pp.210-219.
- Publisher:
- Elsevier
The positive impact of access to healthcare on health and survival among older adults is well-documented in Western societies. However, whether the pattern still holds in developing countries where healthcare coverage is more limited is largely unknown. China, a developing country with the largest population in the world, has been transforming its antiquated healthcare system during the past few decades in response to rapid population aging. Yet, in recent years the lack of access to healthcare has been identified as the top concern by most citizens in China. We used the Chinese Longitudinal Healthy Longevity Survey and the community-level data sources from the National Bureau of Statistics of China to examine the impact of current as well as childhood access to healthcare services on subsequent three-year survival and healthy survival at old ages from 2002 to 2005 under a multilevel context. Healthy survival was measured by a cumulative deficit index calculated from thirty-nine variables pertaining to various dimensions of health. The analyses showed that access to healthcare at present and during childhood improved the odds of subsequent three-year survivorship by 13–19% and 10%, respectively, controlling for various confounders. But the effect of access to healthcare at present was no longer statistically significant once baseline health status in 2002 was controlled for. Access to healthcare at present increased odds of healthy survival by 22–68%, while access to healthcare in childhood increased odds of healthy survival by 18%. All patterns held true for both men and women, for urban and rural areas, across ages, as well as across socioeconomic statuses. The findings suggested that positive inputs such as access to healthcare services over the life course make a substantial difference in healthy longevity, which has implications for the establishment of the universal healthcare system.
Survival in the community of the very old depressed, discharged from medical inpatient care
- Authors:
- WILSON Kenneth, MOTTRAM Patricia, HUSSAIN Maryyum
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(10), October 2007, pp.974-979.
- Publisher:
- Wiley
The aim was to examine the prevalence and associated risk factors of depression in older patients discharged home from acute medical care and their influence on duration of survival in the community. A cross-sectional, prevalence study of depression in recently discharged patients and a prospective, case-controlled study of depressed and psychiatrically asymptomatic sub groups, exploring the relationship between depression, associated risk factors, and duration of survival in the community. A community study of patients aged 75 and older discharged from the Countess of Chester Hospital and Wirral Hospitals Trust serving Wirral and West Cheshire, England. Three hundred and eleven patients were entered into the prevalence study. One hundred and fifty-eight patients (54 depressed and 104 asymptomatic) were entered into the prospective case controlled study and followed up for up to two years. Depression was defined by GMS/AGECAT criteria. Demographic details, handicap, pain, forced expiratory volume and social network were measured as dependent variables in the prevalence study and included in the analysis of risk factors potentially associated with duration of survival in the community. A depression prevalence rate of 17.4% was found. Age, forced expiratory volume and handicap were associated with depression but depression was the only base-line variable associated with reduced survival in the community as defined by mortality and re-admission. Depression is common in older people discharged from acute medical care and is a major risk factor for reduced duration of community survival.