Search results for ‘Subject term:"very old people"’ Sort:
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Older patients have the most to gain from orthopaedic enhanced recovery programmes
- Authors:
- STARKS Ian, et al
- Journal article citation:
- Age and Ageing, 43(5), 2014, pp.642-648.
- Publisher:
- Oxford University Press
Background: Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. The authors aimed to investigate the potential benefits of this pathway in patients over the age of 85 years. Methods: Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated. Results: In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days). Difference in length of stay was most pronounced in the group of patients aged 85 years and over (9 to 5 days for total hip replacement and 8 to 5 days for total knee replacement). Nearly all patients were discharged directly home (97.4%). Readmission rates were over 45% lower in patients aged 85 and over when compared with national averages (5.2 vs. 9.4%). Conclusions: This is the first series in the literature to assess the role of enhanced recovery pathways in the very elderly. This study not only shows that successful fast track rehabilitation can be achieved in the very elderly population undergoing elective joint replacement surgery, but that it is this cohort of vulnerable patients who have the most to gain from such multidisciplinary recovery programmes. (Edited publisher abstract)
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.
Mirror meetings with frail older people and multidisciplinary primary care teams: process and impact analysis
- Authors:
- GROL Sietske, MOLLEMAN Gerard, SCHERS Henk
- Journal article citation:
- Health Expectations, 22(5), 2019, pp.993-1002. Online only
- Publisher:
- Wiley
Objectives: To analyse the process and impact of confronting multidisciplinary teams (MTs) in primary care with the experiences of frail older patients through mirror meetings (MMs), with the aim of supporting teams to organize care in a more patient‐oriented way. Methods: Process and impact analyses were performed using a mixed‐method approach. MMs were held with 14 frail older patients and four MTs comprising 23 health‐care professionals (HCPs) in primary care in the Netherlands. Results: Mirror meetings were feasible for frail older people living at home, although their recruitment was time‐consuming. Interaction between the patients was scarce, but they valued the opportunity to share their stories. HCPs preferred MMs overwritten reports about patient experiences. An impact analysis revealed four dominant professional areas for improvement: improve alignment with patient goals, improved communication with patients both orally and in writing, developing new pathways to connect with informal caregivers and an increased understanding that most HCPs are relative strangers to their patients. Conclusions: Mirror meetings are a relatively simple and promising method for exploring the ways in which frail older patients experience care. Practice implications: Given the right conditions, MMs could result in valuable processes to enable MTs to improve their working methods. (Publisher abstract)
Patient participation in discharge planning conference
- Authors:
- BANGSBO Angela, LIDEN Eva, DUNER Anna
- Journal article citation:
- International Journal of Integrated Care, 14(4), 2014, pp.1-11. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: There is a need for individualised discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by Harre & van Langenhove. Methods: The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008–2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings. Results: Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning. Conclusions: The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation. (Edited publisher abstract)
Creating compassionate care within the hospital intensive care unit: beyond positivism and toward wisdom and responsibility
- Author:
- WAX Murray L.
- Journal article citation:
- Qualitative Research, 3(1), April 2003, pp.119-138.
- Publisher:
- Sage
Of deaths in the US, an increasing proportion occur within hospital intensive care units amidst miraculous medical technology. A positivist ethos dominates. As patients are transformed into 'cases', they lose social identity, and their dying becomes a medical defeat, rather than a natural and social process. Families encounter sedated intubated specimens rather than social persons from whom they wish ceremonially to depart. In response to these problems, there are ongoing efforts at transformation and remediation.
Seen but not heard: elderly women's experiences in hospital
- Authors:
- FREEMAN Amy, O'CONNOR Deborah
- Journal article citation:
- Canadian Social Work Review, 19(1), 2002, pp.65-84.
- Publisher:
- Canadian Association for Social Work Education
This article identified critical gaps in five areas: bathing, mobility, nutrition, communication and care of dentures. Additionally patients lost their sense of personal identity whilst in hospital. To cope with such gap in care, patients looked to alternative sources of support including informal care from family members.
Increasing longevity: medical, social and political implications
- Editor:
- TALLIS Raymond
- Publisher:
- Royal College of Physicians of London
- Publication year:
- 1998
- Pagination:
- 150p.,diags.,bibliog.
- Place of publication:
- London
Papers from a conference on the social, medical and political implications of an ageing population. Includes chapters on: population ageing over the next few decades; ageing, ill health and disability; the economic implications of increasing longevity; advances in the understanding of biological ageing; new technology and the older patient; making rational use of resources; ageing in developing countries; the politics and economics of an ageing population; the research agenda for medicine and old age; genetics and the future of human longevity; and the medical response to an ageing society.