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Friend P, Trenary T, Oldenburg H. Occupational Therapy Practitioners' Perceptions on Addressing Cognition in Acute Care: A National Survey. Occup Ther Health Care 2024:1-21. [PMID: 38400567 DOI: 10.1080/07380577.2024.2315487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
This study aimed to identify commonly used standardized cognitive screens and functional performance assessments among occupational therapy practitioners at level 1 trauma centers in the USA. A survey completed by 269 occupational therapy practitioners revealed the most common cognitive screens and the association between cognitive tool training and standardized cognitive tool implementation. Implications for practice are discussed with suggestions for improving occupational therapy practice.
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Affiliation(s)
- Payton Friend
- Graduate Occupational Therapy Program, St. Catherine University, St. Paul, MN, USA
| | - Tamra Trenary
- Physical Medicine and Rehabilitation Department, Mayo Clinic-Rochester, Rochester, MN, USA
| | - Hannah Oldenburg
- Graduate Occupational Therapy Program, University of Minnesota, Minneapolis, MN, USA
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2
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Tarhan N, Arslan M. Psychometric assessment of pharmacists' counseling in dementia. PATIENT EDUCATION AND COUNSELING 2023; 115:107903. [PMID: 37506523 DOI: 10.1016/j.pec.2023.107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/07/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE This study aimed to explore pharmacists' counseling for dementia by developing a measurement tool based on the Theory of Planned Behavior. METHODS A survey was applied online to community pharmacists; in total, 190 community pharmacists participated in the study. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mann-Whitney U test were performed. RESULTS A six-factor structure was obtained from the EFA, and the CFA confirmed the structure. These factors explained 71.294% of the total variance. The Cronbach's alpha coefficients for the factors ranged from 0.728 to 0.913. In addition, the pharmacists rated themselves as having positive attitudes and intentions toward counseling for dementia. Differences in these factors were found between the groups based on their participation in vocational training on dementia. CONCLUSION The developed measurement tool had a satisfactory construct and convergent and discriminant validities and reliabilities. PRACTICE IMPLICATIONS The developed measurement tool can be used to investigate pharmacists' self-reported counseling for dementia and can also be applied to the counseling behavior of pharmacists in various health conditions.
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Affiliation(s)
- Nilay Tarhan
- Department of Pharmacy Management, Izmir Katip Celebi University Faculty of Pharmacy, Izmir, Turkiye.
| | - Miray Arslan
- Department of Pharmacy Management, Van Yuzuncu Yil University Faculty of Pharmacy, Van, Turkiye
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Saragosa M, Kuluski K, Okrainec K, Jeffs L. “Seeing the day-to-day situation”: A grounded theory of how persons living with dementia and their family caregivers experience the hospital to home transition and beyond. J Aging Stud 2023. [DOI: 10.1016/j.jaging.2023.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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4
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Elbeddini A, Tayefehchamani Y, Yilmaz Z, Villegas JJ, Zhang EY. Evaluation of a community-based memory clinic in collaboration with local hospitals to support patients with memory decline. J Taibah Univ Med Sci 2022; 17:220-234. [PMID: 35592795 PMCID: PMC9073869 DOI: 10.1016/j.jtumed.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study evaluates the role of a specialised and multidisciplinary healthcare team, including a pharmacist, in providing medication management for patients with mild cognitive impairment (MCI) and dementia, in a memory clinic. Methods The study analysed the dataset of 102 patients of a geriatric and memory clinic in a rural area of Ontario, Canada. The case histories of the patients were reviewed a week before the clinic day and a pharmacist performed medication reconciliations. During the clinic day, cognitive tests were conducted and outcomes were discussed with the team, to create a care plan and schedule a follow-up within 3, 6 or 12 months. Results Most patients had an average of 5 prescriptions and 2 non-prescription medications deprescribed, and 57% of patients were started on memory-related medications. A total of 712 medications (p-value 0.001) were deprescribed, with 510 prescriptions and 202 non-prescription items. Out of the 712 deprescribed drugs, 374 were discontinued with no therapeutic substitutions, 202 were reduced in dosage and 136 were switched to a safer alternative. A total of 43 patients showed improved Activities of Daily Living (ADL) performance after 3 and 6 months and 68 patients showed improvement after 12 months. Conclusion This study highlights the importance of a multidisciplinary approach in addressing drug-therapy problems, medication optimisation, and deprescription in patients with dementia. The presence of a pharmacist in the multidisciplinary team enables impactful medication optimisation and leads to improved patient outcomes. This demonstrates the value of specialised expertise in medication management for patients with dementia.
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Affiliation(s)
- Ali Elbeddini
- Winchester District Memorial Hospital, Winchester, ON, Canada
| | | | - Zekiye Yilmaz
- Clinical Pharmacy Department, Acibadem University, Turkey
| | - Josiah J. Villegas
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada
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5
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Tumusiime WA, Hardman CJ, Breen JL. Antipsychotic prescribing in people admitted to hospital with dementia or delirium. Australas J Ageing 2021; 41:258-264. [PMID: 34792258 DOI: 10.1111/ajag.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate antipsychotic prescribing in people with dementia or delirium admitted to a large regional Queensland hospital. METHODS A retrospective observational study analysing medical records of patients prescribed antipsychotics over 6 months. RESULTS We audited a sample of 141 patients, 65 years or over (over 45 years for indigenous peoples) with dementia or delirium, without severe mental illness, prescribed antipsychotics. Over a third (35%) were prescribed antipsychotics prior to admission, with 73% prescribed a new antipsychotic in hospital. Only 23% received documented review of antipsychotic therapy. Under half (48%) had evidence of non-pharmacological interventions as first-line management. Sixty-eight patients (48%) were discharged with antipsychotics; however, only 4% were provided an antipsychotic management plan. CONCLUSION Initiation and continuation of antipsychotics in patients with dementia or delirium in hospital is common, with infrequent review. There is significant potential to reduce prescribing antipsychotics in people admitted to hospital with dementia or delirium.
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Affiliation(s)
| | - Caitlin J Hardman
- Ipswich Hospital, Ipswich, Queensland, Australia.,School of Pharmacy, University of Queensland, St. Lucia, Queensland, Australia
| | - Juanita L Breen
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Suwa S, Tsujimura M, Yumoto A, Iwata N, Shimamura A. Multidisciplinary pharmacotherapy collaboration for home-based older adults with dementia: a study focusing on physicians, pharmacists, and nursing professionals. Psychogeriatrics 2021; 21:749-762. [PMID: 34212449 DOI: 10.1111/psyg.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home-based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support. METHODS This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home-based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home-based older adults with dementia were extracted. A mail-based, self-administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home-based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four-point Likert scale. RESULTS The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses. CONCLUSIONS It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.
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Affiliation(s)
- Sayuri Suwa
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Mayuko Tsujimura
- School of Nursing, Faculty of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Akiyo Yumoto
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Naoko Iwata
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuko Shimamura
- Department of Nursing, Faculty of Health Science, Toho University, Chiba, Japan
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Abstract
Multiple transitions across care settings can be disruptive for older adults with dementia and their care partners, and can lead to fragmented care with adverse outcomes. This scoping review was conducted to identify and classify care trajectories across multiple settings for people with dementia, and to understand the prevalence of multiple transitions and associated factors at the individual and organizational levels. Searches of three databases, limited to peer-reviewed studies published between 2007 and 2017, provided 33 articles for inclusion. We identified 26 distinct care trajectories. Common trajectories involved hospital readmission or discharge from hospital to long-term care. Factors associated with transitions were identified mainly at the level of demographic and medical characteristics. Findings suggest a need for investing in stronger community-based systems of care that may reduce transitions. Further research is recommended to address knowledge gaps about complex and longitudinal care trajectories and trajectories experienced by sub-populations of people living with dementia.
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Knox S, Downer B, Haas A, Ottenbacher KJ. Mobility and Self-Care are Associated With Discharge to Community After Home Health for People With Dementia. J Am Med Dir Assoc 2021; 22:1493-1499.e1. [PMID: 33476569 DOI: 10.1016/j.jamda.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES A priority health outcome for patients, families, and the Centers for Medicare & Medicaid Services (CMS) is a patient's ability to return home and remain in the community without adverse events following discharge from post-acute care services. Successful discharge to community (DTC) is defined as being discharged to the community and not experiencing a readmission or death within 30 days of discharge. The objective of this study was to determine the association between patient factors and successful DTC after home health for individuals with Alzheimer's disease and related dementias (ADRD). DESIGN This retrospective study derived data from 100% national CMS data files from October 1, 2016, through September 30, 2017. SETTINGS AND PARTICIPANTS Criteria from the Home Health Quality Reporting program were used to identify a cohort of 790,439 Medicare home health beneficiaries, 143,164 (18.0%) with ADRD. MEASURES Successful DTC rates with associated 95% confidence intervals (CIs) were calculated for each patient characteristic. Multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC after home health, by ADRD diagnosis, mobility, self-care, caregiver support, and medication management, adjusted for patient demographics and clinical characteristics. RESULTS Overall, 79.4% of beneficiaries had a successful DTC. Beneficiaries with ADRD had a significantly lower odds of successful DTC than those without ADRD (RR=0.947, 95% CI=0.944-0.950). This association remained significant after adjustment for caregiver support, assistance with medications, independence in mobility, and level of self-care. Greater need for caregiver support, greater need for assistance with medications, greater dependence in mobility, and greater self-care dependence were all associated with decreased risk of successful DTC. CONCLUSIONS AND IMPLICATIONS Older adults with ADRD receiving home health had decreased RR of successful DTC. To have a successful DTC, older adults with ADRD need sufficient support from caregivers and independence in functioning.
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Affiliation(s)
- Sara Knox
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA.
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Allen Haas
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
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Kable A, Hullick C, Palazzi K, Oldmeadow C, Searles A, Ling R, Pond D, Fullerton A, Fraser S, Bruce R, Murdoch W, Attia J. Evaluation of a safe medication strategy intervention for people with dementia with an unplanned admission: Results from the Safe Medication Strategy Dementia Study. Australas J Ageing 2020; 40:356-365. [PMID: 33166034 DOI: 10.1111/ajag.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/24/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether a safe medication strategy compared with usual care, provided to people with dementia during an unplanned admission, reduces readmissions to hospital and re-presentation to emergency departments within three months. METHODS A prospective, controlled pre-/post-trial conducted at two regional hospitals in New South Wales, Australia. RESULTS No treatment effect was seen for time to first re-presentation or readmission within three months (P = .3). Compliance with six strategies applicable for all participants in the intervention phase was 58%. There was no treatment effect for secondary outcomes including dose administration aid use, home medicines review (HMR) requests by general practitioners and completed HMRs; however, they were significantly higher at the intervention site in both phases. CONCLUSION A bundle of care to improve medication safety in people with dementia did not reduce re-presentations or readmissions within three months.
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Affiliation(s)
- Ashley Kable
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Carolyn Hullick
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | | | - Andrew Searles
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Rod Ling
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Anne Fullerton
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Samantha Fraser
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Remia Bruce
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Wendy Murdoch
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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10
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Evaluation of Carer Strain and Carer Coping with Medications for People with Dementia after Discharge: Results from the SMS Dementia Study. Healthcare (Basel) 2020; 8:healthcare8030248. [PMID: 32751986 PMCID: PMC7551266 DOI: 10.3390/healthcare8030248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
This study reports carer strain and coping with medications for people with dementia with an unplanned admission to hospital, and it evaluates the impact of a safe medication intervention on carer coping and carer strain. This was a quasi-experimental pre/post-controlled trial that included a survey of carers about managing medications for people with dementia after discharge. For 88 carers who completed surveys, 33% were concerned about managing medications, and 40% reported difficulties with medication management, including resistive behaviours by people with dementia. Dose administration aids were used by 72% of carers; however, only 15% reported receiving a recent home medicines review by a community pharmacist. High carer strain was reported by 74% of carers. Carer comments described many issues that contributed to high carer stress, as well as their engagement in vigilant activities to maintain medication safety. Strategies that can contribute to carers managing medications and reducing their strain include an increased use of dose administration aids, increased provision of home medicines reviews, and increased education of health professionals to provide adequate support and education about managing medications.
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11
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Barry HE, Bedford LE, McGrattan M, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM. Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention. BMC Health Serv Res 2020; 20:120. [PMID: 32059718 PMCID: PMC7023803 DOI: 10.1186/s12913-020-4971-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/11/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with dementia (PwD) face unique challenges with medicines management, yet little is known about these challenges from the perspectives of primary healthcare professionals, particularly general practitioners (GPs) and community pharmacists. Few medicines management interventions have been developed which are aimed at community-dwelling PwD. This study sought to develop an intervention to improve medicines management for PwD in primary care using a theory-informed approach. METHODS Semi-structured interviews were conducted with GPs (n = 15) and community pharmacists (n = 15) to explore participants' views and experiences of medicines management for PwD, and their perceptions of barriers and facilitators to successful medicines management for PwD. The 14-domain Theoretical Domains Framework was the underpinning theoretical guide, allowing key theoretical domains to be identified and mapped to behaviour change techniques (BCTs) which are considered the 'active ingredients' of an intervention. Draft interventions were developed to operationalise selected BCTs and were presented to GPs and community pharmacists during task groups. Final selection of an intervention for feasibility testing was guided by feedback provided during these task groups and through application of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria. RESULTS Participants expressed a number of concerns about medicines management for PwD, particularly monitoring adherence to medication regimens and conducting medication review. Two draft interventions comprising selected BCTs ('Modelling or demonstration of behaviour'; 'Salience of consequences'; 'Health consequences'; 'Social and environmental consequences'; 'Action planning'; Social support or encouragement', 'Self-monitoring of behaviour') were developed, each targeting GPs and community pharmacists. Following the task groups and discussions within the research team, the community pharmacy-based intervention was selected for future feasibility testing. The intervention will target community pharmacists to conduct a medication review (incorporating an adherence check) with a PwD, delivered as an online video demonstrating key behaviours. The video will include feedback emphasising positive outcomes of performing the behaviours. Action planning and a quick reference guide will be used as complementary intervention components. CONCLUSIONS A community pharmacist-based intervention has been developed targeting medicines management for PwD in primary care using a systematic, theory-informed approach. Future work will determine the usability and acceptability of implementing this intervention in clinical practice.
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Affiliation(s)
- Heather E Barry
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Laura E Bedford
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Máiréad McGrattan
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Cristín Ryan
- The School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - A Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.,Belfast Health & Social Care Trust, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - A Louise Robinson
- Institute for Ageing and Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gerard J Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
| | | | | | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK.
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12
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Dementia Severity Associated With Increased Risk of Potentially Preventable Readmissions During Home Health Care. J Am Med Dir Assoc 2019; 21:519-524.e3. [PMID: 31734120 DOI: 10.1016/j.jamda.2019.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Approximately 14% of Medicare beneficiaries are readmitted to a hospital within 30 days of home health care admission. Individuals with dementia account for 30% of all home health care admissions and are at high risk for readmission. Our primary objective was to determine the association between dementia severity at admission to home health care and 30-day potentially preventable readmissions (PPR) during home health care. A secondary objective was to develop a dementia severity scale from Outcome and Assessment Information Set (OASIS) items based on the Functional Assessment Staging Tool (FAST). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Home health care; 126,292 Medicare beneficiaries receiving home health care (July 1, 2013-June 1, 2015) diagnosed with dementia (ICD-9 codes). MEASURES 30-day PPR during home health care. Dementia severity categorized into 6 levels (nonaffected to severe). RESULTS The overall rate of 30-day PPR was 7.6% [95% confidence interval (CI) 7.4, 7.7] but varied by patient and health care utilization characteristics. After adjusting for sociodemographic and clinical characteristics, the odds ratio (OR) for dementia severity category 6 was 1.37 (95% CI 1.29, 1.46) and the OR for category 7 was 1.94 (95% CI 1.64, 2.31) as compared to dementia severity category 1/2. CONCLUSIONS AND IMPLICATIONS Dementia severity in the later stages is associated with increased risk for potentially preventable readmissions. Our findings suggest that individuals admitted to home health during the later stages of Alzheimer's disease and related dementias may require greater supports and specialized care to minimize negative outcomes such as readmissions. Development of a dementia severity scale based on OASIS items and the FAST is feasible. Future research is needed to determine effective strategies for decreasing potentially preventable readmissions of individuals with severe dementia who receive home health care. Future research is also needed to validate the proposed dementia severity categories used in this study.
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Manias E, Bucknall T, Hughes C, Jorm C, Woodward-Kron R. Family involvement in managing medications of older patients across transitions of care: a systematic review. BMC Geriatr 2019; 19:95. [PMID: 30925899 PMCID: PMC6441224 DOI: 10.1186/s12877-019-1102-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background As older patients’ health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients’ lives. To date, there has been no review of the role of families in older people’s medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients’ medications across transitions of care. Methods Five databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers. Results Twenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients’ needs, and believed they had to display perseverance to have their views heard by health professionals. Conclusions Greater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members’ contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems. Electronic supplementary material The online version of this article (10.1186/s12877-019-1102-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Tracey Bucknall
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.,Alfred Health, Commercial Road, Prahran, VIC, 3181, Australia
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, University Road, Belfast, Northern Ireland, BT7 1NN, UK
| | - Christine Jorm
- Sydney Medical School, The University of Sydney, Edward Ford Building A27, Fisher Road, Camperdown, NSW, 2050, Australia.,NSW Regional Health Partners, 72 Watt St, Newcastle, NSW, 2300, Australia
| | - Robyn Woodward-Kron
- School of Medicine, The University of Melbourne, Grattan Street, Parkville, VIC, 3052, Australia
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14
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Pisa FE, Palese F, Romanese F, Barbone F, Logroscino G, Riedel O. How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data. Int J Methods Psychiatr Res 2018; 27:e1724. [PMID: 29869820 PMCID: PMC7133096 DOI: 10.1002/mpr.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. METHODS We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. RESULTS Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). CONCLUSION Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used.
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Affiliation(s)
- Federica Edith Pisa
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | | | - Fabio Barbone
- Department of Medicine, University of Udine, Udine, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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15
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Horne F, Burns P, Traynor V, Gillespie R, Mullan J, Baker A, Harrison L, Win KT. Managing medications for individuals living with a dementia: Evaluating a web-based information resource for informal carers. Int J Older People Nurs 2018; 13:e12198. [DOI: 10.1111/opn.12198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Frances Horne
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Pippa Burns
- School of Medicine; University of Wollongong; Wollongong NSW Australia
- Centre for Health Research Illawarra Shoalhaven Population; Australian Health Services Research Institute; University of Wollongong; Wollongong NSW Australia
| | - Victoria Traynor
- School of Nursing; University of Wollongong; Wollongong NSW Australia
| | - Robyn Gillespie
- School of Health and Society; University of Wollongong; Wollongong NSW Australia
| | - Judy Mullan
- School of Medicine; University of Wollongong; Wollongong NSW Australia
- Centre for Health Research Illawarra Shoalhaven Population; Australian Health Services Research Institute; University of Wollongong; Wollongong NSW Australia
| | - Amanda Baker
- School of Education; University of Wollongong; Wollongong NSW Australia
| | - Lindsey Harrison
- School of Health and Society; University of Wollongong; Wollongong NSW Australia
| | - Khin Than Win
- School of Computing and Information Technology; University of Wollongong; Wollongong NSW Australia
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16
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Feasibility of Integrating Residential Care Pharmacists into Aged Care Homes to Improve Quality Use of Medicines: Study Protocol for a Non-Randomised Controlled Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030499. [PMID: 30720779 PMCID: PMC5877044 DOI: 10.3390/ijerph15030499] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 12/03/2022]
Abstract
Older adults are particularly susceptible to iatrogenic disease and communicable diseases, such as influenza. Prescribing in the residential aged care population is complex, and requires ongoing review to prevent medication misadventure. Pharmacist-led medication review is effective in reducing medication-related problems; however, current funding arrangements specifically exclude pharmacists from routinely participating in resident care. Integrating an on-site clinical pharmacist into residential care teams is an unexplored opportunity to improve quality use of medicines in this setting. The primary objective of this pilot study is to investigate the feasibility of integrating a residential care pharmacist into the existing care team. Secondary outcomes include incidence of pharmacist-led medication review, and incidence of potential medication problems based on validated prescribing measures. This is a cross-sectional, non-randomised controlled trial with a residential care pharmacist trialled at a single facility, and a parallel control site receiving usual care and services only. The results of this hypothesis-generating pilot study will be used to identify clinical outcomes and direct future larger scale investigations into the implementation of the novel residential care pharmacist model to optimise quality use of medicines in a population at high risk of medication misadventure.
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Navti B, Apampa B. Pharmaceutical care services to people living with dementia in care homes: A qualitative study of community pharmacists' perceptions. DEMENTIA 2017; 18:2282-2302. [PMID: 29250993 DOI: 10.1177/1471301217743305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a paucity of information on the perceptions of community pharmacists about the nature and effectiveness of pharmaceutical care services they provide to people living with dementia in care homes. This paper explores pharmacists’ perceptions of the nature and effectiveness of pharmacy services provided, and their experiences when providing these services. Community pharmacists delivering services to care homes with dementia in Thurrock, Essex and in Medway, Kent, England were invited to participate in the study involving face-to-face interviews. Analysis of semi-structured interviews with 15 community pharmacists revealed that the main pharmaceutical service provided by the pharmacists was prescription processing, normally involving the clinical review and supply of medication into monitored dosage systems (dosette boxes) and delivery to the homes. This was coupled with advice to care homes on the appropriate storage and administration of drugs and appliances supplied, which was in line with the NHS Community Pharmacy Contractual Framework Enhanced Service for care homes. A majority of the community pharmacists interviewed acknowledged that the services they were currently commissioned to provide did not meet the pharmaceutical care needs of dementia patients in care homes, including the monitoring of the appropriateness, safety and effectiveness of drug therapy.
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Affiliation(s)
- Beryl Navti
- University of Sussex and Advanced Mental Health Pharmacist, North East London NHS Foundation Trust, UK
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18
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Zanforlin E, Zagotto G, Ribaudo G. The Medicinal Chemistry of Natural and Semisynthetic Compounds against Parkinson's and Huntington's Diseases. ACS Chem Neurosci 2017; 8:2356-2368. [PMID: 28862431 DOI: 10.1021/acschemneuro.7b00283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Among the diseases affecting the central nervous system (CNS), neurodegenerations attract the interest of both the clinician and the medicinal chemist. The increasing average age of population, the growing number of patients, and the lack of long-term effective remedies push ahead the quest for novel tools against this class of pathologies. We present a review on the state of the art of the molecules (or combination of molecules) of natural origin that are currently under study against two well-defined pathologies: Parkinson's disease (PD) and Huntington's disease (HD). Nowadays, very few tools are available for preventing or counteracting the progression of such diseases. Two major parameters were considered for the preparation of this review: particular attention was reserved to these research works presenting well-defined molecular mechanisms for the studied compounds, and where available, papers reporting in vivo data were preferred. A literature search for peer-reviewed articles using PubMed, Scopus, and Reaxys databases was performed, exploiting different keywords and logical operators: 91 papers were considered (preferentially published after 2015). The review presents a brief overview on the etiology of the studied neurodegenerations and the current treatments, followed by a detailed discussion of the natural and semisynthetic compounds dividing them in different paragraphs considering their several mechanisms of action.
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Affiliation(s)
- Enrico Zanforlin
- Department of Pharmaceutical
and Pharmacological Sciences, University of Padova, Padova 35131, Italy
| | - Giuseppe Zagotto
- Department of Pharmaceutical
and Pharmacological Sciences, University of Padova, Padova 35131, Italy
| | - Giovanni Ribaudo
- Department of Pharmaceutical
and Pharmacological Sciences, University of Padova, Padova 35131, Italy
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Dementia at the End of Life and Family Partners: A Symbolic Interactionist Perspective on Communication. Behav Sci (Basel) 2017; 7:bs7030042. [PMID: 28698488 PMCID: PMC5618050 DOI: 10.3390/bs7030042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/30/2022] Open
Abstract
People with dementia are not dying; they are experiencing changes in the brain. This paper utilizes a symbolic interaction theoretical perspective to outline communicative alternatives to polypharmacy. There is a growing interest in sociological interventions to untangle the “disordered discourses” associated with dementia. Such practices challenge common stigmas attached to dementia as an “ongoing funeral” or “death certificate.” Changing the expectations, attitudes and communication patterns of family care partners can positively impact them and the person living with dementia at the end of life. This paper delineates multiple non-verbal communication interventions (e.g., the trip back in time, dementia citizenship and sensory engagement modalities) to explore techniques to engage persons with advanced dementia.
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Gill N, Hammond S, Cross J, Smith T, Lambert N, Fox C. Optimising care for patients with cognitive impairment and dementia following hip fracture. Z Gerontol Geriatr 2017; 50:39-43. [PMID: 28364260 PMCID: PMC5408034 DOI: 10.1007/s00391-017-1224-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/08/2017] [Indexed: 11/27/2022]
Abstract
The global shift in demographics towards aging populations is leading to a commensurate increase in age-related disease and frailty. It is essential to optimise health services to meet current needs and prepare for anticipated future demands. This paper explores issues impacting on people living with cognitive impairment and/or dementia who experience a hip fracture and are cared for in acute settings. This is important given the high mortality and morbidity associated with this population. Given the current insufficiency of clear evidence on optimum rehabilitation of this patient group, this paper explored three key themes namely: recognition of cognitive impairment, response by way of training and education of staff to optimise care for this patient group and review of the importance of outcomes measures. Whilst there is currently insufficient evidence to draw conclusions about the optimal ways of caring for patients living with dementia following hip fracture, this paper concludes that future research should improve understanding of healthcare staff education to improve the outcomes for this important group of patients.
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Affiliation(s)
- Nigel Gill
- Norwich Medical School, University of East Anglia, Earlham Road, NR4 7TJ, Norwich, Norfolk, UK
| | - Simon Hammond
- Norwich Medical School, University of East Anglia, Earlham Road, NR4 7TJ, Norwich, Norfolk, UK
| | - Jane Cross
- School of Health Sciences, University of East Anglia, NR4 7TJ, Norwich, UK
| | - Toby Smith
- School of Health Sciences, University of East Anglia, NR4 7TJ, Norwich, UK
| | - Nigel Lambert
- Norwich Medical School, University of East Anglia, Earlham Road, NR4 7TJ, Norwich, Norfolk, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Earlham Road, NR4 7TJ, Norwich, Norfolk, UK.
- Hellesdon Hospital, Norfolk and Suffolk NHS Foundation Trust, NR6 5BE, Norwich, Norfolk, UK.
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