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Han P, Sun Y, Chen H, Liu Y, Liu S, Wang J, Chi C, Dai Z, Chen J, Zeng L, Jiang J. The early career resilience experience of generation Z newly graduated registered nurses in standardized training in the emergency department: a qualitative study in Shanghai. BMC Nurs 2024; 23:391. [PMID: 38844934 PMCID: PMC11155168 DOI: 10.1186/s12912-024-02043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND The period of standardized training is a transitional stage when Generation Z newly graduated registered nurses (Gen Z NGRNs) change their role from student to nurse. Affected by the COVID-19, they lack clinical practice and practicum experience in emergency departments in their university studies. At the beginning of career, they are under great pressure. Resilience is one of the factors that reduce their stress level and increases endurance. It is of interest to understand how this representative group of nurses gained and played the experience of resilience early in their careers. OBJECTIVE To explore Gen Z NGRNs' experience and process of resilience, to provide a new perspective and theoretical basis for psychological rehabilitation or intervention of medical staff who experienced transition shock. METHODS This study employed a qualitative design based on the phenomenological approach. 18 nurses from a third-level class-A hospital in Shanghai who participated in standardized training in emergency department were enrolled using purposive sampling. Data collection was through in-depth and semi-structured interviews and continued until reaching data saturation. RESULTS The investigation uncovered three themes and ten subthemes. Pressure and challenge contained high workload and high risk coexist, death's stress response, more emergencies and high professional requirements. Coping and adaptation contained team help, psychological restructuring, peer support, transformational leadership. Reflection and planning contained enhance learning, appreciate life. CONCLUSIONS Our study described the embodiment and coping experience of the physical and mental stress faced by Gen Z NGRNs during their standardized training in the emergency department. It is emphasized that nurse educators should pay attention to the character and actual needs of Gen Z NGRNs, explore and formulate strategies, so as to guide NGRNs to quickly adapt and grow in the new role. The ultimate goal is to increase nurse retention and improve the quality of nursing.
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Affiliation(s)
- Peng Han
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Yingying Sun
- Human Resource Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Huifeng Chen
- Department of medical affairs, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai, 200433, China
| | - Yue Liu
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Shuyang Liu
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Jing Wang
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Chunwei Chi
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Zhenjuan Dai
- Emergency department, Song Jiang District Central Hospital, Shanghai, 201699, China
| | - Jing Chen
- College of Design and Innovation, Tongji University, Shanghai, 200092, China.
| | - Li Zeng
- Nursing Department, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
| | - Jinxia Jiang
- Emergency Department, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
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Browne B, Ali K, Ford E, Tabet N. Determinants of hospital readmissions in older people with dementia: a narrative review. BMC Geriatr 2024; 24:336. [PMID: 38609878 PMCID: PMC11015733 DOI: 10.1186/s12877-024-04905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Over 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmissions within 30 days of their discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of hospital readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase their risk of readmissions. This narrative review aimed to identify psychosocial determinants of hospital readmissions, within the context of known physical factors. METHODS Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022 and followed up in February 2024. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories. RESULTS Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 6369 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs, and one study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. Psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, socioeconomic inequalities among ethnic minorities, and behavioural and psychological symptoms. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies. CONCLUSION Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions, increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. However, future research should focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.
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Affiliation(s)
- Bria Browne
- Centre for Dementia Studies, Brighton and Sussex Medical School, The University of Sussex Brighton, Brighton, UK.
| | - Khalid Ali
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Elderly Care and Stroke Medicine, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Naji Tabet
- Centre for Dementia Studies, Brighton and Sussex Medical School, The University of Sussex Brighton, Brighton, UK
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Zhang Y, Luo H, Lum TY, Knapp M, Vetrano DL, Chui CC, Wang P, Wong GH. Association of Comorbidity With Healthcare Utilization in People Living With Dementia, 2010-2019: A Population-Based Cohort Study. DEMENTIA 2024; 23:422-437. [PMID: 37211819 DOI: 10.1177/14713012231177593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Evidence on the healthcare utilization associated with comorbidity in people with dementia is lacking in Chinese societies. This study aimed to quantify healthcare utilization associated with comorbidity that is common in people living with dementia. We conducted a cohort study using population-based data from Hong Kong public hospitals. Individuals aged 35+ with a dementia diagnosis between 2010 and 2019 were included. Among 88,151 participants, people with at least two comorbidities accounted for 81.2%. Estimates from negative binomial regressions showed that compared to those with one or no comorbid condition other than dementia, adjusted rate ratios of hospitalizations among individuals with six or seven and eight or more conditions were 1.97 [98.75% CI, 1.89-2.05] and 2.74 [2.63-2.86], respectively; adjusted rate ratios of Accident and Emergency department visits among individuals with six or seven and eight or more conditions were 1.53 [1.44-1.63] and 1.92 [1.80-2.05], respectively. Comorbid chronic kidney diseases were associated with the highest adjusted rate ratios of hospitalizations (1.81 [1.74-1.89]), whereas comorbid chronic ulcer of the skin was associated with the highest adjusted rate ratios of Accident and Emergency department visits (1.73 [1.61-1.85]). Healthcare utilization for individuals with dementia differed substantially by both the number of comorbid chronic conditions and the presence of some specific comorbid conditions. These findings further highlight the importance of taking account of multiple long-term conditions in tailoring the care approach and developing healthcare plans for people with dementia.
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Affiliation(s)
- Yingyang Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Terry Ys Lum
- Department of Social Work and Social Administration; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Davide L Vetrano
- Aging Research Center, NVS Department, Karolinska Institutet, Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Celine Cs Chui
- School of Nursing, The University of Hong Kong, Hong Kong, China; School of Public Health, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
| | - Pengcheng Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Gloria Hy Wong
- Department of Social Work and Social Administration; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
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Zafeiridi E, McMichael A, O’Hara L, Passmore P, McGuinness B. Hospital admissions and emergency department visits for people with dementia. QJM 2024; 117:119-124. [PMID: 37812203 PMCID: PMC10896632 DOI: 10.1093/qjmed/hcad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Previous studies have suggested that people with dementia (PwD) are more likely to be admitted to hospital, have prolonged hospital stay, or visit an emergency department (ED), compared to people without dementia. AIM This study assessed the rates of hospital admissions and ED visits in PwD and investigated the causes and factors predicting this healthcare use. Further, this study assessed survival following hospital admissions and ED visits. DESIGN This was a retrospective study with data from 26 875 PwD and 23 961 controls. METHODS Data from national datasets were extracted for demographic characteristics, transitions to care homes, hospital and ED use and were linked through the Honest Broker Service. PwD were identified through dementia medication and through causes for hospital admissions and death. RESULTS Dementia was associated with increased risk of hospital admissions and ED visits, and with lower odds of hospital readmission. Significant predictors for hospital admissions and readmissions in PwD were transitioning to a care home, living in urban areas and being widowed, while female gender and living in less deprived areas reduced the odds of admissions. Older age and living in less deprived areas were associated with lower odds of an ED visit for PwD. In contrast to predictions, mortality rates were lower for PwD following a hospital admission or ED visit. CONCLUSIONS These findings result in a better understanding of hospital and ED use for PwD. Surprisingly, survival for PwD was prolonged following hospital admissions and ED visits and thus, policies and services enabling these visits are necessary, especially for people who live alone or in rural areas; however, increased primary care and other methods, such as eHealth, could provide equally effective care in order to avoid distress and costs for hospital admissions and ED visits.
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Affiliation(s)
- E Zafeiridi
- Centre for Public Health, Queen’s University, Belfast, UK
| | - A McMichael
- Centre for Public Health, Queen’s University, Belfast, UK
| | - L O’Hara
- Centre for Public Health, Queen’s University, Belfast, UK
| | - P Passmore
- Centre for Public Health, Queen’s University, Belfast, UK
| | - B McGuinness
- Centre for Public Health, Queen’s University, Belfast, UK
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Watson J, Green MA, Giebel C, Akpan A. Identifying longitudinal healthcare pathways and subsequent mortality for people living with dementia in England: an observational group-based trajectory analysis. BMC Geriatr 2024; 24:150. [PMID: 38350866 PMCID: PMC10865521 DOI: 10.1186/s12877-024-04744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk. METHODS Group-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters. RESULTS Four healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership. CONCLUSION Healthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.
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Affiliation(s)
- James Watson
- Department of Primary Care and Mental Health, The University of Liverpool, 1st Floor, Waterhouse Building B, Liverpool, L69 3GF, UK.
| | - Mark A Green
- School of Environmental Sciences, The University of Liverpool, Liverpool, UK
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Applied Research Collaboration North West Coast, Liverpool, UK
| | - Asangaedem Akpan
- Department of Medicine for Older People and Stroke, Liverpool University Hospitals NHS FT, Liverpool, UK
- Healthy Ageing Group, University of Cumbria, Carlisle, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Clinical Research Network, North West Coast, Liverpool, UK
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Javier Afonso-Argilés F, Comas Serrano M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, Pujadas Lafarga T, Ichart Tomás X, Puig-Campmany M, Vena Martínez AB, Renom-Guiteras A. Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes. Rev Clin Esp 2023; 223:585-595. [PMID: 37838224 DOI: 10.1016/j.rceng.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/10/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. METHOD This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. RESULTS A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. CONCLUSIONS Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.
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Affiliation(s)
- F Javier Afonso-Argilés
- Servicio de Geriatría, Fundació Sanitària Mollet, Barcelona, Spain; Estudiante de doctorado de la Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - M Comas Serrano
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - X Castells Oliveres
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | | | - D García Pérez
- Servicio de Urgencias, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, Spain
| | - T Pujadas Lafarga
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Barcelona, Spain
| | - X Ichart Tomás
- Servicio de Urgencias, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Puig-Campmany
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A B Vena Martínez
- Servicio de Geriatría, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - A Renom-Guiteras
- Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain; Servicio de Geriatría, Hospital del Mar, Barcelona, Spain
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Zhou Y, Hasdemir D. Validation and expansion of a behavioral framework for dementia care partner resilience (CP-R). DEMENTIA 2023; 22:1392-1419. [PMID: 37294955 PMCID: PMC10521159 DOI: 10.1177/14713012231181160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Resilience - the ability to bounce back after a stressor - is a core component of successful family caregiving for people living with dementia. In this manuscript, we describe the preliminary empirical validation of a new behavioral framework developed from existing literature for assessing care partner resilience, CP-R, and propose its potential value for future research and clinical care. METHODS We selected 27 dementia care partners who reported significant challenges prompted by a recent health crisis of their care recipient from three local university-affiliated hospitals in the United States. We conducted semi-structured interviews to elicit care partners' accounts of what they did to address those challenges that helped them recover during and after the crisis. Interviews were transcribed verbatim and analyzed using abductive thematic analysis. FINDINGS When persons with dementia experienced health crises, care partners described various challenges in managing new and often complex health and care needs, navigating informal and formal care systems, balancing care responsibilities with other needs, and managing difficult emotions. We identified five resilience-related behavioral domains, including problem-response (problem-solving, -distancing, -accepting, and -observing), help-related (help-seeking, -receiving, and -disengaging), self-growth (self-care activities, spiritual-related activities, and developing and maintaining meaningful relationships), compassion-related (self-sacrifice and relational compassion behaviors), and learning-related (learning from others and reflecting). DISCUSSIONS AND IMPLICATIONS Findings support and expand the multidimensional CP-R behavior framework for understanding dementia care partner resilience. CP-R could guide the systematic measurement of dementia care partners' resilience-related behaviors, support individual tailoring of behavioral care plans, and inform the development of resilience-enhancing interventions.
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Affiliation(s)
- Yuanjin Zhou
- Steve Hicks School of Social Work, University of Texas at Austin, Austin,TX, USA
| | - Dilara Hasdemir
- Steve Hicks School of Social Work, University of Texas at Austin, Austin,TX, USA
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Makhmutov R, Meyer G, Ellen ME, Fleischer S. Avoidable Care Transitions: A Consensus-Based Definition Using a Delphi Technique. Innov Aging 2023; 7:igad106. [PMID: 37941831 PMCID: PMC10629938 DOI: 10.1093/geroni/igad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Indexed: 11/10/2023] Open
Abstract
Background and Objectives Older adults are at increased risk of frequent transitions between care settings, even though some care transitions are avoidable. The term "avoidable care transitions" is not clearly defined in the research literature. This study aimed to find a consensus-based definition for "avoidable care transitions." Research Design and Methods This study was conducted as part of the TRANS-SENIOR research network. A 4-round Delphi survey was based on a literature review that identified existing definitions of "avoidable care transitions." Articles in MEDLINE via PubMed and CINAHL were searched. In total 95 references were included, and 106 definitions were identified. Definitions were coded to find themes, resulting in 3 themes with 2 codes for each. Results In total, 99 experts from 9 countries were invited, and the response rates in Delphi Rounds 1, 2, 3, and 4 were 37.5%, 19.1%, 33.3%, and 23.3%, respectively. Upon reaching the predefined minimum of 90% agreement, the following definition was declared as final: "Avoidable care transitions (a) are without significant patient-relevant benefits or with a risk of harm outweighing patient-relevant benefits and/or (b) are when a comparable health outcome could be achieved in lower resource settings using the resources available in that place/health care system, and/or (c) violate a patient's/informal caregiver's preference or an agreed care plan." Discussion and Implications Consensus on a definition for "avoidable care transitions" was reached by a multidisciplinary and international panel of experts comprising researchers and providers. The resulting definition consists of 3 distinct dimensions relating to the balance of benefit and harm to a patient, resource consumption, and a patient's or informal caregiver's preferences. The new definition might enhance the common understanding of avoidable care transitions and is now ready for application in research and quality and safety management in health care.
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Affiliation(s)
- Rustem Makhmutov
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Moriah E Ellen
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Steffen Fleischer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Bavelaar L, Visser M, Walshe C, Preston N, Kaasalainen S, Sussman T, Cornally N, Hartigan I, Loucka M, di Giulio P, Brazil K, Achterberg WP, van der Steen JT. The impact of the mySupport advance care planning intervention on family caregivers' perceptions of decision-making and care for nursing home residents with dementia: pretest-posttest study in six countries. Age Ageing 2023; 52:7066941. [PMID: 36861181 PMCID: PMC9978311 DOI: 10.1093/ageing/afad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. OBJECTIVES to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. DESIGN a pretest-posttest design. SETTING in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. PARTICIPANTS in total, 88 family caregivers completed baseline, intervention and follow-up assessments. METHODS family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. RESULTS family caregivers reported less decision-making uncertainty (-9.6, 95% confidence interval: -13.3, -6.0, P < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. CONCLUSIONS the mySupport intervention may be impactful in countries beyond the original setting.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mandy Visser
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Paola di Giulio
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny T van der Steen
- Address correspondence to: Jenny T. van der Steen, Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbox 9600, 2300 Leiden, the Netherlands.
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Jönsson L, Tate A, Frisell O, Wimo A. The Costs of Dementia in Europe: An Updated Review and Meta-analysis. PHARMACOECONOMICS 2023; 41:59-75. [PMID: 36376775 PMCID: PMC9813179 DOI: 10.1007/s40273-022-01212-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of dementia is increasing, while new opportunities for diagnosing, treating and possibly preventing Alzheimer's disease and other dementia disorders are placing focus on the need for accurate estimates of costs in dementia. Considerable methodological heterogeneity creates challenges for synthesising the existing literature. This study aimed to estimate the costs for persons with dementia in Europe, disaggregated into cost components and informative patient subgroups. METHODS We conducted an updated literature review searching PubMed, Embase and Web of Science for studies published from 2008 to July 2021 reporting empirically based cost estimates for persons with dementia in European countries. We excluded highly selective or otherwise biased reports, and used a random-effects meta-analysis to produce estimates of mean costs of care across five European regions. RESULTS Based on 113 studies from 17 European countries, the estimated mean costs for all patients by region were highest in the British Isles (73,712 EUR), followed by the Nordics (43,767 EUR), Southern (35,866 EUR), Western (38,249 EUR), and Eastern Europe and Baltics (7938 EUR). Costs increased with disease severity, and the distribution of costs over informal and formal care followed a North-South gradient with Southern Europe being most reliant on informal care. CONCLUSIONS To our knowledge, this study represents the most extensive meta-analysis of the cost for persons with dementia in Europe to date. Though there is considerable heterogeneity across studies, much of this is explained by identifiable factors. Further standardisation of methodology for capturing resource utilisation data may further improve comparability of future studies. The cost estimates presented here may be of value for cost-of-illness studies and economic evaluations of novel diagnostic technologies and therapies for Alzheimer's disease.
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Affiliation(s)
- Linus Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
| | - Ashley Tate
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Oskar Frisell
- Institute of Health Economics (IHE), Stockholm, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia. J Clin Med 2022; 12:jcm12010059. [PMID: 36614856 PMCID: PMC9821230 DOI: 10.3390/jcm12010059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients ≥65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS ≥ 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01−1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6−3.65]), acute renal failure (HR 1.64 [1.33−2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38−2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17−1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01−1.1] p = 0.005; NEWS ≥ 5 HR 2.45 [1.88−3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital mortality.
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Okamae A, Ogawa T, Makizako H, Matsumoto D, Ishigaki T, Kamiya M, Miyashita T, Ihira H, Taniguchi Y, Misu S, Ohnuma T, Chibana T, Morikawa N, Ikezoe T. Efficacy of therapeutic exercise on activities of daily living and cognitive function among older residents in long-term care facilities: A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2022; 104:812-823. [PMID: 36574530 DOI: 10.1016/j.apmr.2022.11.002] [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: 04/01/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04). CONCLUSIONS Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.
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Affiliation(s)
- Akio Okamae
- Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center, Kurooka5, Tambasasayama, Hyogo.
| | - Tatsuya Ogawa
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, 3-2-2 Sasayuridai, Kanmaki-cho, Kitakatsuragi-gun, Nara
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima
| | - Daisuke Matsumoto
- Department of Physical Therapy, Faculty of Health Sciences, Kio University, 4-2-2 Umami-naka, Koryo-cho, Kitakatsuragi-gun, Nara
| | - Tomoya Ishigaki
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, 3-1-17 Taihou, Atsuta, Nagoya, Aichi
| | - Midori Kamiya
- The First Nursing Course, Aichi Prefectural School of General Nursing, Nagoya, Aichi
| | - Toshinori Miyashita
- Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Nankokita 1-26-16, Suminoe Ward, Osaka
| | - Hikaru Ihira
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido
| | - Yoshiaki Taniguchi
- Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan; Department of Physical Therapy, Kagoshima Medical Professional College, Kagoshima
| | - Shogo Misu
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, 6-2-23, Morikita-machi, Higashinada-ku, Kobe, Hyogo
| | - Takeshi Ohnuma
- Rehabilitation Progress Center Incorporated, Itabashi rehabili home-visit nursing station, 2-11, hikawacho, itabashi-ku, Tokyo
| | - Tomohisa Chibana
- Kawaguchi Neurosurgery Rehabilitation Clinic, 9-25-202 Koriencho, Hirakata City, Osaka
| | - Natsu Morikawa
- Boys & Girls, Daycare facilities for persons with severe motor and intellectual disabilities, CIL Toyonaka, Elegance Sakuranocho 1(st) floor,2-2-2, Sakuranocho,Toyonaka City,Osaka
| | - Tome Ikezoe
- Faculty of Rehabilitation, Kansai Medical University, Uyamahigashicho 18-89, Hirakata, Osaka
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de van der Schueren MAE, Borkent JW, Spaans GW, Nijhof A, Manders M. GLIM in nursing homes; practical implications. Clin Nutr 2022; 41:2442-2445. [PMID: 36215863 DOI: 10.1016/j.clnu.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Only very few papers have described malnutrition prevalence rates according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in nursing homes, likely due to practical reasons such as missing data on body composition, dietary intake, or acute disease/inflammation. METHODS Data was collected in 5 different nursing homes. Food intake measurements took place over 3 days of observations, and intakes below 90% of energy or protein requirements were regarded as insufficient. The GLIM diagnosis was based on body weight loss and/or low BMI in combination with insufficient food intake. Additionally, we also studied the sensitivity of GLIM with the question from the Mini Nutritional Assessment Short Form (MNA-SF) on insufficient food intake (GLIMMNA) versus GLIM with measured food intake. RESULTS Out of 176 participants, 21.0% were categorized as malnourished according to GLIM. Observations revealed an insufficient food intake in 81.3% (N = 143) of residents; only 39% of those (N = 56) scored positive on the MNA-SF question regarding low food intake. GLIMMNA diagnosed 17.0% of residents as malnourished. Sensitivity of GLIMMNA for GLIM was 62.2%, and specificity 95.0% (kappa = 0.61). CONCLUSION Twenty-one percent of nursing home residents were diagnosed malnourished based on a limited set of GLIM criteria. The MNA question on insufficient food intake missed ∼60% of residents with a truly low food intake. Herewith, malnutrition prevalence rates with GLIMMNA decreased to 17%. We advise measuring food intake for studies, and to be aware of too low prevalence rates of GLIM when an estimate of reduced food intake is applied.
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Affiliation(s)
- Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Jos W Borkent
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Gijs W Spaans
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Annemarie Nijhof
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Marleen Manders
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Harkin D, Coates V, Brown D. Exploring ways to enhance pain management for older people with dementia in acute care settings using a Participatory Action Research approach. Int J Older People Nurs 2022; 17:e12487. [PMID: 35761509 PMCID: PMC9787744 DOI: 10.1111/opn.12487] [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: 11/07/2021] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dementia is a progressive condition that leads to reduced cognition, deteriorating communication and is a risk factor for other acute and chronic health problems. The rise in the prevalence of dementia means untreated pain is becoming increasingly common with healthcare staff being challenged to provide optimal pain management. This negatively impacts the person living with dementia and their carers. There is minimal evidence that explores the pain management experience of patients as they move through acute care settings. OBJECTIVE To understand the complexities of managing the pain of older people with dementia as they progress through acute care settings, with the view of assisting staff to improve practice. METHOD A Participatory Action Research approach, guided by the Promoting Action Research in Health Services framework, was used. Three Action Cycles were completed comprising of an exploratory audit and two case studies (Action Cycle One), three focus groups with a total of 14 participants (Action Cycle Two) and the development and implementation of immediate and long-term actions (Action Cycle Three). RESULTS Thematic analysis identified four themes that affected pain management practices. These were not knowing the patient; balancing competing priorities; knowledge and understanding of pain and dementia and not assimilating available information. CONCLUSION Pain management practices for patient living with dementia, across acute care settings, was influenced by shared ways of thinking and working. Not knowing the patient, fragmentation of information and having insufficient knowledge of the subtleties of dementia led participants to deliver task-focused, target and policy-driven care that was not person-centred in its approach. Facilitated reflection enabled acute care teams to actively participate in identifying problems and finding solutions to enhance practice.
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Affiliation(s)
| | - Vivien Coates
- Florence Nightingale Foundation Professor of Clinical Nursing Practice ResearchUlster University & Western Health & Social Care TrustLondonderryUK
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15
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Tohira H, Masters S, Ngo H, Bailey P, Ball S, Finn J, Arendts G. Descriptive Study of Ambulance Attendances for Older Adults with and without Dementia in Western Australia. PREHOSP EMERG CARE 2022; 27:851-858. [PMID: 35771727 DOI: 10.1080/10903127.2022.2096947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe and compare characteristics of ambulance attendances for older adults with and without dementia. METHODS A retrospective cohort study was conducted using electronic patient care records from the main ambulance service in Western Australia. All attendances for people aged 65 years or older in the years 2019-21 were included. Dementia status was adjudicated from the clinical history and medication lists. Patient and case characteristics of those with and without dementia were compared and stratified by type of residence. RESULTS There were 277,996 emergency ambulance attendances made by 124,711 older adults, of whom 23.5% had dementia. The mean number of attendances per person was 3.3 in the dementia cohort vs 2.0 in those without dementia. Falls were the leading reason for ambulance attendance. People with dementia were significantly frailer, required longer at-scene intervals, were less likely to be transported as the highest priority, and had lower 30-day survival. CONCLUSIONS Dementia is common amongst older adults attended by paramedics and is associated with higher ambulance utilization per person. People with dementia attended by paramedics have stronger signals of vulnerability, such as increased frailty. As the number of people living with dementia increases in the future, there are implications for workforce training and service planning. There are opportunities for developing alternatives to emergency department transportation for some people with dementia.
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Affiliation(s)
- Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Stacey Masters
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Hanh Ngo
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Paul Bailey
- St John Western Australia, Belmont, WA, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Arendts
- Discipline of Emergency Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
- Emergency Department, Fiona Stanley Hospital, Murdoch, WA, Australia
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16
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Pellico-López A, Herrero-Montes M, Cantarero Prieto D, Fernández-Feito A, Cayon-De las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study. PeerJ 2022; 10:e13596. [PMID: 35734637 PMCID: PMC9208369 DOI: 10.7717/peerj.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.
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Affiliation(s)
- Amada Pellico-López
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,Cantabria Health Service, Santander, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - David Cantarero Prieto
- IDIVAL, Research Group of Health Economics and Health Services Management–Research Institute Marqués de Valdecilla, Santander, Spain,Departamento de Economía, Universidad de Cantabria, Santander, Spain
| | - Ana Fernández-Feito
- Facultad de Medicina y Ciencias de la Salud, Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Oviedo, Spain
| | - Joaquin Cayon-De las Cuevas
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain,Departamento de Derecho Privado, Universidad de Cantabria, Santander, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain
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17
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Gungabissoon U, Perera G, Galwey NW, Stewart R. Potentially avoidable causes of hospitalisation in people with dementia: contemporaneous associations by stage of dementia in a South London clinical cohort. BMJ Open 2022; 12:e055447. [PMID: 35383067 PMCID: PMC8984034 DOI: 10.1136/bmjopen-2021-055447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the frequency of all-cause and ambulatory care sensitive condition (ACSCs)-related hospitalisations among individuals with dementia. In addition, to investigate differences by stage of dementia based on recorded cognitive function. SETTING Data from a large London dementia care clinical case register, linked to a national hospitalisation database. PARTICIPANTS Individuals aged ≥65 years with a confirmed dementia diagnosis with recorded cognitive function. OUTCOME MEASURES Acute general hospital admissions were evaluated within 6 months of a randomly selected cognitive function score in patients with a clinical diagnosis of dementia. To evaluate associations between ACSC-related hospital admissions (overall and individual ACSCs) and stage of dementia, an ordinal regression was performed, modelling stage of dementia as the dependant variable (to facilitate efficient model selection, with no implication concerning the direction of causality). RESULTS Of the 5294 people with dementia, 2993 (56.5%) had at least one hospitalisation during a 12-month period of evaluation, and 1192 (22.5%) had an ACSC-related admission. Proportions with an all-cause or ACSC-related hospitalisation were greater in the groups with more advanced dementia (all-cause 53.9%, 57.1% and 60.9%, p 0.002; ACSC-related 19.5%, 24.0% and 25.3%, p<0.0001 in the mild, moderate and severe groups, respectively). An ACSC-related admission was associated with 1.3-fold (95% CI 1.1 to 1.5) increased odds of more severe dementia after adjusting for demographic factors. Concerning admissions for individual ACSCs, the most common ACSC was urinary tract infection /pyelonephritis (9.8% of hospitalised patients) followed by pneumonia (7.1%); in an adjusted model, these were each associated with 1.4-fold increased odds of more severe dementia (95% CI 1.2 to 1.7 and 1.1 to 1.7, respectively). CONCLUSIONS Potentially avoidable hospitalisations were common in people with dementia, particularly in those with greater cognitive impairment. Our results call for greater attention to the extent of cognitive status impairment, and not just dementia diagnosis, when evaluating measures to reduce the risk of potentially avoidable hospitalisations.
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Affiliation(s)
- Usha Gungabissoon
- Epidemiology (Value Evidence and Outcomes), GSK, Brentford, London, UK
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Gayan Perera
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Robert Stewart
- Psychological Medicine, King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
- Mental Health of Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
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18
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Sidani S, Fox MT, Butler JI, Maimets IK. Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home. Int J Older People Nurs 2022; 17:e12463. [PMID: 35362239 DOI: 10.1111/opn.12463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalised older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. OBJECTIVES To describe the development of a multi-component intervention to promote sleep. METHODS We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components. RESULTS The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with ageing, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress and sleep-related beliefs and behaviours. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalisation. DISCUSSION Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility. IMPLICATIONS FOR PRACTICE The intervention has potentials to improve sleep during the transition from hospital to home.
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Affiliation(s)
- Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Mary T Fox
- School of Nursing, York University, Toronto, Ontario, Canada.,York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Jeffrey I Butler
- School of Nursing, York University, Toronto, Ontario, Canada.,York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, Toronto, Ontario, Canada
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Soobiah C, Phung M, Tadrous M, Jamieson T, Bhatia RS, Desveaux L. Understanding Engagement and the Potential Impact of an Electronic Drug Repository: Multi-Methods Study. JMIR Form Res 2022; 6:e27158. [PMID: 35353042 PMCID: PMC9008523 DOI: 10.2196/27158] [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: 01/14/2021] [Revised: 08/06/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Centralized drug repositories can reduce adverse events and inappropriate prescriptions by enabling access to dispensed medication data at the point of care; however, how they achieve this goal is largely unknown. OBJECTIVE This study aims to understand the perceived clinical value; the barriers to and enablers of adoption; and the clinician groups for which a provincial, centralized drug repository may provide the most benefit. METHODS A mixed methods approach, including a web-based survey and semistructured interviews, was used. Participants were clinicians (eg, nurses, physicians, and pharmacists) in Ontario who were eligible to use the digital health drug repository (DHDR), irrespective of actual use. Survey data were ranked on a 7-point adjectival scale and analyzed using descriptive statistics, and interviews were analyzed using qualitative descriptions. RESULTS Of the 161 survey respondents, only 40 (24.8%) actively used the DHDR. Perceptions of the utility of the DHDR were neutral (mean scores ranged from 4.11 to 4.76). Of the 75.2% (121/161) who did not use the DHDR, 97.5% (118/121) rated access to medication information (eg, dose, strength, and frequency) as important. Reasons for not using the DHDR included the cumbersome access process and the perception that available data were incomplete or inaccurate. Of the 33 interviews completed, 26 (79%) were active DHDR users. The DHDR was a satisfactory source of secondary information; however, the absence of medication instructions and prescribed medications (which were not dispensed) limited its ability to provide a comprehensive profile to meaningfully support clinical decision-making. CONCLUSIONS Digital drug repositories must be adjusted to align with the clinician's needs to provide value. Ensuring integration with point-of-care systems, comprehensive clinical data, and streamlined onboarding processes would optimize clinically meaningful use. The electronic provision of accessible drug information to providers across health care settings has the potential to improve efficiency and reduce medication errors.
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Affiliation(s)
- Charlene Soobiah
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michelle Phung
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Mina Tadrous
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
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20
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Soysal P, Tan SG, Rogowska M, Jawad S, Smith L, Veronese N, Tsiptsios D, Tsamakis K, Stewart R, Mueller C. Weight loss in Alzheimer's disease, vascular dementia and dementia with Lewy bodies: Impact on mortality and hospitalization by dementia subtype. Int J Geriatr Psychiatry 2021; 37. [PMID: 34807996 DOI: 10.1002/gps.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Loss of weight is associated with cognitive decline as well as several adverse outcomes in dementia. The aim of this study was to assess whether weight loss is associated with mortality and hospitalization in dementia subtypes. METHODS A cohort of 11,607 patients with dementia in Alzheimer's disease (AD), vascular dementia (VD), or dementia with Lewy bodies (DLB) was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was developed to established whether loss of weight was recorded around the time of dementia diagnosis. Cox proportional hazard models were applied to examine the associations of reported weight loss with mortality and emergency hospitalization. RESULTS Weight loss around the time of dementia was recorded in 25.5% of the whole sample and was most common in patients with DLB. A weight loss-related increased risk for mortality was detected after adjustment for confounders (Hazard ratio (HR):1.07; 95% confidence interval (CI):1.02-1.15) and in patients with AD (HR: 1.11; 95% CI: 1.04-1.20), but not in DLB and VD. Weight loss was associated with a significantly increased emergency hospitalization risk (HR: 1.14; 95% CI: 1.08-1.20) and in all three subtypes. CONCLUSIONS While there were associations with increased hospitalization risk for all three subtype diagnoses, weight loss was only associated with increased mortality in AD. Weight loss should be considered as an accompanying symptom in dementia and interventions should be considered to ameliorate risk of adverse outcomes.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Semen Gokce Tan
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Sana Jawad
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lee Smith
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Dimitrios Tsiptsios
- Neurophysiology Department, Sunderland Royal Hospital, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, UK
| | - Konstantinos Tsamakis
- Second Department of Psychiatry, University General Hospital 'ATTIKON', School of Medicine, Athens, Greece
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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