Geriatric Beds Research Articles

Проблемы медицинского обеспечения лиц старше трудоспособного возраста (на примере Республики Татарстан)

Currently, most countries are showing a demographic trend characterized by an increase in the number of older people. In Russia, there is also a significant aging of the population, in connection with which, the number of people older than working age seeking medical care is growing every year. At the same time, the need is growing not only for treatment and rehabilitation, but also for the prevention of diseases, the implementation of active longevity programs. All this emphasizes the relevance and necessity of high-quality and sufficient medical support for this category of people. Purpose: to study the features of medical support for people older than working age on the example of the Republic of Tatarstan. Materials and methods: the data of official statistics, including those of the Ministry of Health of the Republic of Tatarstan, were used in the work. Analytical, statistical, mathematical research methods were used. Findings: To create optimal resource provision in the provision of medical care to people older than working age, it is necessary to: introduce new indicators of the state of health, increase the number of geriatricians, increase the number of geriatric beds, not reduce therapeutic beds, constantly increase the coverage of preventive medical examinations, medical examinations of people older than working age age, based on their share in the population structure (at least 25%).

343 RIGHT CARE, RIGHT PLACE, RIGHT TIME? WHAT PROPORTION OF ACUTELY-UNWELL OLDER PATIENTS UNDERGO EVIDENCE-BASED COMPREHENSIVE GERIATRIC ASSESSMENT?

Abstract Background There is robust evidence that Comprehensive Geriatric Assessment (CGA) improves outcomes for acutely unwell older people. Relatively little research has examined how this translates to real life clinical settings, however. The aim of this study therefore was to ascertain how many older people admitted to hospital underwent CGA and how this impacted on readmission rates. Methods The study site is a large teaching hospital with 150 specialist geriatric medicine beds and ‘specialty-take’ of frail, older people by the geriatric medicine service. Data pertaining to contact with a geriatric medicine service were collected for 400 consecutive ED presentations of patients aged ≥70 years from 1/1/21, as well as Clinical Frailty Scale (CFS) and readmission within 30 days. Results Over one-third (139/400, mean CFS 3.7) of patients were discharged home directly from the ED, with the remainder (261/400, mean CFS 4.5) admitted to hospital. Almost-half overall (122/261, mean CFS 4.7) and 58% of those ≥80 years, were admitted under the care of a geriatrician, with 73% (89/122) cared for on a specialist geriatric medicine ward. Of those not admitted under a geriatrician, 10% (13/139) subsequently underwent CGA on a consultation basis. In total, 48% (126/261, mean CFS 3.7) of patients ≥70 years, including one-third of those ≥80 years with a CFS≥5 (36/99), completed their admission without undergoing CGA. Of those ≥80 years with a CFS≥5 who did not receive CGA, readmission within 30 days was 24% compared to 13% for those who underwent CGA. Conclusion Patients who underwent CGA were older, with higher levels of frailty. However, one-third of those aged ≥80 years with CFS ≥5 did not undergo CGA and early readmission was higher in this cohort. CGA in the acute setting is a finite resource and it is imperative it is delivered to those who require it most.

Models of Care in Geriatric Intensive Care-A Scoping Review on the Optimal Structure of Care for Critically Ill Older Adults Admitted in an ICU.

OBJECTIVE:A growing proportion of critically ill patients admitted in ICUs are older adults. The need for improving care provided to older adults in critical care settings to optimize functional status and quality of life for survivors is acknowledged, but the optimal model of care remains unknown. We aimed to identify and describe reported models of care.DATA SOURCES:We conducted a scoping review on critically ill older adults hospitalized in the ICU. Medline (PubMed), Embase (OvidSP), Cumulative Index to Nursing and Allied Health Literature (Ebsco), and Web of Science (Clarivate) were searched from inception to May 5, 2020.STUDY SELECTION:We included original articles, published abstracts, review articles, editorials, and commentaries describing or discussing the implementation of geriatric-based models of care in critical care, step-down units, and trauma centers. The organization of care had to be described. Articles only discussing geriatric syndromes and specific interventions were not included.DATA EXTRACTION:Full texts of included studies were obtained. We collected publication and study characteristics, structures of care, human resources used, interventions done or proposed, results, and measured outcomes. Data abstraction was done by two investigators and reconciled, and disagreements were resolved by discussion.DATA SYNTHESIS:Our search identified 3,765 articles, and we found 19 reporting on the implementation of geriatric-based models of care in the setting of critical care. Four different models of care were identified: dedicated geriatric beds, geriatric assessment by a geriatrician, geriatric assessment without geriatrician, and a fourth model called “other approaches” including geriatric checklists, bundles of care, and incremental educational strategies. We were unable to assess the superiority of any model due to limited data.CONCLUSIONS:Multiple models have been reported in the literature with varying degrees of resource and labor intensity. More data are required on the impact of these models, their feasibility, and cost-effectiveness.

Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey.

Objectives: Mental healthcare has gained momentum and significant attention in China over the past three decades. However, many challenges still exist. This survey aimed to investigate mental health resources and the psychiatric workforce in representative top-tier psychiatric hospitals in China.Methods: A total of 41 top-tier psychiatric hospitals from 29 provinces participated, providing data about numbers and types of psychiatric beds, numbers of mental health professionals, outpatient services and hospitalization information covering the past 3 years, as well as teaching and training program affiliation.Results: Significant variations were found among participating hospitals and across different regions. Most of these hospitals were large, with a median number of psychiatric beds of 660 (range, 169-2,141). Child and geriatric beds accounted for 3.3 and 12.6% of all beds, respectively, and many hospitals had no specialized child or geriatric units. The overall ratios of psychiatrists, psychiatric nurses, and psychologists per bed were 0.16, 0.34, and 0.03, respectively. More than 40% of the hospitals had no clinical social workers. Based on the government's staffing guidelines, less than one third (31.7%) of the hospitals reached the lower limit of the psychiatric staff per bed ratio, and 43.9% of them reached the lower limit of the nurse per bed ratio.Conclusion: Although some progress has been made, mental health resources and the psychiatric workforce in China are still relatively insufficient with uneven geographical distribution and an acute shortage of psychiatric beds for children and elderly patients. In the meantime, the staffing composition needs to be optimized and more psychologists and social workers are needed. While addressing these shortages of mental health resources and the workforce is important, diversifying the psychiatric workforce, promoting community mental health care, and decentralizing mental health services may be equally important.

The impact of an ageing population on the required hospital capacity: results from forecast analysis on administrative data.

In this study, we evaluate the impact of population ageing on the required hospital capacity. We used hospital discharge (years 2003-2014) and population data to estimate the required hospital capacity by 2025 for older inpatients (≥ 75years) taking into account population changes and trends in hospital admission rates and length of stay. In addition, we developed an alternative scenario to evaluate the impact of accelerated ageing based on the peaks in population ageing from 2030 onwards. The number of inpatient stays for our study population is expected to increase from 478,027 in 2014 to 590,313 in 2025 (+ 23.5%). The average length of stay is expected to decrease by 18.4% (- 2.3days). As a consequence, the number of inpatient days and the required bed capacity will only increase by 42,709 days (+ 0.7%) and 72 beds (+ 0.4%), respectively. The accelerated ageing scenario shows that the increase between 2014 and 2025 is more pronounced for inpatient stays (+ 50.5%), inpatient days (+ 21.9%) and hospital beds (+ 21.1%). Ageing will, if no drastic policy actions are taken, impact the required hospital capacity. This can initially (by 2025) be more or less controlled by further reductions in length of stay. From 2030, it is expected that the required hospital bed capacity will increase exponentially with a pronounced shift between general acute care beds towards geriatric and chronic care beds. If policy makers want to revert this trend, substantial investments in hospital alternatives will be required.

Bed Blocking in Hospitals Due to Scarce Capacity in Geriatric Institutions—Cost Minimization via Fluid Models

Problem definition: This research focuses on elderly patients who have been hospitalized and are ready to be discharged, but they must remain in the hospital until a bed in a geriatric institution becomes available; these patients “block” a hospital bed. Bed blocking has become a challenge to healthcare operators because of its economic implications and the quality-of-life effect on patients. Indeed, hospital-delayed patients who do not have access to the most appropriate treatments (e.g., rehabilitation) prevent new admissions. Moreover, bed blocking is costly, because a hospital bed is more expensive to operate than a geriatric bed. We are thus motivated to model and analyze the flow of patients between hospitals and geriatric institutions to improve their joint operation. Academic/practical relevance: Practically, our joint modeling of hospital-institution is necessary to capture blocking effects. In contrast to previous research, we address an entire time-varying network, which enables an explicit consideration of blocking costs. Theoretically, our fluid model captures blocking without the need for reflection, which simplifies the analysis as well as the convergence proof of the corresponding stochastic model. Methodology: We develop a mathematical fluid model, which accounts for blocking, mortality, and readmission—all significant features of the discussed environment. Then, for bed allocation decisions, the fluid model and especially, its offered load counterpart turn out insightful and easy to implement. Results: The comparison between our fluid model, a two-year data set from a hospital chain, and simulation results shows that our model is accurate and useful. Moreover, our analysis yields a closed form expression for bed allocation decisions, which minimizes the sum of underage and overage costs. Solving for the optimal number of geriatric beds in our system shows that significant reductions in cost and waiting list length are achievable compared with current operations. Managerial implications: Our model can support healthcare managers in allocating geriatric beds to reduce operational costs. Moreover, our model facilitates three extensions: a periodic reallocation of beds, incorporation of setup costs into bed allocation decisions, and accommodating home care (or virtual hospitals) when feasible.

Geriatric care resources in an aging society of rural and urban areas in Poland – mapping of current situation

GUS demographic forecasts show that by 2035 subpopulation of people with 65 years or more in Poland will grow by 62% compared to 2010. While the subpopulation of people with 80 years or more will increase as much as 96% over the same period. The aim of this article is a diagnosis of selected geriatric care resources in a situation of aging population of rural and urban areas in Poland. To achieve this aim, the study includes demographic forecasting for Poland until 2035 with differentiation on voivodeships and rural and urban areas. Additionally, an analysis of selected geriatric care resources (geriatric beds and specialists in geriatrics) in the context of an aging population was considered. The obtained results conclude that in Poland there is lack of geriatric care resources such as geriatric beds and specialists in geriatrics. Although the projected percentage of people aged 65+ in rural areas will be lower in 2035 than in the urban areas, the access to these resources in rural areas is more limited, due to the concentration of geriatric care resources mainly in big cities.

Where to go if not the hospital? Reviewing geriatric bed utilization in an acute care hospital in Singapore.

Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable bed days (PABD), which are days spent in acute hospitals delivering only non-acute services. We aimed to access the prevalence, causes and consequences of PABD among geriatric patients. We examined all hospitalizations from 1 August through 31 December 2013 in the geriatric wards of an acute hospital in Singapore. PABD were identified using a modified Appropriateness Evaluation Protocol. Non-acute services were classified as subacute care, rehabilitative care, long-term care or social care. Hospitalization patterns were determined based on the presence or absence of non-acute services, and multinomial logistic regression was used to determine predictors of different patterns. Of the 273 bed days used by 254 patients, 49% were potentially avoidable. The most common non-acute services provided were rehabilitative care (19%), subacute care (12%) and long-term care (8%). New acute issues arose after the admission conditions subsided in 2.4% of hospitalizations, 61% of which were nosocomial infections. Being socially at risk as assessed on admission predicted the development of new acute issues (sensitivity=62%; specificity=88%). In the present study, almost half of the bed days were potentially avoidable. New acute issues can arise after PABD, which are dangerous to these frail older adults. Proactive discharge planning and increasing access to intermediate and long-term care services are required to reduce PABD. Geriatr Gerontol Int 2017; 17: 1575-1583.

A description of the utilization of long term care and elderly care facilities in Hungary

Introduction: Due to demographic changes (the growing rate of elderly population), high patient expectations, increasing care and support needs and growing pressure for accountability, it is necessary to revise the health care system of Hungary. These facts mean general challenges at European level, but up to this point the Hungarian health care system is not ready for handling these changes with adequate solutions. According to the Hungarian Central Statistical Office the proportion of the population over 65 years is 17.2%, but considering the forecast of demographic trends it will increase. In this study we would like to give an overview about Hungarian long-term and elderly care services.Methods: This analysis shows the utilization of National Health Insurance Fund financed chronic and nursery care capacities (except rehabilitation). There are 11 573 long-term care beds in Hungary, which serve the people with chronic conditions and nursing needs. We have compared the utilization and age composition of the acute (performance based financing) and long-term care (financing by per diem) services. Furthermore we have examined the main professional activities which have been provided to over 65 years old patients by hospitals.Results: This study presents that during ten years there has been a significant growth in the proportion of the total hospital days of the population over 65. This proportion was 38% in 2004 and now this is 49%. We found that the proportion of population over 65 is 80% in long-term care departments which are led by physicians, and this number is 89% in the nursing departments. Furthermore, this population occupies 69 % of the hospital days in the departments of general internal medicine (the total number of beds is 3964). The lead diagnoses are chronic kidney failure, congestive heart failure, anemia and noninsulin-dependent diabetes mellitus in the departments of general internal medicine.In Hungary there are merely 150 geriatric beds and the distribution of them from a geographical perspective is unequal. It is an interesting fact that only 89 % of elderly people were served by the geriatric care units, despite the fact that this care is specialized for elderly people and multi-morbid conditions.The utilization of social services is full, the waiting time to get into residential homes is very long. 82% of the elderly people require nursing in residential homes, but at present this is not solved, controlled and financed.Discussion: Based on our results we have found that long-term care types are not sharply separated. It is not clear, what is the difference between the task of internal medicine, geriatric care and long-term care in elderly care. The shortcoming of the health care system is that the legal regulations do not fix the concrete activities; therefore the chronic care capacities frequently serve social and nursing needs. In addition, the home care capacities are not sufficient and there is no connection between social and health care providers.Conclusions: It is worth considering examining where we can connect the two sectors’ services, how we can incite the communication and cooperation, because without task sharing and coordination this services will not be able to satisfy efficiently the needs of elderly population.We have to highlight the possibilities of integrated care at system level and to build a service model especially focusing the people with chronic conditions and long-term nursing needs.

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States. The primary objective was to determine the number, distribution, and characteristics of geriatric EDs in the United States in 2013. This was a survey with potential respondents identified via a snowball sampling of known geriatric EDs, EM professional organizations' geriatric interest groups, and a structured search of the Internet using multiple search engines. Sites were contacted by telephone, and those confirming geriatric EDs presence received the survey via e-mail. Category questions included date of opening, location, volumes, staffing, physical plant changes, screening tools, policies, and protocols. Categories were reported based on general interest to those seeking to understand components of a geriatric ED. Thirty-six hospitals confirmed geriatric ED existence and received surveys. Thirty (83%) responded to the survey and confirmed presence or plans for geriatric EDs: 24 (80%) had existing geriatric EDs, and six (20%) were planning to open geriatric EDs by 2014. The majority of geriatric EDs are located in the Midwest (46%) and Northeast (30%) regions of the United States. Eighty percent serve from 5,000 to 20,000 elder patients annually. Seventy percent of geriatric EDs are attached to the main ED, and 66% have from one to 10 geriatric beds. Physical plant changes include modifications to beds (96%), lighting (90%), flooring (83%), visual aids (73%), and sound level (70%). Seventy-seven percent have staff overlapping with the nongeriatric portion of their ED, and 80% require geriatric staff didactics. Sixty-seven percent of geriatric EDs report discharge planning for geriatric ED patients, and 90% of geriatric EDs had direct follow-up through patient callbacks. The snowball sample identification of U.S. geriatric EDs resulted in 30 confirmed respondents. There is significant variation in the components constituting a geriatric ED. The United States should consider external validation of self-identified geriatric EDs to standardize the quality and type of care patients can expect from an institution with an identified geriatric ED.

El anciano en la unidad de geriatría de agudos

Although the implementation of acute geriatric units (AGUs) in general hospitals has a grade A of evidency, in Spain, only 12% of them have this resource. The estimation of geriatric especializad beds for the care of acute frail elderly people is of 2.6/1000 inhabitants older than 75 years. AGUs have demonstrated to reduce the functional loss associated with the hospitalization and to increase the percentage of older people that can return home, without increases in mortality nor costs. In this review we present the characteristics of patients who benefit from AGUs, the services offered, the structure and functioning of the unit, the role of the professionals that work in it and the quality indicators that must be acomplished.

Geriatricians – a role reappraisal?

Geriatricians – a role reappraisal?

Étude descriptive des bactériémies dans un hôpital gériatrique universitaire

Objectives. - To describe clinical features, microbiologic characteristics and outcome of bacteremia in the elderly patients hospitalized in a geriatric hospital. Patients and methods. - All episodes of bacteremia diagnosed from January 1 st to December 31 st 1998 were analysed, excluding false-positive cases due to skin contamination. The hospital comprises 1084 geriatric beds distributed as 111 in acute care (ACF), 333 in rehabilitation and intermediate-care (RICF), and 516 in long-term-care facilities (LTCF). Results. - Sixty-six episodes of bacteremia were observed in 65 patients. Among them 59 (89%) were nosocomial bacteremia distributed as 20 in ACF, 29 in RICF and 10 in LTCF (rates of 0.6, 0.35, and 0.05 episodes per 1000 patient-days, respectively.). Escherichia coli and Staphylococcus aureus were the main bacterial species involved in 31% and 28% of the cases, respectively. E. coli strains were 50% resistant to amoxicillin and 41% resistant to co-amoxiclav, and 68% of S. aureus strains were resistant to methicillin. Portals of entry were urinary tract (44%), respiratory tract (14%), digestive tract (11%), and soft tissue (8%). The same bacterial strain as in bacteremia was isolated from a peripheric site in 30 cases (47%), most of them being urines. For 15% cases, portal of entry cannot be determined. Mortality associated to nosocomial bacteremia was 25%, and death was significantly associated to MRSA, urinary or intravascular devices, chronic wounds and inappropriate antibiotic prescription. Conclusion. - In geriatric hospitals, bacteremia are mainly nosocomial cases. Prevention should focus on indwelling devices and antibiotic resistance.

Public and private supply of health services by autonomous communities in Spain

This chapter summarizes the main territorial inequalities in health care supply, and the related effects on access and use of health care facilities. Firstly, in the field of primary health care, the most notable inequalities refer to the process of introduction of the reform and to complementary services supply, together with the coverage of and access to some health care programs. Secondly, the distribution of hospital beds across regions is far from being uniform, specially with respect to geriatric and psychiatric beds. In addition, profit oriented private care is unequally distributed across territories. Thirdly, the availability of high-tech health care services is remarkably different across regions, although inequalities have been reduced during the last decade. Inequality in long-term care (not only in terms of supply, but also in access and use) is even higher than regional inequalities in health care supply. In addition to these territorial inequalities there are some significant gender inequalities.

Geriatric medicine in Sweden: a study of the organisation, staffing and care production in 2000-2001.

the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden. questionnaire survey. The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001. there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine. the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.

Hospitals, geriatric medicine, and the long-term care of elderly people 1946-1976.

This article investigates the development and interaction of the views of medical professionals and health officials on elderly care between 1946 and the early 1970s. It examines how the cultural and political context in which new ideas on the treatment of elderly people emerged in the early post-war period affected policy development in this area. The article argues that, in combination, the political and financial imperatives of health officials and the cultural prejudices of many in the medical profession created a situation in which progressive ideas about geriatric medicine and home care were used, not to improve the overall standard of care for elderly people, but to restrict their access to long-term medical and nursing care. The most important development in this respect, it will be argued, were efforts made by government from the mid-1950s to restrict the amount of provision for older people in hospitals, through the introduction of a geriatric bed norm. What lay at the heart of this question, the article concludes, was the reluctance of policy-makers to confront directly issues relating to the continuing care of old people with complex health problems. The reasons for this reluctance will be examined.

The value of taking an ‘ethics history’

Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement. Design—Questionnaire administered by six junior doctors...

Modelling hospital and social care bed occupancy and use by elderly people in an English health district.

The paper confirms that exponential equations can be used to model the total system and sub-systems of institutional health and social care for elderly people using bed occupancy census data for 6,068 elderly aged 65 and over. Two streams of flow were present in NHS acute hospitals, Local Authority residential homes and independent sector nursing homes. Three streams of flow were present in the overall data set and in the NHS geriatric hospital beds, NHS psychiatry beds and independent sector residential care homes. In total 22% of patients/residents stayed an average of 24 days (short stay), 69% for 825 days (medium stay) and 9% for 3,384 days (long stay). In both sexes, the older a patient/resident, the longer the time they occupied short stay beds and the shorter the time they occupied long stay beds.

Stochastic Models of Geriatric Patient Bed Occupancy Behaviour

Summary This paper considers a census approach to the modelling of the time that geriatric patients spend in hospital and subsequently in the community by using a stochastic compartmental Markov model. A selection process is developed using maximum likelihood estimation to fit the model to daily census data on the duration spent in the hospital or the community. Census data are used as they are easy to collect and therefore maximize the usability of the model. The model is fitted to an extensive 16-year data-set and shown to provide realistic estimates of movements of patients by using only a single day’s census result.

Do community hospitals reduce the use of district general hospital inpatient beds?

Community hospitals have been supported by the general public and by professionals as one means of increasing choice between local, low technology, care and high technology care at the district general hospital. However, there is no information on the impact of community hospitals on district general hospital use subsequent to NHS and community care reforms. Examination of routinely gathered activity data in the Bath Health District revealed that availability of community hospital beds was associated with reduced use of central inpatient services in the city of Bath. The reduction was most apparent for medical and geriatric beds. Decrease in the use of surgical beds was small. However, total inpatient bed use (including central and community hospital beds) was higher in the population with access to community hospital beds. We conclude that community hospitals offer one option for accessible health care and, as such merit systematic evaluation of costs and benefits. This study presents some evidence that savings could be achieved through improved efficiency.