Geriatric Team Research Articles

Pharmacist-Led Medication Management in Acute Geriatric Medicine and Its Associations with Rehospitalizations: A Cohort Study

Introduction: Hospitalization and discharge in older patients are critical and clinical pharmacists have shown to ameliorate risks. Our objective was to assess their benefit as part of the geriatric team regarding rehospitalizations and related outcomes after discharge focusing on general practitioners’ decision to continue or change discharge medication (GPD). Methods: Prospective implementation study with 6-month follow-up in an acute geriatric clinic. Patients ≥70 years with comorbidities, impairments, and a current drug therapy were consecutively assigned to three groups: control group (CG), implementation group (IG), and wash-out group (WG). CG only received medication reconciliation (MR) at admission; IG and their hospital physicians received a pharmaceutical counseling and medication management; during WG, pharmaceutical counseling except for MR was discontinued. We used a negative-binomial model to calculate rehospitalizations and days spent at home as well as a recurrent events survival model to investigate recurrent rehospitalizations. Results: One hundred thirty-two patients (mean age 82 years, 76 women [57.6%]) finished the project. In most of the models for rehospitalizations, a positive GPD led to fewer events. We also found an effect of pharmaceutical counseling on rehospitalizations and recurrent rehospitalizations in the CG versus WG but not in the CG versus IG models. 95.3% of medication recommendations by the pharmacist in the clinic setting were accepted. While the number of positive GPDs in CG was low (38%), pharmaceutical counseling directly to the GP in IG led to a higher number of positive GPDs (60%). Discussion: Although rehospitalizations were not directly reduced by our intervention in the CG versus IG, the pharmacist’s acceptance rate in the hospital was very high and a positive GPD led to fewer rehospitalization in most models.

New Horizons in Peripheral Artery Disease.

Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams.

Defining geriatric care in a developing country: A Multidisciplinary model empowering clinical pharmacists

BackgroundThe elderly population often has complex health needs due to multimorbidity, polypharmacy, and inappropriate prescriptions. Clinical pharmacists play an important role in optimizing pharmacotherapy as a part of a multidisciplinary geriatric care team. However, there is a lack of integrated models in developing countries. AimTo develop a standardized framework for the provision of clinical pharmacy services in geriatric care – A Comprehensive Geriatric Care Model. MethodsA systematic service design process was used to develop an innovative geriatric care model in a tertiary hospital in southern India. The roles of stakeholders were captured through interviews and observations. Evidence-based clinical pharmacy services were developed focusing on medication reconciliation, medication review, patient counselling, and transitions of care. ResultsThe Comprehensive Geriatric Care Model integrates the pharmacist into coordinated care. The responsibilities of physicians, nurses, patients, caregivers, and pharmacists throughout the inpatient stay are shown in swim-lane diagrams. Pharmacy services address inappropriate prescriptions, poor adherence, adverse drug reactions, and fragmented care. ConclusionsThe systematic development of an interprofessional geriatric care model embedded with evidence-based clinical pharmacy services was made possible using a patient-centered service design methodology. The implementation and evaluation of this collaborative approach could significantly improve the quality of care and outcomes for older adults.

Practices, issues and possibilities at the interface between geriatrics and palliative care (InGaP): An exploratory study and knotworking

Introduction With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow. Methods An exploratory qualitative interview study was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice. Results Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a detrimental effect on their care or needs. Conclusions There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life.

Preoperative cognitive impairment and postoperative delirium among Holocaust survivors who achieved longevity.

Holocaust survivors (HS) experience higher rates of physiological and psychological morbidities, increasing their vulnerability to perioperative complications. Limited information exists regarding their perioperative neurocognitive disorders. This study aimed to assess the rates of preoperative cognitive impairment, postoperative delirium, and other complications among HS aged 75+ undergoing elective surgery. This is a single-center retrospective cohort study that analyzed prospectively collected data. All surgical patients born before 1945 who underwent elective noncardiac surgery at a tertiary hospital in Israel during 2020-2021 were included. The HS group was identified through the hospital's information system. Preoperative cognitive impairment was assessed using the Mini-Cog test. Postoperative delirium was defined as a combined outcome, which included a positive 4A's-Test (4AT) result during the postanesthesia care unit stay up to the second postoperative day, a positive 3-Minute Diagnostic Confusion Assessment Method (3D-CAM) test administered by the geriatric team, and identification through the medical records using the Chart-based Delirium Identification Instrument (CHART-DEL). We used multivariable regression to assess the risk factors for postoperative delirium. Out of 1332 eligible patients, 422 (32%) were HS, while the others served as controls. Both groups had a similar rate of preoperative cognitive impairment (24%, p = 0.89) and postoperative delirium (16%, p = 0.95). HS exhibited a higher risk of the composite adverse events (24% vs. 20%, p = 0.05, aOR [95% CI] 1.3 [1.0-1.7]), driven mainly by falls during hospitalization (4% vs. 2%, p = 0.03, aOR 2.1 [1.1-4.1]). HS patients were more likely to be childless (33% vs. 11%, p = 0.001) and had higher rates of chronic antidepressant and benzodiazepine use. HS achieving longevity do not face increased risks of preoperative cognitive impairment and postoperative delirium. However, special care is still warranted due to their elevated rate of other complications during hospitalization.

The Virtual Geriatric Assessment Interdisciplinary Team Project: Interprofessional Geriatric Training Against the Backdrop of COVID-19.

Interprofessional geriatric education programs enhance trainees' knowledge of older adults, and the valuable contributions health and social care practitioners make to their well-being when specialists work collaboratively. In response to the 2020 COVID-19 pandemic restrictions, in-person geriatric interprofessional education (IPE) programs were redesigned for virtual delivery. Nineteen virtual programs were held between September 2020 and December 2022. Of the 369 health and social care trainees who participated, 67.2% completed both pre- and post-program surveys. Survey instruments included the Interprofessional Collaborative Competency Attainment Survey (ICASS), which measures perceptions associated with patient-centered, team-based, collaborative care. Significant differences were obtained across ICASS domains, including communication, conflict management/resolution, and team functioning, suggesting that virtual programs may enhance attitudes and perceived abilities for interprofessional collaborative practice. Furthermore, participants' perceived understanding of older adult needs improved, as did their interest in geriatrics. Results illustrate that virtual geriatric interprofessional (IP) programs may be viable alternatives to in-person opportunities.

1710 Using the Visual Assessment Tool (VAT) on all patients at risk of falls in the day assessment unit (DAU)

Abstract Objective To conduct a QIP to ensure that >80% of DAU patients’ vision was assessed via the VAT as per National Audit of Falls Prevention Guidance. Background Patients with visual impairment are twice as likely to fall than those without. The NAIF 2015 report identified <50% of elderly patients had their vision assessed in hospital; also evident at Southend Hospital. Methods Data collection from 56 patients over 8 weeks following weekly interventions helped us analyse their impact on VAT use. Control data (week 1) was pre-intervention. Intervention Six interventions were applied over 7 weeks: teaching to nurses, HCAs and doctors about VAT; email to Geriatrics team; reminder email to DAU nursing team and a feedback questionnaire. Results and Discussion Mean age was 82 and 38% of patients attending DAU had an ophthalmic history. Pre-intervention (week 1) identified 0% VAT use. In week 2, there was a 75% increase in VAT use after teaching nursing and HCA staff. In week 3, there was only 12.5% VAT use after the poster intervention. In week 4, there was a 25% uptake on VAT use with no intervention. Week 5’s intervention witnessed 100% in VAT use, which remained high in week 6 (85.7%), 7 (100%) and 8 (100%). The final intervention questionnaire highlighted that 100% of staff were (i) previously unaware of VAT, (ii) agreed on its importance in assessment of elderly patients, (iii) found teaching adequate, (iv) thought there was enough awareness on VAT use via the QIP, (v) agreed that an incomplete VAT was due to inability to undertake section 4 and 5. Conclusion VAT use identified 3 ophthalmic problems that would have otherwise not been managed. While the QIP did not meet the target of >80% VAT use, it successfully informed DAU staff in proper conduct of VAT in falls patients.

Understanding the experiences of PHC nurses in caring for older patients in the post-fifth wave of the COVID-19 pandemic: an exploratory qualitative study.

To ensure the best possible care, the perspective of PHC nurse work experience during the COVID-19 pandemic should be considered when developing nursing care protocols for older patients who receive PHC services. This exploratory qualitative study was conducted with 18 nurses working continuously in PHC between the first and fifth waves of the pandemic. Semi-structured thematic interviews were undertaken. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis. The first topic describes the nurses' experiences of physical and mental suffering in caring for older patients in response to the pandemic. The second topic covers the experience of reorganizing PHC work. The third topic focuses on the difficulties of caring for older patients. The final topic includes issues of support needs for nurses in PHC work. The experience and understanding of PHC nurses in caring for older people during the COVID pandemic should lead to significant changes in the system of nursing care for geriatric patients and in the cooperative role within geriatric care specialist teams. Drawing on the experience of COVID-19, it is necessary to work on the weak points of PHC exposed by the pandemic in order to improve the quality of care and life for geriatric patients.

An evaluation of a transitional care programme for older adults in a general hospital in the Netherlands: Needs, preferences, and perspectives of the average old and the oldest old

Aim: This research aimed to evaluate a transitional care programme for older adults who were acutely admitted to a general hospital, with a special focus on health outcomes and healthcare utilisation for the oldest patients and to clarify patients’ and health care providers’ perspectives on the care provided.
 Background: Populations around the world are ageing, and many older adults have complex health problems owing to multimorbidity. Consequently, they experience many transitions in care. During the past decade, transitional care for older adults has become increasingly important in terms of safe transitions and prevention of adverse events during transitions.Research however, often leaves the oldest old and the most vulnerable out of scope.
 Methodology and methods: A mixed methods research design, based upon pragmatism and critical realism, was used in a parallel convergent design study. Measurements in the quantitative phase of the study were based on the The Older Persons and Informal Caregivers Survey Minimal Dataset (TOPICS-MDS). Data from the hospital registry and questionnaires were used. In the qualitative phase of the study reflexive thematic analysis was used on data gathered in interviews with patients, hospital nurses and community nurses and two focus group meetings with the geriatric team, and staff and managers from the home care organisations.
 Findings: The quantitative part of the study did not show any significant results of the effect of the Transitional Care Bridge (TCB) programme on the prevention of functional decline, health care utilisation and other health outcomes. However, the study revealed an increase in preventive care in the more frail TCB group. The qualitative part of the study reveals the programme was valued by patients, family members and professionals. The familiarity with the programme and personal attitudes of professionals may have influenced expectations and outcomes. Many patients enrolled in the programme were very frail and often unaware of the programme. As they often already received some kind of home care, patients were initially referred to the usual carers. The assessment of the care needs of the oldest patients to some extent fail to recognise what would contribute most to ageing well at home. Professionals in hospital as well as home care organisations struggled with motivation towards the programme and felt they still remained working within their silos. Professional roles were not always clearly defined, valued and reflected upon, and outcomes relating to collaboration reveal a gap between the different worlds of hospital and home.
 
 Discussion: Different contexts, organisational interests, personal attitudes and lack of reflection have influenced collaboration and the delivery of the programme. Transitional care interventions should be redeveloped for and with the oldest adults and their informal caregivers and address their needs during the period shortly after discharge, and help them build structure into their daily routines, and resume activities and exercise. Reflective practices on shared values, implications and outcomes should be developed as a competence within and between all involved organisations of transitional care. More reflective and emergent research approaches are needed to inform policies on ageing well in place and prevention.

Development and feasibility of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care).

The Geriatric Activation Program Pellenberg (GAPP), among other programs for geriatric rehabilitation, improves patient functioning. However, hospitalized patients rarely move enough to meet the WHO recommendation of 300 minutes of moderate-intensity exercise per week.
 Increasing exercise time by physiotherapy is hindered by staffing and financial restrictions both being dependent on health care and hospital financing. Integrating unpaid caregivers in an geriatric rehabilitation program could close this gap.
 Along with the physiotherapist, we wish to make the patient's informal caregiver an exercise partner. We want to teach the caregiver how to literally support their family member in hands-on sessions and to enable them to take part in the pluridisciplinary geriatric rehabilitation team.
 The development of the Geriatric Activity Program Pellenberg with the Caregiver as an exercise partner (GAPP+Care) was founded on three aspects: 1) the WHO daily activity guideline; 2) the current program GAPP; and 3) a systematic review on the effect of informal caregiver involvement on self-efficacy of hospitalized older adults.
 We conducted semi-structured interviews to determine the overall perception of patients and caregivers toward the GAPP+Care concept. Based on the findings, GAPP+Care was finalized. The questions were divided into 3 domains: 1) reasons to participate, 2) exercise moments (number, duration and time), and 3) the exercise booklet. The interview started with explaining GAPP+Care and a prototype of the exercise booklet was given. Sixteen patients from UZ Leuven's geriatric rehabilitation ward, as well as 15 informal caregivers, took part in the study. 75% of patients and 80% of family caregivers stated that they would participate in the GAPP+Care exercise program. The main motivations for participating were activation of the patient, to follow their progress, as well as to learn more about their abilities. The main reasons for refusal were a lack of time, greater care load for the caregiver, and the patient's lack of motivation. Although 52% of participants agreed to four additional exercise moments per week, 45% prefers less moments. All participants reported that the instruction booklet was clear, easy to read, and simple to use. With some adjustment GAPP+Care appears to be acceptable for implementation on a geriatric rehabilitation ward.
 The GAPP+Care program consists of GAPP plus three additional 30-minute exercise sessions each week led by an informal caregiver (+Care). One of these three exercise sessions is always carried out in partnership with a physiotherapist, while the other two can be independently given by the caregiver at any time, such as in the evening or on the weekend. These +Care practice sessions, in addition to the individual physiotherapy treatment, continue in the patient's home for the first six weeks following discharge.
 GAPP+Care requires an integrated approach towards patients and their family caregivers. We initiated a feasibility study of GAPP+Care (March 2022 - March 2023). In this study we are investigating: 1) the feasibility, appropriateness, barriers and facilitators of GAPP+Care, 2) the fidelity to GAPP+Care, and 3) the percentage (proportion) of eligible individuals and their willingness to participate in GAPP+Care.

Delirium diagnostic 2012 to 2021, contribution of CAM and clinical nurses of the geriatric consultation team in CIUSSS de l’Estrie‐CHUS

AbstractBackgroundTo evaluate the evolution of diagnostic of delirium following the introduction of CAM as a geriatric vital sign as part of The Specialized Approach to Senior Care (l’approche adaptée à la personne âgée, AAPA) in University Hospital CIUSSS de l’Estrie‐CHUS in 2014.MethodTraining on CAM and delirium was given in 2014. The nurses of the geriatric consultation team make recommendations/coaching to the treating teams during geriatric consultations. We analyze ICD‐10 data from > 65‐year‐olds hospitalized at the CHUS before (2012) and after (2016). A criteria base analysis of the files with diagnosis of delirium on the discharge letter or a geriatric consultation of November 2016 describes the considerations related to delirium.ResultOf the 32,000 hospitalizations at CHUS in 2016, 13,000 are over 65 years old and 1296 have a geriatric consultation. 2.2% in 2012 to 2.7% in 2016 had delirium according to the exit letter. That is 3% of 65‐75 year olds and 8% of those over 75. 102 consecutive files of geriatric nursing consultations from November 2016 are reviewed. 63 new diagnoses of delirium with an average of 3 recommendations from the AAPA to the treatment team.ConclusionDelirium remains under‐documented at release and improves little from 2012 to 2021. The modalities of use of the current tools remain insensitive. The support of geriatric consultation teams remains necessary to support the development of AAPA against delirium.

P129: Buiding a telepsychiatry program for older people in rural Portugal

The geriatric psychiatry team at the Local Health Unit of Baixo Alentejo (ULSBA) serves the largest district of Portugal, the district of Beja, covering 10,4% of Portugal area. Baixo Alentejo is predominantly rural and a relatively poor area, with a high percentage of older adults (28% of its population being over 65 years old), a declining population due to unremitting exodus, an underdeveloped public transportation system and insufficient health care assistance. Among the telemedicine programs developed in the last decades, care in nursing homes for the elderly has figured prominently. Many studies report decrease of costs and inconvenience resulting from patients having to travel to hospitals, and so to optimize, simplify and reduce costs of psychogeriatric care.We report the planning and implementation of a telepsychiatry program adopted by a geriatric psychiatry team of a local mental health service, starting in 2023. Videoconference consultations were provided for 58 nursing homes, with an average of 10 patients per day. Most patients were initially evaluated at the hospital by a nurse and a psychiatrist, being all subsequent consultations made every three to six months. Most patients were female. The most frequent diagnosis was dementia due to Azheimer disease. A clinical evaluation standardized sheet was sent prior to the consultation and the interview with the nurse had the purpose of completing those data that the psychiatrist considered necessary after reading the material sent. The presence of staff in the room with the patient not only helped carry out the interview, but it also allowed observation of how the patient interacted in a face-to-face situation.Healthcare institutions all over the world are increasingly adopting telehealth services given their numerous benefits in enhancing access to care. This practice comes with several challenges, being the fact that a nurse or someone from the staff must be present in the teleconsultation one of the most significant ones, as staff is already overburdened.Innovations to overcome sensory deficits and collaboration with community services should be explored to improve its acceptance among the most vulnerable population.It is fundamental to assess cost-effectiveness and patient/caregivers satisfaction with the service.

Geriatric Interprofessional Team Transformation for Primary Care overview.

The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital – A practice development project

IntroductionElderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs. MethodsThe current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of “practice environment” from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix. ResultsSeveral adaptations and changes were made addressing the three elements of “practice environment”. These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures. ConclusionsThrough active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

162 Establishing a geriatric friendly Emergency Department in Ireland with a checklist and gap analysis

Abstract Background The population is ageing rapidly worldwide and in Ireland there has been a significant year on year increase of patients over sixty five presenting to the Emergency Department (ED). With the complexity of older patients, there is a focus on the creation of a department that caters to their needs. Methods A scoping literature review was performed to identify a checklist that could be utilised for establishing standards for a Geriatric Emergency Department. It was decided to use the ‘The Geriatric Emergency Department Guidelines’ written by the American College of Physicians et al1 as a model. This was then adapted to the Irish ED. Subsequently we applied this checklist to analyse the components that were in place within our own department. Results This study took place in a tertiary university hospital which sees over 50,000 patients per year. Within the ED there is a multi-disciplinary Geriatric Emergency Department Intervention Team (GEDI) in place and an Age Related Assessment Unit (ARAU) has recently been opened. Upon performing the gap analysis the majority of items on the checklist are in place with these resources. Those that are missing include certain members of the multidisciplinary team due to national issues with staffing and environmental constraints secondary to overcrowding within the ED. Despite these universal challenges, areas of improvement that are achievable in both the short and long term were identified. Conclusion An Emergency Department that caters to the older population is increasingly important. With the creation of a checklist and gap analysis demonstrating ease of use, essential components of care can be identified and readily implemented to create a department suitable for the older person.

15 Hospital at home—a potential alternative option to acute hospital admission for older adults

Abstract Background Novel ways to respond to the acute care needs of older adults are needed. Hospital at Home (H@H) could be a viable alternative to emergency hospitalisation. We developed inclusion and exclusion criteria for selected medical conditions that could theoretically be treated in a hospital at home setting if supported by a geriatric medicine multidisciplinary team with a consultant, Advanced Nurse Practitioner (ANP), Physiotherapist (PT) and Cccupational Therapist (OT). Methods We completed a retrospective cohort study of unselected medical admissions over a two week period in a level four hospital. We developed illness specific criteria for stable patients that if met could allow a patient to be treated in a hospital at home environment. These conditions included community acquired pneumonia, congestive cardiac failure, COPD exacerbation and urinary tract infection. Results There were 307 medical admissions over the study period, with 144 over the age of 75 (47%). Mean age 83.2. 59 patients met our inclusion criteria for a potential H@H service (41%). All patients were clinically stable based on admission vital signs. The mean length of stay was shorter for patients eligible for H@H than patients who did not meet the criteria (9 days vs 14 days, p 0.01), and patients meeting the H@H criteria were more likely to be discharged home directly. They were less likely to have needed occupational therapy (32% vs 52%, p = 0.02) or medical social worker input (22% vs 42%). There was no difference in frailty category or readmission rates by whether or not a patient met the H@H criteria. Conclusion Over 40% of unselected medical take patients were of a low acuity that could have theoretically met our inclusion criteria for a supported hospital at home model. Strategies are needed to support expansion of this model of care.

Bedside palliative care and geriatric consultations: adherence rate in hospitalised patients

ObjectivesThis study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics...

Ten years of a geriatric oncology service at a public university cancer centre in Brazil.

The implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the University of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncology team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.

Impact of geriatric co-management on outcomes in hospitalised cardiology patients aged 85and over.

Cardiovascular disease and frailty are common among the population aged85+. We hypothesised these patients might benefit from geriatric co-management, as has been shown in other frail patient populations. However, there is limited evidence supporting geriatric co-management in older, hospitalised cardiology patients. Aretrospective cohort study was performed in alarge teaching hospital in the Netherlands. We compared patients aged85 and over admitted to the cardiology ward before (control group) and after the implementation of standard geriatric co-management (intervention group). Data on readmission, mortality, length of stay, number of consultations, delirium, and falls were analysed. The data of 1163 patients were analysed (n = 542 control, n = 621 intervention). In the intervention group, 251 patients did not receive the intervention because of logistic reasons or the treating physician's decision. Baseline characteristics were comparable in the intervention and control groups. Patients in the intervention group had ashorter length of stay (-1day, p = 0.01) and were more often discharged to ageriatric rehabilitation facility (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.10-3.54, p = 0.02) compared with the control patients. Other outcomes were not significantly different between the groups. After implementation of standard geriatric co-management for hospitalised cardiology patients aged85 and over, the length of hospital stay shortened and the number of patients discharged to ageriatric rehabilitation facility increased. The adherence to geriatric team recommendations was high. Geriatric co-management would appear to optimise care for older hospitalised patients with cardiac disease.

Evaluating a new emergency department avoidance service for older people: patient and relative experiences

BackgroundHigh emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged...