Home Care Research Articles

AEGIS-AcutE Geriatric Intervention Study: pilot study of frontline acute geriatric assessment to improve quality of care in emergency department.

Due to the increasing number of older patients in emergency departments (EDs) with frailty, cognitive impairment and multimorbidity, there is a need for geriatric expertise in EDs. This retrospective study is of older patients visiting Turku University Hospital ED between 2 January and 31 December 2022. Patients aged 75years of older were screened for frailty using Triage Risk Screening Tool (TRST) and Clinical Frailty Scale (CFS). Nonacute, frail patients (CFS ≥4) suitable for Targeted Geriatric Assessment (TGA) (n = 1096) were scanned for the risk of delirium, cognitive impairment, change in functional status, falls, malnutrition and depression. A comprehensive patient record was made with recommendations for future care. TRST was completed in 70% of the ED visits, and two-thirds of those were considered high-risk. Among the patients assessed by the geriatric team (TGA), nonspecific complaint (38%) and falls (35%) were the main reasons for ED admission. Cognitive impairment was present in over 60% and orthostatic hypotension in 40% of the patients. The 72-hour revisit rate for TGA-patients was 2.3%. For the real-life control group, the 72-hour revisit rate was 4.6% (P = .001). Thirty-day revisit rates were 10% and 16%, respectively (P < .001). The need for rehabilitation, cognitive evaluation and intensifying home care were the main recommendations for future care. TGA approach provides structured and accurate information on older patients' background. This may lead to more precise diagnostics, a thorough consideration of hospital intake and a secure discharge from the ED. Ensuring continuity of care may help to reduce readmissions to EDs.

The impact of ageing-in-place reforms on the provision of home care packages for older Australians, 2008-21: a repeated cross-sectional study.

To assess changes following the 2013-21 Home Care Package (HCP) reforms in the rate of HCPs provided to Australians aged 65 years or older, the characteristics of people who have received HCPs, and the capacity of the program to meet demand for its services during 2018-21. Repeated cross-sectional population-based study; analysis of Australian Institute of Health and Welfare GEN Aged Care and Australian Department of Health Home Care Packages program data. HCPs provided to non-Indigenous Australians aged 65 years or older, 2008-09 to 2020-21. Changes in age- and sex-standardised HCP rates (number per 1000 older people) and changes in proportions of recipients for selected characteristics, 2013-14 to 2020-21, overall and by care level; correspondence of proportional HCP supply and demand, 2018-19 to 2020-21, by care level. A total of 490 276 HCPs were provided during 2008-21. The age- and sex-standardised HCP rate rose from 9.23 per 1000 people aged 65 years or more in 2013-14 to 16.4 per 1000 older people in 2020-21. The increases in age- and sex-standardised HCP rate between 2013-14 and 2020-21 were greatest for level 1 (from 0.19 to 5.05 per 1000 older people) and level 3 HCPs (from 0.35 to 3.62 per 1000 older people); the rate for level 2 HCPs declined from 6.75 to 5.82 per 1000 older people, and that for level 4 HCPs did not change. The proportion of culturally and linguistically diverse recipients rose from 10.8% to 16.2%; the overall proportion of recipients living outside major cities rose slightly, from 28.1% to 28.7%, but declined for higher care level HCPs (level 3: from 30.8% to 27.8%; level 4: from 29.6% to 25.2%). During 2018-19 to 2020-21, the proportions of lower level (1 and 2) HCPs generally exceeded demand, while the supply of higher level (3 and 4) HCPs generally fell short of demand. Despite the increased overall availability of HCPs, the supply of higher care level HCPs is still lower than the demand, probably contributing to suboptimal support for the ageing-in-place preferences of older Australians, especially in regional and remote areas.

Navigating artificial intelligence in care homes: Competing stakeholder views of trust and logics of care

The COVID-19 pandemic shed light on systemic issues plaguing care (nursing) homes, from staff shortages to substandard healthcare. Artificial Intelligence (AI) technologies, including robots and chatbots, have been proposed as solutions to such issues. Yet, socio-ethical concerns about the implications of AI for health and care practices have also been growing among researchers and practitioners. At a time of AI promise and concern, it is critical to understand how those who develop and implement these technologies perceive their use and impact in care homes. Combining a sociological approach to trust with Annemarie Mol's logic of care and Jeanette Pol's concept of fitting, we draw on 18 semi-structured interviews with care staff, advocates, and AI developers to explore notions of human-AI care. Our findings show positive perceptions and experiences of AI in care homes, but also ambivalence. While integrative care incorporating humans and technology was salient across interviewees, we also identified experiential, contextual, and knowledge divides between AI developers and care staff. For example, developers lacked experiential knowledge of care homes' daily functioning and constraints, influencing how they designed AI. Care staff demonstrated limited experiential knowledge of AI or more critical views about contexts of use, affecting their trust in these technologies. Different understandings of ‘good care’ were evident, too: ‘warm’ care was sometimes linked to human care and ‘cold’ care to technology. In conclusion, understandings and experiences of AI are marked by different logics of sociotechnical care and related levels of trust in these sensitive settings.

Evaluating the health outcomes of aging in place: the role of medicaid aging waiver program on U.S. older adults

The Medicaid Aging Waiver program (MAW) subsidizes the cost of long-term care (LTC) at home or in communities to satisfy older people’s increasing desire to age in place. The MAW program might be health improving for older people by allowing them to age at home. However, less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. I use policy expenditure across states over time linked with detailed health information from the Health and Retirement Study (HRS) to identify the associated effects of MAWs on health outcomes of older adults who are at risk of needing LTC and who are resources constrained to be potentially eligible for Medicaid. Overall, the findings suggest that the MAW program is beneficial to health: a $1,000 increase in MAW spending for each older person results is associated with a 1.4 percent improvement in self-reported health status, a 1.5 percent reduction in functional mobility limitations, a 1.6 percent decrease in Instrumental Activities of Daily Living (IADL) limitations, and a 1.7 percent improvement in negative psychological feelings. For older people who are most likely not eligible for MAWs, such as those who are wealthy or in good health and do not require LTC, these health-improving effects have not been observed.

Evaluation of Patients Receiving Home Care Services and Services Provided

Aim: It is important to know patient characteristics and medical needs in the planning and operation of home care services (HCS). In this study, the descriptive characteristics of patients who received HCS and the medical services provided were evaluated. Materials and Methods: Patients receiving HCS for at least one-year were included this cross-sectional study. Patient records were examined and in addition to descriptive features, the number of visits made by the HCS unit in the last year for each patient, the reasons for these visits and the procedures performed was recorded. Results: While 60.4% of the patients were female, 83.6% were ≥65 years. It was determined that 72.6% of the patients were bedridden, 30.5% used a urinary catheter and 32.9% had pressure ulcer. A total of 2774 (median=16) home visits were made, and the most common medical procedures were blood test and wound dressing. Functional bed use and pressure ulcer for wound dressing, rural location and diabetes for blood test and rural location, urinary catheter use and history of pulmonary embolism for urinalysis were determined as risk factors. Conclusion: The characteristics of the patients receiving HCS, and the services provided were determined and it was seen that they were related to each other.

Economic burden of frailty in older adults accessing community-based aged care services in Australia.

To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non-frail individuals following their first assessment by an aged care assessment team (ACAT) for a government-funded home care package. The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non-frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow-up, PRAC entry or death were summarized monthly by frailty status. 13 315 non-frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70-1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67-1.79) compared with non-frail individuals. Total healthcare costs over the 3-year post-assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••-••.

Application of communication technologies in ensuring patient safety in home care: Pros and cons

The Article Abstract is not available.

Workload of home care nurses: Italian adaptation, validity, and reliability of the National Aeronautics and Space Administration Task Load Index questionnaire.

The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses.

Abstract Mo049: Loss of Y chromosome and cardiovascular events in chronic kidney disease

Background: Chronic kidney disease represents one of the strongest risk factors for cardiovascular diseases, and particularly for heart failure. Despite improved pharmaceutical treatments mortality remains high. Recently, experimental studies demonstrated that mosaic loss of Y chromosome (LOY) associates with cardiac fibrosis in mice. Since diffuse cardiac fibrosis is the common denominator for progression of all forms of heart failure, we determined the association of LOY on mortality and cardiovascular disease outcomes in patients with chronic kidney disease. Methods: LOY was quantified in patients with stable CKD (CARE for HOMe study, derivation cohort, N=279) and dialysis patients (4D study, validation cohort, N=544). The association between LOY and mortality, combined cardiovascular and heart failure-specific endpoints, and echocardiographic measures was assessed. Results: In CARE for HOMe, mortality was higher in men as compared to women across the entire range of impaired renal function. The frequency of LOY increased with age. LOY was associated with increased mortality (HR 2.58, 95%CI 1.33-5.03) and risk for cardiac decompensation or death (HR 2.30, 95%CI 1.23-4.27). Patients with LOY &gt;17 % showed a significant decline of ejection fraction and an increase of E/E’ within five years. Consistently, validation in the 4D study revealed that LOY was associated with increased mortality (HR 3.13, 95%CI 1.97-4.99), higher risk of death due to heart failure and sudden cardiac death (HR 4.14, 95%CI 2.00-8.57), but not atherosclerotic events (see figure). Patients with LOY &gt;17 % showed significantly higher plasma levels of soluble ST2, a biomarker for myocardial fibrosis. Mechanistically, intermediate monocytes from patients with LOY &gt;17 % showed significantly higher CCR2 expression and higher plasma levels of the CCR2 ligand CCL2, which may have contributed to increased heart failure events. Conclusions: LOY identifies male patients with chronic kidney disease at high risk for mortality and heart failure events.

Delay and Pay? Healthcare Costs Associated with Late Oral Anti-coagulant Prescribing in People with Atrial Fibrillation.

Atrial fibrillation (AF) is associated with increased morbidity and mortality and exerts an increasingly significant burden on global healthcare resources, with its prevalence rising with an ageing population. Despite a substantial thromboembolic risk, particularly in the period immediately following diagnosis, oral anti-coagulation is frequently not initiated or is delayed. The aim of this study was to evaluate healthcare costs in people with AF, comparing those who were commenced on oral anti-coagulation in the immediate period following the index diagnosis date with those in whom initiation was late and those who never started anti-coagulation. This retrospective cost analysis used linked Scottish health data to identify adults newly diagnosed with AF between January 1st 2012 and April 30th 2019 with a baseline CHA2DS2-VASc score of ≥2. This AF population was sub-divided according to timing of the first prescription of oral anti-coagulant (OAC) during a 2-year follow-up period: never started (OAC never initiated), immediate OAC (OAC prescribed within 60 days of incident AF diagnosis), and delayed OAC (OAC prescribed more than 60 days after incident AF diagnosis). A two-part model was developed, adjusted for key covariates, including age, sex, and frailty, to estimate costs for inpatient admissions, outpatient care, prescriptions, and care home admissions, and overall costs. Of an overall AF population of 54,385, 26,805 (49.3%) never commenced OAC, 7654 (14.1%) initiated an OAC late, and 19,926 (36.6%) were prescribed anti-coagulation immediately. The mean adjusted cost for the overall AF population was £7807 per person per year (unadjusted: £8491). Delayed OAC initiation was associated with the greatest adjusted estimated mean annual cost (unadjusted: £13,983; adjusted: £9763), compared to those that never started (unadjusted: £10,433; adjusted: £7981) and those that received an immediate OAC prescription (unadjusted: £3976; adjusted: £6621). Increasing frailty, mortality, and female sex were associated with greater healthcare costs. AF is associated with significant healthcare resource utilisation and costs, particularly in the context of delayed or non-initiation of anti-coagulation. Indeed, there exists substantial opportunity to improve the utilisation and prompt initiation in people newly diagnosed with AF in Scotland. Interventions to mitigate against the growing economic burden of AF should focus on reducing admissions to hospitals and care homes, which are the principal drivers of costs; prescriptions and outpatient appointments account for a relatively small proportion of overall costs for AF.

Trivial benefits: how care home managers can give tax-free gifts to employees

Adam Bernstein discusses the tax-free benefit rule that allows care home managers to give their staff gifts.

Lifelong learning: supporting older people in care homes to maintain and acquire skills

Swee Hong Chia discusses the ways in which older people can be supported to continue former skills and interests, as well as fostering new hobbies and providing learning opportunities.

The complex overlap between syncope and falls: helping older people to stay safe and well in the nursing or residential care home

In this article, Sarah Jane Palmer discusses falls as a result of syncope among the elderly and frail patients in nursing or residential care, and how to prevent and manage this condition.

Dual mastering and labour exploitation: Life and work stories of Romanian women in home care in Italy from Romania

The study analyses the dual nature of mastering in the specific context of home care with reference to Romanian women employed in Italian families through life stories collected in Italy and Romania. This duality stems from the overlap between personal and work time in the home environment. The surveillance of Romanian domestic workers by the employers are combined with prejudices and sometimes sexual urges, expressed through verbal and non-verbal language, to define a coercive and segregating way of life and work, with consequences for workers in terms of exploitation, mental health and dependence on the employers' needs, even to the extent of defining specific workers'transnational relationships with the family of origin and its social network. The processes of dehumanisation and exploitation will be analysed by interviewing women who have worked in care of Romanian nationalities and who have lived or still live in Italy. The analysis of the concept of dor, a Romanian word meaning the longing for what one has left behind and the yearning for what one will no longer find, leads to the formulation of a hypothesis while considering Romanian women employed in Italy in the ethnicized labour market: their being considered as less ‘immigrant'. In other words, as European care givers' flows are not well controlled, it creates more favorable conditions for irregular work. This is a condition of masking or hiding persistent conditions of marginality and subordination.

Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis

To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF). Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown. We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis. We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support. Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.

Establishing a Comprehensive Nursing Clinic Using the Case Management Model.

To explore the practical effect of the case management model in a comprehensive nursing clinic. Based on the case management model, the authors constructed a comprehensive nursing clinic providing wound care, ostomy care, peripherally inserted central catheter care, drainage tube care, nursing consultations, and home care. They evaluated the practical effect of the comprehensive nursing clinic according to workload, economic benefits, and satisfaction of the medical staff and patients. Since the inception of the comprehensive nursing clinic, the number of visits has increased by 63.57%, and the satisfaction of patients and medical staff has also improved. This comprehensive nursing clinic based on the case management model meets the medical needs of patients, has improved the satisfaction of patients and the medical staff, and enhances the professional sense of value and comprehensive quality of specialized nurses.

An Exploratory Study on Non-Contact Nursing Experiences of Clinical Nurses during the COVID-19 Pandemic

This study aimed to understand the non-contact nursing experiences of clinical nurses during the COVID-19 pandemic. A qualitative research design applying thematic analysis was used. The participants were purposive sampled from three institutes: a tertiary hospital, a general hospital, and a residential treatment center in Seoul. Data were collected between December 2021 and January 2022 through individual in-depth interviews with 12 clinical nurses. The data were analyzed using Braun and Clarke's method to identify the meaning of the participants' experiences. During the COVID-19 pandemic, the fields where the participants performed non-contact nursing included intensive care units and isolation wards of hospitals, a residential treatment center, and home cares. Their tasks in non-contact nursing commonly involved remote monitoring using digital devices or equipment, consultation and education. From their experiences performing tasks in these fields, the four theme clusters and nine themes were derived. The four theme clusters are as follows: (1) Confusion of nursing role; (2) Conflict due to insufficient support system; (3) Concern about the quality of nursing; (4) Reflection on the establishment of nursing professionalism. This study highlights the necessity for institutionalizing professional nursing areas, nursing education, and practical support by clarifying the purpose and goals of non-contact nursing and developing nursing knowledge through frameworks.

How Patients and their Relatives Coordinate (Inter-) Professional Work in Home Care

How Patients and their Relatives Coordinate (Inter-) Professional Work in Home Care

A systematic review of the economic burden of colorectal cancer.

Colorectal cancer is the third most common cancer in the Western Hemisphere. It is the third most common cancer in men after prostate and lung cancers and the second most common cancer in women after breast cancer. According to some studies, the incidence and prevalence of colorectal cancer is increasing rapidly. In the present study, a systematic review of the articles related to the economic burden of colorectal cancer was carried out. The articles were taken from the following databases: SID, Medline/Pubmed, Embase, Scopus, Web of Science, NHS Economic Evaluation Database (EED), Econlit, and Google Scholar. Furthermore, the PICOTS model was used to select the inclusion criteria. The quality of the articles' methodologies was evaluated using Drummond's checklist. Then, some data were extracted from relevant articles, in terms of year, place of research, sample size, costing approach, type of measured costs, average direct medical costs, average direct nonmedical costs, and average indirect costs. The data from 37 studies dealing with the costs of patients with colorectal cancer were extracted. Most of the studies were conducted in the United States, and the social perspective was the most common perspective to measure the costs. According to the majority of the studies, direct medical costs were considered the greatest driver in causing the economic burden of colorectal cancer. The costs of hospitalization, medicine, surgery, chemotherapy, and radiotherapy accounted for the largest share of direct medical costs, and the costs of transportation, accommodation, and home care were the greatest share of direct nonmedical costs. Furthermore, the costs associated with disability, absenteeism, and premature death were identified as the main drivers of indirect costs. The findings of this study showed that colorectal cancer imposes great direct and indirect costs on families, the health system, and society. The best way to deal with this disease and, hence, to reduce its economic burden is to take comprehensive preventive measures and modify the lifestyle. In addition, health policymakers can limit the costs of this disease by expanding the screening program.

In Celebration of WHO International Day of Older Person : How to Stay Young Symposium

The Geriatric Unit at Dar Al Shifa Hospital in Kuwait is announcing a geriatric symposium. The symposium is in Celebration of WHO International Day of Older Person. The theme of the conference is “ How to Stay Young “. It will take a place on Sat Oct 5th , 2024 at DASH-Auditorium. The conference will cover the following topics Longevity issues Dementia &amp; Alzheimer’s Preventive strategies in older people How to prevent cardiovascular diseases Nutrition, Frailty, Sarcopenia Prevention of Osteoporosis Use of genetic testing New modalities in prevention and Management of diabetes New modalities in prevention and management of dyslipidemia Parkinson disease new modalities of treatment and prevention We will bring together a network of key players, renowned scientists and professionals representing all the following f ields of gerontology and geriatrics: Research and education, social services, nursing or care homes, relevant public and administrative authorities as well as any other discipline dealing with the elderly or their quality of life. The speakers are from Kuwait , GCC national and Europe in addition to Thailand, Spain, USA The symposium can be carried at the auditorium of our hospital