Medical Wards For Older People Research Articles

Exploring how Small Acts of Friendship encourage human flourishing on medical wards for older people

Background: Small Acts of Friendship is a project to help make the experiences of older people in an acute NHS hospital more humane. Aim: This research aims to explore how the project encourages human flourishing on wards for older people, using Dewing and McCormack’s (2017) model. We cover the barriers and emotions brought up by such a project, as well as looking for evidence of flourishing and a flourishing workplace. Methods: The qualitative method of experience-based co-design was used to set up and evaluate the project. Data consisted of interviews and observations with staff, relatives and patients involved in the project, and were analysed using comics as a tool for an iterative, deep analysis. Results: The results show how staff and patients responded to the project; the responses have been aligned to stages of Dewing and McCormack’s model. In one area the Small Acts of Friendship project was found to have resulted in a change in culture towards person-centred care. Implications for practice: Reflecting on the project brought out emotions that might ordinarily remain under the surface of practice for staff who look after older people, so they may need to be supported Hospital wards for older people can make changes towards a flourishing workplace through a project such as this

A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people

BackgroundThe positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards...

94INCREASED PHYSICAL ACTIVITY LEVELS AMONG HOSPITALISED OLDER PEOPLE: THE ROLE OF TRAINED VOLUNTEERS

Introduction: sedentary behaviour among older inpatients is associated with increased risk of functional decline, institutionalisation and death. Studies have shown that exercise and mobility interventions can reduce the risks of some of these adverse effects. However, most studies use paid staff to deliver such interventions. We explored the feasibility and acceptability of training volunteers to promote increased physical activity among older inpatients. Methods: this pre-post mixed methods study was conducted on acute medical wards for older people. Eligible patients were aged ≥70 years, mobile prior to admission and able to provide written consent. Physical activity levels were measured using two accelerometers: the ankle-worn StepWatch Activity Monitor and wrist-worn GENEActiv. Volunteers were trained and supported by therapists to deliver individual twice-daily activity sessions, which consisted of walking, chair, and/or bed exercises. Six nurses, seven therapists, six volunteers and six patients were interviewed to determine their views of the intervention. Results: 50 participants pre-intervention (mean age 87 years, SD 4.6) had a median daily step count of 626 (IQR 298–1468) and mean daily acceleration of 9.1 milligravity (SD 3.3) ( Conclusions: findings from this study demonstrate the sedentary behaviour of older medical inpatients. Trained volunteers can safely deliver mobility and exercise interventions for older inpatients. A controlled trial is required to determine the impact of trained volunteers on patient outcomes.

Pelvic fragility fractures in older people admitted to hospital: the clinical burden.

Pelvic fragility fractures are common in older people. To deliver better care in hospital, a better understanding of their characteristics and outcomes post-hospitalisation will allow clinicians to better design hospital services to manage their needs. Using routinely collected electronic hospital records over 3months, data were collected and analysed on consecutive patients admitted with pelvic fragility fractures (as defined by a pelvic fracture sustaining following a fall from standing height or less) to acute medical wards for older people. Twenty-four patients were admitted over this period. Their mean age was 87years (SD 9.4), the majority were female (83%), a significant proportion had cognitive impairment with an abbreviated mental test score of ≤ 7 (67%), and the median number of comorbid conditions was three. These patients were at high risk of future fractures (50% with a known diagnosis of osteoporosis; significant FRAX scores; 75% had a fall) but only 50% had a bone health assessment. The median duration in hospital was 13days. 33% of patients were discharged home directly while the rest were discharged to either a care home or another hospital for further rehabilitation. 54% had a hospital-related complication including kidney injury, delirium, and hospital-acquired infections-there were two inpatient mortalities. At 3months post-fracture, 54% were readmitted and 33% died. Pelvic fragility fractures are associated with worse inpatient and post-discharge clinical outcomes. This is an older multi-morbid cohort needing significant post-fracture rehabilitation care. Their care in hospital needs to address their management complexities.

Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment: identifying facilitators and barriers using a theory-led intervention

BackgroundLow grip strength in older inpatients is associated with poor healthcare outcomes including longer length of stay and mortality. Measuring grip strength is simple and inexpensive. However, it is not routinely used in clinical practice. We aimed to evaluate the implementation of grip strength measurement into routine clinical practice.MethodsThis implementation study was a mixed methods study based in five acute medical wards for older people in one UK hospital. Intervention design and implementation evaluation were based on Normalization Process Theory (NPT). A training program was developed and delivered to enable staff to measure grip strength and use a care plan for patients with low grip strength. Routine implementation and monitoring was assessed using the “implementation outcome variables” proposed by WHO: adoption, coverage, acceptability, fidelity, and costs analysis. Enablers and barriers of implementation were identified.ResultsOne hundred fifty-five nursing staff were trained, 63% in just 3 weeks. Adoption and monthly coverage of grip strength measurement varied between 25 and 80% patients across wards. 81% of female patients and 75% of male patients assessed had low grip strength (< 27 kg for men and < 16 kg for women). Staff and patients found grip measurement easy, cheap and potentially beneficial in identifying high-risk patients. The total cost of implementation across five wards over 12 months was less than £2302. Using NPT, interviews identified enablers and barriers. Enablers included: highly motivated ward champions, managerial support, engagement strategies, shared commitment, and integration into staff and ward daily routines. Barriers included lack of managerial and staff support, and high turnover of staff, managers and champions.ConclusionsTraining a large number of nurses to routinely implement grip strength measurement of older patients was feasible, acceptable and inexpensive. Champions’ motivation, managerial support, and shared staff commitment were important for the uptake and normalisation of grip strength measurement. A high percentage of older patients were identified to be at risk of poor healthcare outcomes and would benefit from nutritional and exercise interventions. Measuring grip strength in these patients could provide an opportunity to identify those with normal grip strength for fast tracking through admission to discharge thereby reducing length of stay.Trial registrationClinicaltrials.gov NCTO2447445. Registered May 18, 2015.

Physical activity among hospitalised older people: insights from upper and lower limb accelerometry

BackgroundFew studies have explored the activity levels of hospitalised older people and the intra-daily activity patterns in this group have not been described.AimsTo describe the quantity and daily pattern of physical activity among hospitalised older people using two accelerometers: the ankle-worn StepWatch Activity Monitor (SAM), and the wrist-worn GENEActiv.MethodsThis cross-sectional observational study was conducted on the acute medical wards for older people in one UK hospital. Inclusion criteria: participants aged ≥ 70 years, and able to mobilise prior to admission. Participants wore both devices for up to seven consecutive days, or until hospital discharge, whichever was sooner. Intra-daily activity levels were analysed hourly over each 24 h period.Results38 participants (mean age 87.8 years, SD 4.8) had their activity levels measured using both devices. The SAM median daily step count was 600 (IQR 240–1427). Intra-daily activity analysis showed two peak periods of ambulatory activity between 9 am–11 am and 6 pm–7 pm. With physical activity defined as ≥ 12 milli-g (GENEActiv), the median time spent above this cut-off point was 4.2 h. 62% of this activity time was only sustained for 1–5 min. Acceptability of both devices was high overall, but the wrist-worn device (96%) was more acceptable to patients than the ankle-worn device (83%).ConclusionActivity levels of these hospitalised older people were very low. Most physical activity was sustained over short periods. The intra-daily pattern of activity is an interesting finding which can help clinicians implement time-specific interventions to address the important issue of sedentary behaviour.

The effect of chair-based pedal exercises for older people admitted to an acute hospital compared to standard care: a feasibility study.

chair-based pedal exercises potentially offer a simple method of improving physical activity in older people admitted to hospital. to assess the feasibility of using chair-based pedal exercisers on acute medical wards for older people. To study if there is any effect on muscle strength, mobility and time spent physically active. fifty participants ≥65 years who were able to pedal admitted to acute medical wards for older people in a UK hospital. participants were randomised to either pedal for 5 min three times a day with minimal supervision; or standard care. Outcome data (compliance with exercise and change in lower limb muscle strength, mobility and level of physical activity) were collected on day 7 or on discharge, whichever came 1st. there were no significant differences in baseline characteristics between the intervention and standard care group. Participants remained in the study for an average of 5 days. None in the intervention group adhered to the prescribed exercise duration. The intervention group completed a median of 152 revolutions, or a median total pedal time of 5 min during the entire study period. There were no differences in change in lower limb muscle strength, mobility score or the percentage of time spent active between the two groups. pedal exercises with minimal supervision are not feasible as a single intervention to improve physical activity in older people admitted to hospital. There may be a role for it as part of a multifaceted strategy to improve physical activity in hospital.

Inpatient prescription charts on medical wards for older people – room for improvement?

The aim of the study was to determine adherence to Mid- Yorkshire Hospitals NHS Trust inpatient prescribing standards while implementing change and education in written prescribing to promote safe prescribing and patient safety. The retrospective audit was undertaken at Pinderfields General

A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol.

BackgroundHandgrip strength is a non-invasive marker of muscle strength, and low grip strength in hospital inpatients is associated with poor healthcare outcomes including longer length of stay, increased functional limitations, and mortality. Measuring grip strength is simple and inexpensive. However, grip strength measurement is not routinely used in clinical practice. The aim of this study is to evaluate the feasibility of implementing grip strength measurement into routine clinical practice.Methods/designThis feasibility study is a mixed methods design combining qualitative, quantitative, and economic elements and is based on the acute medical wards for older people in one hospital. The study consists of three phases: phase 1 will define current baseline practice for the identification of inpatients at high risk of poor healthcare outcomes, their nutrition, and mobility care through interviews and focus groups with staff as well as a review of patients’ clinical records. Phase 2 will focus on the feasibility of developing and implementing a training programme using Normalisation Process Theory to enable nursing and medical staff to measure and interpret grip strength values. Following the training, grip strength will be measured routinely for older patients as part of admission procedures with the use of a care plan for those with low grip strength. Finally, phase 3 will evaluate the acceptability of grip strength measurement, its adoption, coverage, and basic costs using interviews and focus groups with staff and patients, and re-examination of clinical records.DiscussionThe results of this study will inform the translation of grip strength measurement from a research tool into clinical practice to improve the identification of older inpatients at risk of poor healthcare outcomes.Trial registrationClinicaltrials.gov NCTO2447445 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0067-x) contains supplementary material, which is available to authorized users.

Pre-discharge home visits with older people: time to review practice.

The present review paper uses the available evidence to make a case for a reconsideration of the practice of undertaking pre-discharge home visits with frail older people as part of decisions regarding a return home. This practice is embedded into the routine activity of acute medical wards for older people and occupies a large proportion of the time of hospital employed therapy staff, with consequent financial and resource implications. Assessments are often conducted to provide information on safe discharge rather than being located in the interests of the older person and their carer. The introduction of a new range of services bridging hospital and home raises the need for an urgent, critical appraisal of this practice.