Older People In Hospital Research Articles

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort \u2013 Trial Protocol

BackgroundThe aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients’ current prescriptions by applying the published STOPP and START criteria, highlighting drug-drug and drug-disease interactions and providing non-pharmacological recommendations aimed at reducing the risk of incident delirium.MethodsWe will conduct a multinational, pragmatic, parallel arm Prospective Randomized Open-label, Blinded Endpoint (PROBE) controlled trial. Patients with acute illnesses are screened for recruitment within 48 h of arrival to hospital and enrolled if they meet the relevant entry criteria. Participants’ medical history, current prescriptions, select laboratory tests, electrocardiogram, cognitive status and functional status are collected and entered into a dedicated trial database. Patients are individually randomized with equal allocation ratio. Randomization is stratified by site and medical versus surgical admission, and uses random block sizes. Patients randomized to either arm receive standard routine pharmaceutical clinical care as it exists in each site. Additionally, in the intervention arm an individualized SENATOR-generated medication advice report based on the participant’s clinical and medication data is placed in their medical record and a senior medical staff member is requested to review it and adopt any of its recommendations that they judge appropriate. The trial’s primary outcome is the proportion of patients experiencing at least one adjudicated probable or certain, non-trivial ADR, during the index hospitalization, assessed at 14 days post-randomization or at index hospital discharge if it occurs earlier. Potential ADRs are identified retrospectively by the site researchers who complete a Potential Endpoint Form (one per type of event) that is adjudicated by a blinded, expert committee. All occurrences of 12 pre-specified events, which represent the majority of ADRs, are reported to the committee along with other suspected ADRs. Participants are followed up 12 (+/− 4) weeks post-index hospital discharge to assess medication quality and healthcare utilization.This is the first clinical trial to examine the effectiveness of a software intervention on incident ADRs and associated healthcare costs during hospitalization in older people with multi-morbidity and polypharmacy.Trial registration numberClinicaltrials.gov NCT02097654, 27 March 2014.

Nursing practice with hospitalised older people: Safety and harm.

Nursing teams work with hospitalised older people in institutions, which prioritise a biomedical model of care. This model does not fit the needs of older people because it emphasises efficacy and a narrow definition of patient safety, but does not prioritise functional needs. Nursing care is provided around the clock within the context of fiscal restraints as well as negative societal and nursing perspectives about ageing and old people. Yet, nursing perceptions of managing safety and potential harms to older patients within these hospital institutions are not well understood. An integrative review was conducted to examine nursing perspectives of safety and harm related to hospitalised older people. The majority of included papers focused on restraint use. Findings reveal that nurses are using restraints and limiting mobility as strategies to manage their key priority of keeping older patients safe, reflecting a narrow conceptualisation of safety. Policy, administrative support and individual nurse characteristics influence restraint use. Safety policies that nurses interpret as preventing falls can encourage the use of restraints and limiting mobility, both of which result in functional losses to older people. This complex issue requires attention from clinical nurses, leaders, policy makers and researchers to shift the focus of care to preservation and restoration of function for older people in hospital as a safety priority. Clinical leaders and nursing teams should engage in developing processes of care that incorporate maintaining and restoring older people's function.

Influencing building design in care for older people.

A Florence Nightingale Foundation travel scholarship was used to support a nurse's journey to gather information and knowledge on aspects of building design for older people in emergency care. Evidence on the effect of the environment on senior care is well established and some areas have carefully considered this when planning facilities for older people. The travel opportunity was used to explore how large-scale building design was carried out, and to understand how mindsets, models of care and built environments influence the result of large-scale changes to building design to meet the needs of older people in hospital. Furthermore, this enabled an understanding of how demographic data, clinical evidence, outcomes and quality data were embedded into the processes of informing specific building design. The intention of this scholarship was for the author to be able to influence hearts and minds in her sphere so every opportunity can be taken to embrace a better, more informed approach to the therapeutic built environment, specifically for older people in hospital and community settings.

Pejorative phrases or innocent idioms? Exploring terms used by tomorrow’s doctors in relation to older people

ABSTRACTOlder people are the “core business” for 21st century hospitals. Of concern, therefore, is negative stereotyping of older people by medical students. Through a bespoke teaching session for final-year medical students, we aimed to deconstruct the phraseology they employed in relation to older people and to drive attitudinal change among students. This study also aimed to discern whether there was a detectable difference in attitudes toward older people after the session. Forty-seven medical students participated. Students recorded in a “word-cloud” terms they associated with older people in hospital before and after the session. The University of California Los Angeles Geriatrics Attitude Scale (UCLA-GAS) was administered for pre-session. The intervention students, along with a control group, completed this instrument at the end of their placement. Content analysis of word cloud data was performed—an iterative, transparent, structured approach to analysis, along with external critique of findings and collaborative triangulation ensured rigor of analysis. Qualitative analysis demonstrated the use of pejorative and sometimes nihilistic terms. There were evidence of growing appreciation of the inherent complexity of caring for older people and increasing awareness of how healthcare systems can be challenging for older people. Quantitative analysis revealed that there is no statistical difference neither between the UCLA-GAS pre- and post-teaching nor the intervention and control groups. In conclusion, a bespoke educational intervention, designed to promote student reflection on their views toward older people in hospital, can be a catalyst to challenging superficial and stereotypical views.

Sarcopenia as a predictor of hospitalization among older people: a systematic review and meta-analysis

BackgroundPrevious cohort studies investigating the association between sarcopenia and the risk of hospitalization have been inconsistent. We performed a meta-analysis to determine if sarcopenia is a predictor of hospitalization.MethodsProspective cohort studies that evaluated the association between sarcopenia and hospitalization in older people were identified via a systematic search of four electronic databases (PubMed, EMBASE, Science Citation Index, and the Cochrane Library). A random-effect model was applied to combine the results according to the heterogeneity of the included studies.ResultsFive studies (2832 participants) were included in this meta-analysis. Pooled results demonstrated that older people with sarcopenia were at an increased risk of hospitalization (pooled hazards ratio [HR] = 1.57, 95% confidence interval [CI] = 1.26, 1.94, I2 = 4.5%, P = 0.000) compared to those without sarcopenia. Results of subgroup analyses showed that hospitalized patients with sarcopenia had a higher rate of hospitalization (HR = 2.01, 95% CI = 1.41, 2.88, p = 0.000) versus patients without sarcopenia. A similar result was also found in community-dwelling older people with sarcopenia versus those without sarcopenia (HR = 1.40, 95% CI = 1.05, 1.88, p = 0.023). In addition, the subgroup analysis for length of follow-up showed that studies with a follow-up period of 3 years or more (pooled HR = 1.52, 95% CI = 1.19, 1.94, P = 0.001) reported a significantly higher rate of hospitalization among individuals with sarcopenia compared to those without sarcopenia. However, this association was not found in the studies with a follow-up period of less than 3 years (pooled HR = 1.76, 95% CI = 0.90, 3.44, P = 0.099).ConclusionsSarcopenia is a significant predictor of hospitalization among older individuals, and the association may not be significantly affected by the characteristics of the population or the definition of sarcopenia.

Exploring the meaning of home and its implications for the care of older people.

To explore the meaning of home for six baby boomers and consider how this insight can be used when caring for older people in hospital or residential settings. Feeling at home is important to help retain a sense of autonomy, security and well-being, but home is a complex concept to understand. The baby boomers are a large cohort entering later life and understanding their sense of home is not only an example of anticipatory gerontology but it could also provide the tools to explore home with the current older population, who may be in a variety of care settings. A qualitative hermeneutic approach was adopted to explore the meaning of home of six baby boomers. The participants were asked to take photographs showing what home meant to them and interpret these in a recorded photo-elicitation interview. Small teams then reviewed the images to provide further insight. Finally, all the data were reviewed to provide an overall analysis of the revealed meaning of home. Having possessions or stuff was important for the meaning of home; being familiar with the local environment was also "homely," as well as certain textures and familiar sounds and smells; relationships with others and the ability to have choice in where and how the participants live were also significant for their meaning of home. The meaning of home is complex. Nevertheless, in this study, an evocative sense of home was revealed and these insights could be used in discussions with older people in care settings to help increase their sense of autonomy, security and well-being. Furthermore, these insights could also be used to develop a framework to help nursing staff guide these discussions. By considering the multisensory nature of the meaning of home, nurses can create a sense of home for patients. Feeling at home can improve the well-being and a sense of autonomy for patients. Enabling patients to feel more autonomous recognises the importance of a person-centred approach to care.

The Relationship of Frailty and Hospitalization Among Older People: Evidence From aMeta-Analysis.

This research explored the relationship between the stages of frailty and risk for hospitalization in older adults and evaluated the risk for hospitalization among the elderly in relation to various frailty assessment indexes. A systematic literature review and meta-analysis were carried out. A total of 32,998 older people, 8,666 of whom were hospitalized, were included in this study. Two of the researchers independently collected and reviewed the literature. The key search terms used were "frailty" or "frail," "hospitalization," and "older people" or "older" or "geriatric" or "senior." Data were recorded from January 2001 to July 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for quality assessment. A systematic search was carried out using Embase and Scopus to analyze the collected literature. A meta-analysis was conducted on eight studies that discussed the relationship between frailty and hospitalization risk in older adults 65 years of age or older. The results showed that frail older people exhibited the highest risk for hospitalization, following by prefrail and robust older people. Next, different frailty assessment indicators were used to predict the risk for hospitalization among older people. All of these indexes also showed that older persons with frailty had the highest risk for hospitalization, followed by prefrail older people. Frailty is a vital issue in geriatric care and is a crucial factor in the hospitalization of older people. Frail older people were at the highest risk for hospitalization, following by prefrail and robust older people. Assessing frailty as early as possible can reduce the hospitalization risk among older people. Professional nursing staff should use frailty indicators in a timely fashion to assess the status of frailty in older people and should effectively develop frailty prevention strategies to decrease the risk for hospitalization and to enhance quality of life for older adults.

Meeting the nutritional needs of older patients in the hospital setting.

Malnutrition in hospitalised older patients may present in the form of micro-nutrient deficiency such as mineral and/or vitamin deficiencies or macronutrient deficiency represented by protein-energy malnutrition. The prevalence of protein – energy malnutrition among elderly hospitalised patients may vary depending on the population, the setting and the screening tool being used. However, poor nutrition among this population in hospital setting appears to be a global problem and it is often associated with increased mortality, morbidity and longer lengths of hospital stay. In conclusion, the prevalence of malnutrition is high in hospitalised older patients and a number of factors including patient related problems and the hospital environment are responsible for this development. Therefore, strategies for meeting the nutritional needs of older people in hospital should include the use of validated nutritional screening tools to identify those at risk of malnutrition and developing management interventions including the provision of oral nutritional supplements to ameliorate the undernutrition and promote health.

Too few tests for influenza among older people in hospital

It is important to recognise the difference between influenza and other flu-like illnesses. Clinicians should diagnose and treat influenza promptly, especially in vulnerable populations, such as older people, who are more likely to experience complications, such as pneumonia.

Older people in hospital

Older people in hospital

What is Comprehensive Geriatric Assessment (CGA)? An umbrella review.

Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.

Oral care for older people: don’t forget your toothbrush

In this issue of Nursing Older People, we take a much-needed look at the elusive issue of oral hygiene and mouth care for older people in hospital. Even if you are not of the generation of nurses who were inducted into the use of glycerine and lemon swabs, and pink sponges for mouth care, read on: we still have much to learn about how to get this fundamental aspect of care right.

Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital.

This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.

Effectiveness of an Ambient Intelligent Geriatric Management system (AmbIGeM) to prevent falls in older people in hospitals: protocol for the AmbIGeM stepped wedge pragmatic trial

BackgroundAlthough current best practice recommendations contribute to falls prevention in hospital, falls and injury rates remain high. There is a need to explore new interventions to reduce falls rates, especially...

How does the length of day shift affect patient care on older people's wards? A mixed method study

BackgroundInternationally, studies have focused on whether shift length impacts on patient care. There are also ongoing concerns about patient care for older people in hospital. The study aim was to investigate how length of day shift affects patient care in older people’s hospital wards. Objectives1) To explore how length of day shift affects patient care in older people’s wards; 2) To explore how length of day shift affects the quality of communication between nursing staff and patients/families on older people’s wards DesignA mixed method case study. SettingsThe study was based on two older people’s wards in an acute hospital in England. One ward was piloting two, overlapping 8h day shifts for 6 months while the other ward continued with 12h day shifts. Participants and methodsQualitative interviews were conducted with 22 purposively recruited nursing staff (17 registered nurses; 5 nursing assistants). An analysis of patient discharge survey data was conducted (n=279). Twenty hours of observation of nursing staff’s interactions with patients and families was conducted, using an adapted version of the Quality of Interaction Schedule (301 interactions observed), with open fieldnotes recorded, to contextualise the observations. ResultsThere were no statistically significant differences in patient survey results, or quality of interactions, between the two wards. There were three overall themes: Effects of day shift length on patient care; Effects of day shift length on continuity of care and relationships; Effects of day shift length on communication with patients and families. Nursing staff believed that tiredness could affect care and communication but had varied views about which shift pattern was most tiring. They considered continuity of care was important, especially for older people, but had mixed views about which shift pattern best promoted care continuity. The difficulties in staffing a ward with an 8h day shift pattern, in a hospital that had a 12h day shift pattern were highlighted. Other factors that could affect patient care were noted including: ward leadership, ward acuity, use of temporary staff and their characteristics, number of consecutive shifts, skillmix and staff experience. ConclusionsThere was no conclusive evidence that length of day shift affected patient care or nursing staff communication with patients and families. Nursing staff held varied views about the effects of day shift length on patient care. There were many other factors identified that could affect patient care in older people’s wards.

Workplace continuing education for nurses caring for hospitalised older people.

To develop, implement and evaluate a workplace continuing education programme about nursing care of hospitalised older people. The healthcare system cannot rely solely upon nurses' prelicensure education to prepare them to meet the evolving needs of hospitalised older patients. Over the past decade, there has been a dramatic rise in the proportion of older people in hospitals, yet many nurses do not have specialised knowledge about the unique care needs of this population. A multimethod pre-to post-design was employed. Between September 2013 and April 2014, data were collected via surveys, focus groups and interviews. Thirty-two Registered Nurses initially enrolled in the programme of which 22 completed all data points. Three managers also participated in interviews. One-way repeated-measures ANOVAs were conducted to evaluate the effect of the programme and change over time. Qualitative data were analysed using thematic analysis. Survey results indicated improvements in perceptions about nursing care of older people but no changes in knowledge. Themes generated from the qualitative data focused on participants' experiences of taking part in the programme and included: (i) relevance of content and delivery mode, (ii) value of participating in the programme and (iii) continuing education in the context of acute care. This study illustrated the potential role of workplace continuing education in improving care for hospitalised older people, particularly the potential to change nurses' perceptions about this population. Nurses prefer learning opportunities that are varied in delivery of educational elder-focused content and accessible at work. Organisational leaders need to consider strategies that minimise potential barriers to workplace continuing education. Workplace continuing education can play a key role in improving quality of care for hospitalized older adults and ought to be a priority for employers planning education for nurses.

Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case\u2013control study in Taiwan

BackgroundNon-benzodiazepine hypnotics (Z-drugs) are advocated to be safer than benzodiazepines (BZDs). This study comprehensively investigated the association of BZD and Z-drug usage with the risk of hospitalisation for fall-related injuries in older people.MethodsThis study used the Taiwan National Health Insurance Database with a nested matched case-control design. We identified 2238 elderly patients who had been hospitalised for fall-related injuries between 2003 and 2012. They were individually matched (1:4) with a comparison group by age, sex, and index year. Conditional logistic regression was used to determine independent effects of drug characteristics (type of exposure, dosage, half-life, and polypharmacy) on older people.ResultsOlder people hospitalisation for fall-related injuries were significantly associated with current use of BZDs (adjusted odds ratio [AOR] = 1.32, 95% confidential interval [CI] = 1.17–1.50) and Z-drugs (AOR = 1.24, 95%CI = 1.05–1.48). At all dose levels of BZDs, high dose levels of Z-drugs, long-acting BZD, and short-acting BZD use were all significantly increased the risk of fall-related injuries requiring hospitalisation. Polypharmacy, the use of two or more kinds of BZDs, one kind of BZD plus Z-drugs and two or more kinds of BZDs plus Z-drugs, also significantly increased the risk (AOR = 1.61, 95% CI = 1.38–1.89; AOR = 1.65, 95% CI = 1.08–2.50, and AOR = 1.58, 95% CI = 1.21–2.07).ConclusionsDifferent dose levels and half-lives of BZDs, a high dose of Z-drugs, and polypharmacy with BZDs and Z-drugs were associated with an increased risk of fall-related injury requiring hospitalisation in older people. Physicians should balance the risks and benefits when prescribing these drug regimens to older people considering the risk of falls.

How can I help older people in hospital get home sooner and prevent deconditioning?

Concerns about the complications of prolonged bed rest were raised as far back as 1947 ( Asher 1947 ). Hospital stays are associated with iatrogenic infections, medication errors, increased risk of delirium and side effects of prolonged bed rest ( Inouye and Charpentier 1996 , Covinsky et al 2011 ).

Assessment of Physical Activity of Hospitalised Older Adults: A Systematic Review.

The assessment of physical activity levels of hospitalised older people requires accurate and reliable measures. Physical activities that older people in hospital commonly engage in include exercises and walking. Measurement of physical activity levels of older inpatients is essential to evaluate the impact of interventions to improve physical activity levels and to determine associations between physical activity in hospital and other health-related outcome measures. To determine which measures are used to measure physical activity of older people in hospital, and to describe their properties and applications. A systematic review of four databases: Medline, Embase, CINAHL and AMED was conducted for papers published from 1996 to 2016. Inclusion criteria were participants aged ≥ 65 years and studies which included measures of physical activity in the acute medical inpatient setting. Studies which specifically assessed the activity levels of surgical patients or patients with neurological conditions such as stroke or brain injury were excluded. All study designs were included in the review. 18 studies were included from 127 articles selected for full review. 15 studies used objective measures to measure the physical activity of older inpatients: 11 studies used accelerometers and four used direct systematic observations. Seven accelerometers were identified including the StepWatch Activity Monitor, activPAL, GENEActiv, Kenz Lifecorder EX, Actiwatch-L, Tractivity and AugmenTech Inc. Pittsburgh accelerometer. Three studies used a subjective measure (interviews with nurses and patients) to classify patients into low, intermediate and high mobility groups. The StepWatch Activity Monitor was reported to be most accurate at step-counting in patients with slow gait speed or altered gait. The activPAL was reported to be highly accurate at classifying postures. Physical activity levels of older inpatients can be measured using accelerometers. The accuracy of the accelerometers varies between devices and population-specific validation studies are needed to determine their suitability in measuring physical activity levels of hospitalised older people. Subjective measures are less accurate but can be a practical way of measuring physical activity in a larger group of patients.

Use of standard risk screening and assessment forms to prevent harm to older people in Australian hospitals: a mixed methods study

BackgroundStandard risk screening and assessment forms are frequently used in strategies to prevent harm to older people in hospitals. Little is known about good practices for their use.ObjectiveScope the preventable...