<b><i>Background:</i></b> Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient. <b><i>Objectives:</i></b> To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents’ well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016). <b><i>Methods:</i></b> Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents’ well-being and staff attrition were measured before and after PCC implementation. <b><i>Results:</i></b> There were statistically significant improvements in resident well-being (Δ = 0.44, <i>p</i> = 0.029), Positive Engagement Potential (Δ = 0.17, <i>p</i> = 0.002), and Occupational Diversity (Δ = 0.12, <i>p</i> = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC. <b><i>Conclusions:</i></b> Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.
Objective: There are few studies concerning the differences in quality-of-life (QOL) between palliative care patients with and without dysphagia to date. We aimed to compare the QOL and symptoms in palliative patients with and without dysphagia using Swallowing Quality of Life (SWAL-QOL). Methods: Eighty-one palliative patients with and without dysphagia underwent the SWAL-QOL questionnaire. A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 11 SWAL-QOL domains. Results: Dysphagia significantly impacted patients’ QOL in the dysphagic group (mean, 69.5; SD 21.9) than non-dysphagic group (mean, 83.2; SD 14.8) ( P = 0.006). Significant differences were observed between both groups for the domains of burden, eating desire, eating duration, symptoms, food selection, communication and mental health. The results also showed that the dysphagic group had lower symptom score across all symptoms, suggesting higher symptom burdens. Conclusions: This study is the first to examine QOL and swallow symptoms in palliative care patients with and without dysphagia. Dysphagia causes significantly worse QOL in palliative care patients. Screening for dysphagia and managing its impact on symptoms and QOL domains is important in palliative care.
Introduction. Delirium is a common complication of hip fracture that can be avoided or ameliorated by careful anticipatory case management. We aimed to investigate the incidence and risk factors of delirium in older patients with hip fracture treated in our structured integrated care unit, and to evaluate the impact of delirium on healthcare utilisation.Methods. We retrospectively reviewed records of patients aged ≥60 years and admitted to our unit from December 2014 to September 2018 with low-impact hip fracture. Our unit has implemented a structured integrated care programme based on the NICE guidelines. Primary outcome measure was the incidence of delirium. The diagnosis of delirium was established using the Confusion Assessment Method. Secondary outcome measures included length of hospital stay, readmission within 30 days of discharge, and mortality within 30 days and 1 year.Results. A total of 1304 patients were included and classified as nondelirium (349 men and 815 women; mean age, 79.2 years) and delirium (49 men and 91 women; mean age, 82.3 years). The overall withinepisode incidence of delirium was thus 10.7%. Independent risk factors for delirium in older patients with hip fractures were age (odds ratio [OR]=1.028, p=0.02), surgical treatment (OR=2.202, p=0.006), dementia (OR=2.066, p=0.001), elevated body temperature (OR=1.966, p=0.001), urinary tract infection (OR=2.431, p<0.001), and acute coronary syndrome (OR=4.587, p<0.001). Those with delirium had prolonged hospitalisation of ≥10 days (OR=2.033, p<0.001) and higher mortality within 30 days (OR=3.408, p=0.002) and 1 year (OR=1.894, p=0.004).
Conclusion.The incidence of delirium was low in the present study, compared with most studies. The structured integrated care programme in our unit enables early recognition of delirium for prevention and management of delirium in older patients with hip fracture and might contribute to better outcomes.
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