overall, staff and families support the concept of ACP. Methods to overcome the identified barriers are required to embed ACP within end of life care in care homes.
AimsPolypharmacy is increasingly common in older adults, placing them at risk of medication‐related harm (MRH). Patients are particularly vulnerable to problems with their medications in the period following hospital discharge due to medication changes and poor information transfer between hospital and primary care. The aim of the present study was to investigate the incidence, severity, preventability and cost of MRH in older adults in England postdischarge.MethodsAn observational, multicentre, prospective cohort study recruited 1280 older adults (median age 82 years) from five teaching hospitals in Southern England, UK. Participants were followed up for 8 weeks by senior pharmacists, using three data sources (hospital readmission review, participant telephone interview and primary care records), to identify MRH and associated health service utilization.ResultsOverall, 413 participants (37%) experienced MRH (556 MRH events per 1000 discharges), of which 336 (81%) cases were serious and 214 (52%) potentially preventable. Four participants experienced fatal MRH. The most common MRH events were gastrointestinal (n = 158, 25%) or neurological (n = 111, 18%). The medicine classes associated with the highest risk of MRH were opiates, antibiotics and benzodiazepines. A total of 328 (79%) participants with MRH sought healthcare over the 8‐week follow‐up. The incidence of MRH‐associated hospital readmission was 78 per 1000 discharges. Postdischarge MRH in older adults is estimated to cost the National Health Service £396 million annually, of which £243 million is potentially preventable.ConclusionsMRH is common in older adults following hospital discharge, and results in substantial use of healthcare resources.
Background
There is limited understanding of the contribution made by older people and their caregivers to acute healthcare in the home and how this compares to hospital inpatient healthcare.
Objectives
To explore the work of older people and caregivers at the time of an acute health event, the interface with professionals in a hospital and hospital at home (HAH) and how their experiences relate to the principles underpinning comprehensive geriatric assessment (CGA).
Design
A qualitative interview study within a UK multi-site participant randomised trial of geriatrician-led admission avoidance HAH, compared with hospital inpatient care.
Methods
We conducted semi-structured interviews with 34 older people (15 had received HAH and 19 hospital care) alone or alongside caregivers (29 caregivers; 12 HAH, 17 hospital care), in three sites that recruited participants to a randomised trial, during 2017–2018. We used normalisation process theory to guide our analysis and interpretation of the data.
Results
Patients and caregivers described efforts to understand changes in health, interpret assessments and mitigate a lack of involvement in decisions. Practical work included managing risks, mobilising resources to meet health-related needs, and integrating the acute episode into longer-term strategies. Personal, relational and environmental factors facilitated or challenged adaptive capacity and ability to manage.
Conclusions
Patients and caregivers contributed to acute healthcare in both locations, often in parallel to healthcare providers. Our findings highlight an opportunity for CGA-guided services at the interface of acute and chronic condition management to facilitate personal, social and service strategies extending beyond an acute episode of healthcare.
This paper describes the evaluation of a two-day simulation training programme for staff designed to improve inpatient care and compassion in an older persons' unit.
ObjectiveThe programme was designed to improve inpatient care for older people by using mixedmodality simulation exercises to enhance empathetic and compassionate care.
MethodsHealthcare professionals took part in a) a one-day human patient simulation course with six scenarios and b) a one-day ward-based simulation course involving five one-hour exercises with integrated debriefing. A mixed-methods evaluation included observations of the programme, confidence rating scales and follow-up interviews with staff at 7-9 weeks post-training.
ResultsObservations showed enjoyment of course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human-patient simulation (t= 9; df = 56; p<.001) and ward based exercises (t= 9.3; df= 76; p<.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients.Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons.Published in BMJ Quality and Safety, 22, 6, 495-505 Ross, Anderson, Kodate et al. (2013) 3
ConclusionThe study demonstrated that simulation is an effective method for encouraging dignified careand compassion for older persons by teaching non-technical skills which focus on team skills and empathetic and sensitive communication with patients and relatives.
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