Health service use in the older person with complex health needs

Bartlett, Mark; Wang, Joanna; Hay, Liz; Pang, Glen

doi:10.1071/ah16286

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…The need for complex health care and residents with multiple comorbidities could provide further indication of the potential likelihood for re‐hospitalisation. Older adults with comorbid health conditions have previously been identified as having a high number of hospitalisations, 5 with each additional comorbidity indicated to have a 5% increase on the number of hospital admissions 24 . The current study also found that residents with either moderate or high levels of dependency were less likely to be readmitted after the index fall injury hospitalisation.…”

Section: Discussionsupporting

confidence: 52%

Frailty and risk of re‐hospitalisation and mortality for aged care residents following a fall injury hospitalisation

et al. 2020

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Objectives To examine the role of frailty in risk of re‐hospitalisation and mortality for aged care residents following a fall injury hospitalisation. Methods Retrospective analysis of linked hospitalisation and aged care data of adults aged ≥65 years residing in aged care. A semi‐competing risk analysis examined risk of hospital readmission. Results Residents who had intermediate or high frailty, who were aged 70‐79 or 80‐89 years, who had 1‐2 or ≥3 comorbidities, sustained a hip fracture, and who had either low, moderate or high complex health‐care requirements had a higher risk of being readmitted to hospital. Frailty was not associated with mortality for those with no hospital readmission or mortality after readmission. Conclusion Frailty is an important prognostic factor associated with readmission for residents of aged care hospitalised for a fall injury. Frailty screening could assist to identify people at a high risk of re‐hospitalisation following a fall injury.

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Section: Discussionsupporting

confidence: 52%

Frailty and risk of re‐hospitalisation and mortality for aged care residents following a fall injury hospitalisation

et al. 2020

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“…For example, the National Framework for Advance Care Directives emphasizes respect for autonomy and states that valid advance directives should be followed. 39 Even where an ARD provides legally and ethically acceptable evidence of the person's agreement to participate, actual participation may depend on a willing study partner, 40 and study design should reduce the burdens and challenges they experience. 41 Our study gives tentative support to an ARD seeking a person's views on how potential dissent should be handled in the future.…”

Section: E R H E R Hmentioning

confidence: 99%

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Ries

Mansfield

2021

Ethics & Human Research

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Advance research directives (ARDs) enable people to document preferences for future research participation in the event of incapacity. This article reports on interviews with 11 dementia researchers in Australia that focused on the content of a prototype ARD and processes for making and using ARDs. Participants agreed that an ARD template should provide information to explain research and the rationale for making a directive, allow the person to nominate trusted individuals to be involved in future decisions, and record the person's general willingness or unwillingness to be involved in research. Providing a list of various research activities elicits preferences and risk tolerances in more detail. Priority groups for ARD implementation include people with a diagnosis involving progressive cognitive impairment and people interested in research. Researchers and health and legal professionals have a role in promoting ARDs. Our findings suggest that, as a voluntary strategy, ARDs could promote appropriate inclusion in research.

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“…The average number of actors in all networks was 14.5. The average number of ties between the actors was 53.7 (50) In-home care provider 10 (42) other 2 (5) no-one 17 (39) 'I don't know' 3 (7) Informal caregiver**: * Patients could have more than one care co-ordinator.…”

Section: Network Typologiesmentioning

confidence: 99%

“…Frailty is defined as the accumulation of deficits and diminishing reserves [3]. The complex health needs of this group necessitate a diverse range of healthcare professionals to work together in an integrated, patient-centred way, with the aim to provide good quality end-of-life care [4][5][6][7]. Interprofessional collaboration is crucial for delivering integrated care, preferably involving both healthcare and welfare professionals [8,9].…”

Section: Introduction Contextmentioning

confidence: 99%

Professional Care Networks of Frail Older People: An Explorative Survey Study from the Patient Perspective

et al. 2020

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Key pointsPatient participation is high on the public agenda, but multidisciplinary teams who offer care to frail older people find it hard to incorporate patients views in their way of working. Our study focused on the care network of the older patient, and more specific on the role of the informal caregiver. In many networks, the informal caregiver was not or only moderately connected with professional actors. Elderly care networks can be rather vulnerable because the power (knowledge, contacts) lies entirely with the patient. Our study suggests that it would be relatively easy to develop materials to enable professionals to map the patient care network, which could then be used as the basis of conversations about the organisation of care, Background: Frail older people living in the community require multidisciplinary care. Despite the fact that patient participation is high on the public agenda, studies into multidisciplinary care mainly focus on the viewpoints of professionals. Little is known about frail older patients' experiences with care delivered by multidisciplinary teams and their perception of collaboration between professional and informal caregivers. Objective: To gain more insight into the experiences of frail older patients with integrated multidisciplinary care by mapping the care networks of this patient group and their perception of the interconnection between professional and informal caregivers. Methods: Survey study to facilitate a care network analysis. Due to the vulnerable health status of the respondents, questionnaires were completed during interviews. Analysis was performed using an iterative process, using both visual and metric techniques. Participants: 44 older persons, considered 'frail' by their general practitioner. Setting: Four general practices in The Netherlands. Results: The networks of the participants consisted of an average of 15 actors connected by 54 ties. General practitioners were the most common actors in the networks, and were well connected to medical specialists and in-home care providers. The participants did not always perceive a connection between their general practitioner and their informal caregiver. The network analyses resulted in the identification of three subtypes: simple star (n = 16), complex star (n = 16), and sub-group networks (n = 12). Conclusions: Our findings indicate that the elderly often do not experience the integration of multidisciplinary care as such. This is a real opportunity for MTs to improve their care and to make the patients' experiences better in line with what they are aiming: allowing patients to live at home as healthy and independently as possible for as long as possible. We showed that informal caregivers often form communication bridges between patients and professionals. Having a better knowledge of the patient perspective enables the gaps in professional care networks of frail older people to be filled and facilitates the anticipation of crisis situations.

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Health service use in the older person with complex health needs

Cited by 7 publications

References 4 publications

Frailty and risk of re‐hospitalisation and mortality for aged care residents following a fall injury hospitalisation

Frailty and risk of re‐hospitalisation and mortality for aged care residents following a fall injury hospitalisation

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Professional Care Networks of Frail Older People: An Explorative Survey Study from the Patient Perspective

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