Medical Screening of Old People Accepted for Residential Care

Brocklehurst, J. C.; Carty, Matthew; Leeming, Jack; Robinson, J.M.

doi:10.1016/s0140-6736(78)91521-0

Cited by 70 publications

(20 citation statements)

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“…The need for appropriate assessment of older people before long-term care admission has been discussed in the literature for many years [17][18][19][20][21][22][23][24][25]. Because in this study we obtained MMSE scores for the cohort members, it is possible to examine practice in this particular area.…”

Section: Discussionmentioning

confidence: 99%

Dependency in older people recently admitted to care homes

Challis

Mozley

Sutcliffe³

et al. 2000

Age and Ageing

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Objective: to investigate dependency and general health status of a cohort of older people admitted to residential or nursing homes for long-term care. Method: we assessed 308 people aged over 65 years within 2 weeks of admission for long-term care to one of 30 nursing or residential homes in north-west England. Dependency was assessed using the Barthel activities of daily living index and the Crichton Royal Behaviour Rating Scale. We collected information from the homes' records on diagnosed conditions and current medication. Results: 50% of the cohort were in a 'low dependency' band (Barthel score 13-20): 31% of those in nursing homes and 71% of those in residential homes. In nursing homes, low-dependency residents were more likely to be selffunding than those with higher dependency. Of a number of broad diagnostic groupings, only a diagnosis of dementia was associated with nursing-rather than residential-home admission. Of 47 residents who scored 9 or less on the Mini-Mental State Examination (indicating severe cognitive impairment), 85% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. Discussion: the high proportion of new admissions of subjects with low dependency needs raises questions about the effective targeting of resources and about management of the boundary between home-based and institutional care. The existence of an important group of self-funded, low-dependency new admissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local authorities. Many new admissions had conditions which might benefit from rehabilitation but there were almost no therapy staff in the studied homes. In some cases where severe cognitive impairment was evident, there was no evidence that the result of any formal pre-admission psychiatric evaluation had been communicated to nursing or care staff.

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Section: Discussionmentioning

confidence: 99%

Dependency in older people recently admitted to care homes

Challis

Mozley

Sutcliffe³

et al. 2000

Age and Ageing

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“…7,18,19 The ongoing care initiatives described in this survey placed a high priority on effective acute care and reducing hospital admissions from care homes, in line with the National Service Framework for Older People (2001). Clearly, for this frail group, giving timely, high quality and multispecialty care in the care home setting could benefit patients and reduce the burden on acute settings.…”

Section: Do These Residents Need Specialist Care From Geriatricians?mentioning

confidence: 91%

“…[4][5][6] This recommendation is supported by evidence of effectiveness. 7 Care home residents have ongoing and increasingly complex needs. 8,9 A recent national census of 751 care homes revealed that 72% of residents were immobile or required assistance to mobilise, 86% had one or more diagnoses explaining the need for personal care, 54% of care need was related to dementia, stroke or Parkinsonism, and 24% had the 'unholy trinity' of confusion, immobility and incontinence.…”

mentioning

confidence: 99%

Geriatricians and care homes: perspectives from geriatric medicine departments and primary care trusts

2009

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-Older people in care homes are clinically complex and particularly vulnerable to the effects of poor care and poor medicine. They are also a group to whom the NHS seems least committed. Geriatricians have become disengaged over the past two decades, as a result of social policies rather than clinical judgements. In 2000, the Royal College of Physicians, with the Royal College of Nursing and the British Geriatrics Society, issued guidance and recommendations for improving clinical practice. This paper reports progress since then based on results of national surveys of geriatric medicine departments and primary care trusts in England. The results show that important deficiencies persist, though most respondents were in favour of greater specialist involvement. Some suggestions are made for ways to improve the shared care of residents in care homes.KEY WORDS: care homes, continuing care, comprehensive geriatric assessment, geriatricians, nursing homes, old age psychiatrists, older people, physician's role, specialist nursesIn 2007, there were over 350,000 people aged over 65 years resident in care homes in England. 1 There are three levels of care home provision. The first is 24-hour personal care assistance without nursing which is funded by local authorities, subject to means testing, here referred to as residential care homes. The second involves 24-hour access to qualified nursing care, where the NHS funds the nursing component. This group are here referred to as care homes with nursing. The third level of care home provision is NHS continuing care, which provides more complex or intensive nursing and/or other healthcare both within care homes and specially designated long-stay institutions. 2,3 People enter care homes for many reasons related to the loss of physiological, psychological, functional and social reserves. Guidance from the Royal College of Physicians (RCP), the Royal College of Nursing (RCN) and the British Geriatric Society (BGS) is that, before admission, an older person should be assessed for the presence of reversible factors, such as medical and rehabilitation needs, by a team including a physician skilled in geriatric medicine with the aim of preventing some of these placements. [4][5][6] This recommendation is supported by evidence of effectiveness. 7 Care home residents have ongoing and increasingly complex needs. 8,9 A recent national census of 751 care homes revealed that 72% of residents were immobile or required assistance to mobilise, 86% had one or more diagnoses explaining the need for personal care, 54% of care need was related to dementia, stroke or Parkinsonism, and 24% had the 'unholy trinity' of confusion, immobility and incontinence. 10 General practitioners (GPs) have principle responsibility for the medical care of care home residents and it has a major impact on their workload. 11 Less than 40% of GPs have had specialist training in the health and social care needs of older people. 12 NHS clinical input, as well as funding, should be appropriate to the level of ne...

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“…This has been documented in clinical (23,24) and autopsy (25) were inaccurate, and over 80% of the secondary diagnoses were inaccurate or lacking (26). This poses special problems in defining the health of the elderly, especially those in nursing homes, where "senility," "old age," and "hardening of the arteries" are common, yet inaccurate diagnoses (see below and Table 3).…”

Section: Aging Vs Diseasementioning

confidence: 99%