New horizons in care home medicine

Abstract

Care home medicine has been an under-researched area, but over the last decade there has been a substantial growth in publications. Most of these have focused on the 'geriatric giants' of falls, incontinence and mental health issues (especially dementia, behavioural disturbance and depression) as well as other key topics such as medication use and issues related to death and dying. Other areas of recent interest are around access to health services for care home residents, how such services may most effectively be developed and how the quality of life for residents can be enhanced. While many of the reported studies are small and not always well designed, evidence in several areas is emerging which begins to guide service developments. A common theme is that multi-disciplinary interventions are the most effective models of delivery. The role of care home staff as members of these teams is key to their effectiveness. Recent consensus guidelines around falls prevention in care homes synthesise the evidence and recommend multi-disciplinary interventions, and clarify the role of vitamin D and of exercise in certain populations in the care home. The benefits of pharmacist led medication reviews are beginning to emerge; although studies reviewed to date have not yet led to the 'holy grail' of hospital admission avoidance they point to benefits in reduction of drug burden. Effectiveness may be enhanced when working with GPs and care home nurses. Welcome evidence is emerging that in the UK the rate of prescription of anti-psychotics has fallen. This is clear evidence that changes in practice around care homes can be effected. The poor access to non-pharmacological therapies for care home residents with behavioural disturbance remains a significant gap in service. End-of-life care planning and delivery is an important part of care in care homes, and there is evidence that integrated pathways can improve care; however, the use of palliative care medications was limited unless specialist care staff were involved. Integrated models of care that focus on resident-centred goals and which value the role of care home staff as members of the team working to deliver these goals are most likely to result in improvements in the quality of care experienced by care home residents.

Appropriateness of unscheduled hospital admissions from care homes

“…1 In general, care-home residents are characterised by frailty, cognitive and functional impairments and complex comorbidity. 2,3 There has been a growing recognition of the need to develop an evidence base around the provision of care in this setting, 4 with evidence of wide variation in healthcare service provision. 5,6 …”

Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study)

“…This would reduce the burden on participants, and focus interest on outcomes that are most meaningful for residents of care homes, i.e. falls-free mobility and quality of life [55]. …”

Exploring the past, present and future of care home medicine management systems: pharmacists' perceptions of multicompartment compliance aids

“…The recommendation to educate CH staff to administer directly from original packaging is supported by literature showing that education is necessary to achieve change in CHs and that a transition from using MCAs to original packaging is feasible . Recommendations for greater pharmacist input and medicine review alongside MCA use is supported by literature showing that multidisciplinary CH interventions are effective models of delivery and pharmacist input can be beneficial in the CH setting . Checklists that form part of national guidelines outlining CH characteristics which would or would not facilitate MCA use could be developed, as has occurred in other healthcare settings where checklists have been used to good effect …”