New Horizons in comprehensive geriatric Assessment

Parker, Stuart G.; McLeod, Anne; McCue, Patricia; Phelps, Kay; Bardsley, Martin; Roberts, Helen; Conroy, Simon

doi:10.1093/ageing/afx104

Cited by 40 publications

(45 citation statements)

References 38 publications

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“…Current evidence suggests that CGA is likely to benefit older people hospitalised with acute conditions owing to these services generally providing a multidimensional, multidisciplinary approach that includes the identification of medical, social and functional needs, as well as the development of an integrated and co-ordinated care plan to address those needs. 45,46 The question of whether or not there is a need for adaptation of CGA for PWD has not been addressed.…”

Section: Discussionmentioning

confidence: 99%

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

Allan

Wheatley

Smith

et al. 2019

Health Technol Assess

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Background Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. Objectives To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. Design This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. Setting This study was set in the community. Participants The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. Interventions This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. Main outcome measures (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). Results A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. Conclusions The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. Trial registration Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

Allan

Wheatley

Smith

et al. 2019

Health Technol Assess

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“…Since population ageing is progressing, any older adult patient in the hospital may benefit from this additional component of assessment. 20 In addition, nurse and hospital staff education is necessary to improve the hospital course of an older patient through critical steps like ensuring adequate nutrition and post-operative mobility. 21 …”

Section: Clinical Carementioning

confidence: 99%

Academic Geriatric Orthopedics: a New Paradigm for Inpatient Care

2018

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Purpose of review: Healthcare systems are embarking on innovative, technologically savvy approaches to caring for our most rapidly growing population worldwide- the elderly. As healthcare systems respond, adapt and strategically plan for this rapidly growing population, it is paramount that we develop new paradigms of care for older patients. This review highlights some of the approaches academic medical centers are taking to improve the musculoskeletal and orthopaedic health of older adults. Recent Findings: Academic health centers are posed to set and lead the standard of care for the next generation of orthopaedic care for older adults by leveraging innovative informatics platforms, quality improvement methodologies, game-changing research initiatives, education to the next generation of providers and helping change policies to help patients receive the best quality of life possible across the aging spectrum. Summary: Academic geriatric orthopaedics can help society embrace a new paradigm in care for older adults by leveraging rapidly developing technologically and innovative approaches to care, advanced research, and education.

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“…Such an approach is embodied in the Comprehensive Geriatric Assessment (CGA). The CGA describes a model of care on the basis of a multidimensional, multidisciplinary assessment that identifies medical, psychosocial, functional, and environmental needs, and informs development of an integrated/coordinated care plan ( Figure 1) (5,6). Most evidence for its effectiveness comes from acute hospital settings.…”

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confidence: 99%

“…Most evidence for its effectiveness comes from acute hospital settings. Inpatientbased assessments have demonstrated reductions in length of stay, mortality, readmission rates and costs (5). Emergency department assessments may reduce acute admissions and increase referrals to palliative and hospice care (5).…”

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confidence: 99%