The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: results of a before–after study with focus on surgical patients

Bakker, Franka C.; Persoon, Anke; Bredie, S.J.H.; Haren-Willems, Jolanda van; Leferink, Vincent J. M.; Noyez, Luc; Schoon, Yvonne; Rikkert, Marcel G M Olde

doi:10.1016/j.amjsurg.2014.04.009

Cited by 53 publications

(101 citation statements)

References 41 publications

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“…Implementation of a modified Hospital Elder Life Program (HELP) intervention [51] that included ambulation or active range-of-motion exercise 3 times daily resulted in significantly less functional decline at discharge ( p < 0.001) in older adults who had had abdominal surgery compared to usual care. Another inpatient intervention based on HELP called “CareWell in Hospital” (CWH) [52] showed a small improvement in ADLs in their geriatric surgical patients between discharge and 3 months post-discharge compared to pre-implementation (7.7 vs. 4.5, p = 0.035) but effects were influenced by a learning curve of the hospital staff slowing successful implementation.…”

Section: Interventions To Improve Postoperative Functional Outcomes Imentioning

confidence: 99%

Postoperative Functional Outcomes in Older Adults

Brinson¹,

Tang²,

Finlayson

2016

Curr Surg Rep

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As the world’s aging population grows, the surgical population is increasingly made up of older adults. Due to changes in physiologic function and increasing comorbidity burden, older adults are at increased risk of morbidity, mortality, and functional decline after surgery. In addition, decision to undergo surgery for the older adult may be based on the postoperative functional outcome rather than survival. Although few studies have evaluated an older adult’s function as a postoperative outcome, surgeons are becoming increasingly aware of the importance of maintaining or regaining function in an older patient. Interventions to improve postoperative functional outcomes are being developed and show promising results. This review discusses existing literature on postoperative functional outcomes in older adults and recently developed interventions.

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Section: Interventions To Improve Postoperative Functional Outcomes Imentioning

confidence: 99%

Postoperative Functional Outcomes in Older Adults

Brinson¹,

Tang²,

Finlayson

2016

Curr Surg Rep

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“…For example, models of care such as ‘POPS’ (Proactive care of Older People undergoing Surgery), geriatrician‐led multidisciplinary co‐management of older frail surgical patients, nurse‐led Hospital Elder Life Program and anaesthetist‐led Perioperative Surgical Home have all demonstrated improved outcomes reduction of delirium, functional decline, inpatient mortality and length of stay . Multidisciplinary, multicomponent interventions applied in the post‐operative period may also hold promise in improving post‐discharge function and caregiver burden in frail older people undergoing vascular, trauma and cardiothoracic surgical interventions …”

Section: Can Frailty Measurement Be Used To Identify a High‐risk Groumentioning

confidence: 99%

“…68 Multidisciplinary, multicomponent interventions applied in the post-operative period may also hold promise in improving postdischarge function and caregiver burden in frail older people undergoing vascular, trauma and cardiothoracic surgical interventions. 50 It is also important to consider that the goals of a frail older person towards the latter part of life may be at odds with what is presently considered best surgical practice, and many such people may receive treatments inconsistent with their values and goals. Given the increased risks of intervention in the presence of frailty, shared decision-making must be adopted to align the person's goals with the choice of surgical interventions.…”

Section: Evidence For Preoperative Optimizationmentioning

confidence: 99%

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

Subramaniam

Tiruvoipati

Lodge

et al. 2020

ANZ Journal of Surgery

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Background The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post‐operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. Methods Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. Results We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. Conclusion Establishing multidisciplinary collaborative services to provide person‐centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large‐scale studies should focus on implementing and evaluating such multicomponent models of care.

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“…As such, the study is an important step in optimizing geriatric care in medical and surgical hospital departments. A comprehensive geriatric program was developed for the medical and surgical departments of a Dutch university hospital (University Medical Center A), the CareWell in‐Hospital program (CWH; http://www.clinicaltrials.gov: NCT01273116), and evaluated . One crucial element of the CWH program is to raise nurses’ awareness of the heterogeneity of older adults with respect to their health goals and to maximize nurses’ knowledge of geriatric problems and adverse events.…”

mentioning

confidence: 99%

“…A comprehensive geriatric program was developed for the medical and surgical departments of a Dutch university hospital (University Medical Center A), the CareWell in-Hospital program (CWH; www.clinicaltrials.gov: NCT01273116), and evaluated. 8 One crucial element of the CWH program is to raise nurses' awareness of the heterogeneity of older adults with respect to their health goals and to maximize nurses' knowledge of geriatric problems and adverse events. For nurses from medical and surgical departments, the CWH includes geriatric education, consultation facilities of a geriatric team, use of screening instruments, administrative support, and modifications in nursing care practices.…”

mentioning

confidence: 99%