scholarly journals Special needs of frail people undergoing emergency laparotomy surgery

2020 ◽  
Vol 49 (4) ◽  
pp. 540-543
Author(s):  
Kathryn McCarthy ◽  
Jonathan Hewitt
Keyword(s):  
Older People ◽  
Population Group ◽  
Evidence Base ◽  
Emergency Laparotomy ◽  
Frail Older People ◽  
Operative Morbidity ◽  
Surgical Teams ◽  
One Year ◽  
The Uk ◽  
National Emergency

Abstract There are now over 30 000 emergency laparotomies under taken in the UK every year, a figure that is increasing year on year. Over half of these people are aged over 70 years old. Frailty is commonly seen in this population and becomes increasingly common with age and is seen in over 50% of elderly emergency laparotomies in people aged over 85 years old. In older people who undergo surgery one third will have died within one year of surgery, a figure which is worse in frail individuals. For those that do survive, post-operative morbidity is worse and 30% of frail older people do not return to their own home. In the UK, the National Emergency Laparotomy Audit (NELA) is leading the way in providing the evidence base in this population group. Beyond collecting data on every Emergency Laparotomy undertaken in the UK, it is also key in driving improvement in care. Their most recent report highlights that only 23% of patients over 70 years received geriatric involvement following surgery. More encouragingly, the degree of multidisciplinary geriatric involvement seems to be increasing. In the research setting, well designed studies focusing on the older frail emergency laparotomy patient are underway. It is anticipated that these studies will better define outcomes following surgery, improving the communication and decision making between patients, relatives, carers and their surgical teams.

scholarly journals Older people, information, and social networks in rural Cumbria: doctoral research in progress.

2013 ◽  
Vol 30 (94) ◽  
pp. 61-65
Author(s):  
Linda Banwell ◽  
Susan Elizabeth Capel
Keyword(s):  
Older People ◽  
Rural Community ◽  
Population Group ◽  
Information Provision ◽  
Social Network Theory ◽  
Doctoral Research ◽  
Second Stage ◽  
Ethnographic Approach ◽  
The Uk ◽  
Insight Into

Despite there being larger numbers of older people in rural populations in the UK, there has been very little research undertaken with this group. The research uses a social ethnographic approach grounded in information and social network theory. The paper describes the progress so far, places the research within a theoretical context, describes the way stage one fieldwork was undertaken and identifies the themes that emerged to inform stage two design. The second stage fieldwork is described using some of the initial findings from the observation, interview and participant diary data collected. The paper concludes that the research will provide a unique insight into the social networking of information amongst active older people in a very rural community in the rural North Pennines and inform the planning of service provider information provision for this population group.

scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study (Preprint)

2019 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

BACKGROUND International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPOR RR1-10.2196/13607

scholarly journals Defining the older patient population that require, but do not undergo emergency laparotomy: an observational cohort study protocol

2021 ◽  
Author(s):  
Nicola Reeves ◽  
Susan Chandler ◽  
Elizabeth McLennan ◽  
Angeline Price ◽  
Jemma Boyle ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Cohort Study ◽  
Emergency Laparotomy ◽  
Ageing Population ◽  
Older Patient ◽  
Vulnerable Patient ◽  
The Uk ◽  
National Emergency ◽  
Vulnerable Patient Group

<p><strong>Background: </strong>Despite older adults (65 years and above) accounting for almost half of emergency laparotomies and an ageing population, there remains a paucity of research in the older adult emergency surgery population. One key clinical area that requires urgent assessment is the older patient who presents with acute abdominal pathology treatable by laparotomy, but who does not undergo surgery (NoLAP). <strong></strong></p><p><strong>Methods: </strong>This multicentre prospective cohort study [defining the denominator: emergency laparotomy and frailty study 2 (ELF2)] will recruit consecutive older adults that require but do not undergo emergency laparotomy (NoLAP). We will recruit from 47 national health service hospitals over a 3-month timeframe. The same criteria as NELA for inclusion and exclusion will be applied. The primary aim is 90-day mortality. Secondary aims include characterisation of the NoLAP group, frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (ELAP). Decision-making will also be explored. Assuming a NoLAP rate of 32% and 10% dropout, a minimum of 700 patients are required for 95% power (alpha=0.05).</p><p><strong>Conclusions: </strong>The UK national emergency laparotomy audit has provided vital information on those patients undergoing emergency laparotomy and driven standards in operative and perioperative care. However, little is known of outcomes in those patients who do not undergo emergency laparotomy.  Improved understanding of this NoLAP population would aid shared decision-making and improve standards for this otherwise poorly understood vulnerable patient group.</p><p><strong>Trial registration:</strong> This study is registered online at www.clinicaltrial.gov (Reg number: ISRCTN14556210).</p><p><strong> </strong></p>

scholarly journals EP.FRI.974 NELA 30 day mortality: A single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
M A Gok ◽  
O Shams ◽  
F Ftaieh ◽  
U A Khan
Keyword(s):  
High Risk ◽  
Survival Curve ◽  
Emergency Laparotomy ◽  
Single Centre ◽  
High Risk Patients ◽  
Single Centre Experience ◽  
Risk Patients ◽  
The Uk ◽  
National Emergency

Abstract Aims National emergency laparotomy audit (NELA) developed in 2014 in the UK, aims to improve of quality of care of patients undergoing emergency laparotomy. NELA highlights the importance of identifying high risk patients for potential significant morbidity and mortality. The aim of this study is to review the NELA 30 day mortality at a single centre. Methods This is a retrospective review of all 30 day NELA mortality patients since 2014 carried out at East Cheshire NHS Trust until January 2020. The NELA survivors beyond 30 days were used as controls. Results Conclusion The overall NELA 30 day mortality rate was 9.8 %. NELA deaths occurred in the older, frail, multi-comorbid & high ASA status patients. Most NELA deaths occur within 90 days, whereas patient survival curve appears to plateau out beyond 90 days. P possum can be used to identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetists and intensivists may identify and allocate appropriate surgical intervention. 

scholarly journals 670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Barghash ◽  
J Rehman ◽  
F Salimi ◽  
M Mansour
Keyword(s):  
Best Practice ◽  
District General Hospital ◽  
Management Plan ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Retrospective Audit ◽  
Risk Of Mortality ◽  
The Uk ◽  
National Emergency ◽  
Management Alternatives

Abstract Aim Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting. Method This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK. Results We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category. Conclusions A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.

scholarly journals EP.FRI.763 Impact of COVID-19 on the rates of emergency laparotomies at an acute general hospital in the United Kingdom

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Curtis Wright ◽  
Simon Kirkham ◽  
Alex Millward ◽  
Robert MacAdam
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
High Risk ◽  
Observational Study ◽  
Best Practice ◽  
Emergency Laparotomy ◽  
Single Centre ◽  
The United Kingdom ◽  
The Uk ◽  
National Emergency

Abstract Aims The aim of this study was to analyse if the COVID-19 pandemic had any effect on the number of emergency laparotomies performed each month at a single NHS Foundation Trust. Methods This single-centre retrospective observational study included all patients that underwent an emergency laparotomy that was registered as part of the National Emergency Laparotomy Audit (NELA) at Whiston Hospital in Merseyside, UK, between January 2019 and October 2020. The rates recorded throughout March and April 2020 (COVID) were then compared to the preceding 12 months until the first COVID death was recorded in the UK on March 5th, and the 6 months following the initial national lockdown. Results The number of emergency laparotomies performed each month declined from an average of 14.7 (95% CI 13.2 – 16.1) in the preceding 12 months to 5 during COVID (95% CI 5 – 5); a decrease of 65.9%. Following the easing of lockdown rules in early May, this decline was partly reversed with an average of 9.7 (95% CI 8.9 – 10.5) performed each month until October 2020, reflecting a 34.1% reduction from the pre-COVID baseline. The percentage of patients that achieved the NELA best practice tariffs also fell during COVID to 71% from an average of 79.3% (95% CI 76.0 – 82.7) due to fewer high risk laparotomies being admitted to Critical Care post-operatively. Conclusions During the COVID-19 pandemic, emergency laparotomy rates fell and have only partially recovered to pre-pandemic rates. Post-operative admission to critical care for high risk laparotomies also declined during this period. 

scholarly journals Does declared surgeon specialist interest influence the outcome of emergency laparotomy?

2020 ◽  
Vol 102 (6) ◽  
pp. 437-441
Author(s):  
S Hallam ◽  
M Bickley ◽  
L Phelan ◽  
M Dilworth ◽  
DM Bowley
Keyword(s):  
Length Of Stay ◽  
General Surgery ◽  
Special Interest ◽  
Operative Procedure ◽  
Emergency Laparotomy ◽  
Emergency General Surgery ◽  
Call Structure ◽  
Increased Risk ◽  
The Uk ◽  
National Emergency

Introduction In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. Methods Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. Results Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10–5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. Conclusion Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.

scholarly journals 209 Deprescribing in Frail Older People Approaching End-of-Life: Development and Validation of STOPPFrail Version 2

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Denis Curtin ◽  
Paul Gallagher ◽  
Denis O'Mahony
Keyword(s):  
Life Expectancy ◽  
Literature Review ◽  
Older People ◽  
End Of Life ◽  
Geriatric Medicine ◽  
Evidence Base ◽  
Frail Older People ◽  
Delphi Consensus ◽  
Development And Validation ◽  
New Criteria

Abstract Background Older people with advanced frailty are commonly prescribed lengthy, burdensome medication regimens. When life expectancy is likely to be limited, many of the prescribed drugs may be inappropriate. STOPPFrail Criteria were developed in 2016 to assist clinicians with deprescribing decisions in frail older people with limited life expectancy. Due to an expanding evidence base, updating of the criteria was required. Methods A focused literature review was performed to reassess the original criteria and propose new criteria. Eight panelists, with expertise in geriatric medicine, general practice, palliative medicine, psychiatry and clinical pharmacology, reviewed and critiqued a new draft of STOPPFrail criteria. The revised list of criteria was then validated using Delphi consensus methodology. Results The expert panel agreed a final list of 27 criteria after two Delphi validation rounds. STOPPFrail version 2 proposes a method for identifying older people approaching end-of-life and emphasizes shared decision making in the deprescribing process. New criteria relating to the discontinuation of anti-hypertensive medications, anti-thrombotic therapies and vitamin D are included. Conclusion STOPPFrail version 2 has been expanded and updated for the purpose of assisting clinicians with deprescribing decisions in frail older adults approaching end-of-life. The criteria are based on an up-to-date literature review and consensus validation among a panel of experts.

Third sector partnerships for older people: insights from live at home schemes in the UK

2018 ◽  
Vol 22 (3) ◽  
pp. 148-153 ◽  
Author(s):  
Olumide Adisa
Keyword(s):  
Older People ◽  
Online Survey ◽  
Third Sector ◽  
Later Life ◽  
Evidence Base ◽  
Content Type ◽  
Health And Social Care ◽  
Wide Range ◽  
The Uk ◽  
At Home

Purpose While there is a rich literature on the role of partnerships between statutory agencies and third sector organisations for public service delivery in health and social care, the evidence base on, partnerships between community-based groups and charities for older people in the UK is lacking. Drawing on quantitative and qualitative data, the purpose of this paper is to examines partnerships within 46 live at home (LAH) schemes. These schemes were specifically designed to tackle isolation and promote independence and wellbeing by providing a wide range of activities, based on the needs of its members. Design/methodology/approach This study is based on an online survey of 46 LAH schemes and face-to-face interviews with seven scheme managers to capture data on the various partnership initiatives within the LAH schemes. Findings Third sector partnerships for older people varied by type – formal, semi-formal and informal. In addition, third sector partnership working fosters the achievement of clear outcomes for older people who LAH and could be a mechanism for building social capital in communities. The study also identified barriers to developing third sector partnerships within this context. Mapping existing partnerships in LAH schemes were considered to be useful in engaging with partners. LAH scheme managers were better able to identify partnerships that could be deepened and broadened, depending on the desired outcomes. Originality/value To the author’s knowledge, there are few studies on third sector partnership working in LAH schemes for older people. According to Age UK, there are 1.2m chronically lonely older people in the UK. Over half of all people aged 75 and over live alone (ONS, 2015). Loneliness and social isolation in later life are considered to be two of the largest health concerns we face. Scaling up these third sector partnerships may offer a credible way to shore up support for older people who live alone or want to live at home.

Paying for Long-Term Domiciliary Care: A Comparative Perspective

1997 ◽  
Vol 17 (2) ◽  
pp. 123-140 ◽  
Author(s):  
CAROLINE GLENDINNING ◽  
MICHAELA SCHUNK ◽  
EITHNE McLAUGHLIN
Keyword(s):  
Older People ◽  
Policy Development ◽  
Family Care ◽  
Frail Older People ◽  
Eligibility Criteria ◽  
Term Care ◽  
Service Support ◽  
Care Givers ◽  
The Uk

Concerns over growing numbers and proportions of older people in industrialised societies have prompted interest in the development of cheaper ways of providing long-term care for older people. While debate in the UK is currently focused on the costs of residential and nursing care, other European and Nordic countries have introduced schemes designed to encourage or sustain the provision of ‘social’ care by family members, friends and ‘volunteers’, on the assumption that this can be provided at lower net public expense than either residential care or formally-organised domiciliary services.Drawing on material from a detailed comparative study, this paper describes four different models on which such payments are currently based. These models are discussed and evaluated, taking into account factors which include the eligibility criteria for payments; maximising the autonomy of older people and family care-givers; and the relationships between financial payments and access to services.These models locate systems of payment within the broader context of financial and service support designed to help frail older people and those who support them. They therefore highlight the importance of considering both financial support and services in comparative studies of social welfare provision. However, further evaluation and policy development is hindered by the lack of evaluation of different models of paying for care and a lack of evidence about the experiences of older people and care-givers.

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