scholarly journals 30MEASURING THE PROCESS OF CARE OF FRAIL OLDER PATIENTS IN HOSPITAL: THE FRAIL OLDER PATIENT ADMISSION QUESTIONNAIRE (FOPAQ)

2017 ◽  
Vol 46 (suppl_1) ◽  
pp. i1-i22 ◽  
Author(s):  
R Hyatt ◽  
J K Taylor ◽  
M Robertson ◽  
J Dean ◽  
J Finch ◽  
...  
Keyword(s):  
Older Patients ◽  
Patient Admission ◽  
Process Of Care ◽  
Older Patient

scholarly journals Better Medicines for Older Patients: Considerations between Patient Characteristics and Solid Oral Dosage Form Designs to Improve Swallowing Experience

Pharmaceutics ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 32
Author(s):  
Nélio Drumond ◽  
Sven Stegemann
Keyword(s):  
Patient Population ◽  
Older Patients ◽  
Negative Impact ◽  
Water Soluble ◽  
Oral Dosage ◽  
Oral Drug ◽  
Older Patient ◽  
Coating Materials ◽  
Esophageal Transit ◽  
Patient Centric

Oral drug administration provided as solid oral dosage forms (SODF) remains the major route of drug therapy in primary and secondary care. There is clear evidence for a growing number of clinically relevant swallowing issues (e.g., dysphagia) in the older patient population, especially when considering the multimorbid, frail, and polymedicated patients. Swallowing impairments have a negative impact on SODF administration, which leads to poor adherence and inappropriate alterations (e.g., crushing, splitting). Different strategies have been proposed over the years in order to enhance the swallowing experience with SODF, by using conventional administration techniques or applying swallowing aids and devices. Nevertheless, new formulation designs must be considered by implementing a patient centric approach in order to efficiently improve SODF administration by older patient populations. Together with appropriate SODF size reductions, innovative film coating materials that can be applied to SODF and provide swallowing safety and efficacy with little effort being required by the patients are still needed. With that in mind, a literature review was conducted in order to identify the availability of patient centric coating materials claiming to shorten esophageal transit times and improve the overall SODF swallowing experience for older patients. The majority of coating technologies were identified in patent applications, and they mainly included well-known water soluble polymers that are commonly applied into pharmaceutical coatings. Nevertheless, scientific evidence demonstrating the benefits of given SODF coating materials in the concerned patient populations are still very limited. Consequently, the availability for safe, effective, and clinically proven solutions to address the increasing prevalence of swallowing issues in the older patient population is still limited.

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

Preventing skin tears among older adults in general practice

2021 ◽  
Vol 32 (10) ◽  
pp. 402-406
Author(s):  
Sarah Jane Palmer
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Older Patients ◽  
Care Plan ◽  
Older Patient ◽  
Practice Nurses ◽  
Skin Tears ◽  
The Right ◽  
Chronic Problem

In this article, Sarah Jane Palmer discusses the importance of the prevention of skin tears and the role practice nurses can play Skin tears can present a complex and chronic problem for an older patient with fragile skin, and can be very disabling, reducing quality of life dramatically in some cases. The right care is essential from all members of the wider team caring for older patients, in order to identify risk factors for skin tears, as well as formulating a care plan of prevention that relates to these risk factors. Good skin care is essential, as well as patient education, and identifying ongoing issues with the patient's health that present a factor to consider when caring for them, such as mobility issues. Self-care should be encouraged where possible, and the correct use and choice of emollients that are pH balanced is crucial. By preventing skin tears we not only give the patient a far better quality of life, but we also reduce the need for very limited NHS resources.

scholarly journals Emergency laparotomy in the older patient: factors predictive of 12-month mortality—Salford-POPS-GS. An observational study

2020 ◽  
Vol 32 (11) ◽  
pp. 2367-2373 ◽  
Author(s):  
Arturo Vilches-Moraga ◽  
Mollie Rowley ◽  
Jenny Fox ◽  
Haroon Khan ◽  
Areej Paracha ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Observational Study ◽  
Hospital Mortality ◽  
Older Patients ◽  
Care Home ◽  
Emergency Laparotomy ◽  
Older Patient ◽  
Readmission Rates ◽  
Clinical Frailty Scale ◽  
Female Predominance

Abstract Introduction Although high rates of in-hospital mortality have been described in older patients undergoing emergency laparotomy (EL), less is known about longer-term outcomes in this population. We describe factors present at the time of hospital admission that influence 12-month survival in older patients. Methods Observational study of patients aged 75 years and over, who underwent EL at our hospital between 8th September 2014 and 30th March 2017. Results 113 patients were included. Average age was 81.9 ± 4.7 years, female predominance (60/113), 3 (2.6%) lived in a care home, 103 (91.2%) and 79 (69.1%) were independent of personal and instrumental activities of daily living (ADLs) and 8 (7.1%) had cognitive impairment. Median length of stay was 16 days ± 29.9 (0–269); in-hospital mortality 22.1% (25/113), post-operative 30-day, 90-day and 12-month mortality rates 19.5% (22), 24.8% (28) and 38.9% (44). 30-day and 12-month readmission rates 5.7% (5/88) and 40.9% (36). 12-month readmission was higher in frail patients, using the Clinical Frailty Scale (CFS) score (64% 5–8 vs 31.7% 1–4, p = 0.006). Dependency for personal ADLs (6/10 (60%) dependent vs. 38/103 (36.8%) independent, p = 0.119) and cognitive impairment (5/8 (62.5%) impaired vs. 39/105 (37.1%) no impairment, p = 0.116) showed a trend towards higher 12-month mortality. On multivariate analysis, 12-month mortality was strongly associated with CFS 5–9 (HR 5.0403 (95% CI 1.719–16.982) and ASA classes III–V (HR 2.704 95% CI 1.032–7.081). Conclusion Frailty and high ASA class predict increased mortality at 12 months after emergency laparotomy. We advocate early engagement of multi-professional teams experienced in perioperative care of older patients.

scholarly journals Analysis of Epidemiological and Clinical Features in Older Patients With Coronavirus Disease 2019 (COVID-19) Outside Wuhan

2020 ◽  
Vol 71 (15) ◽  
pp. 740-747 ◽  
Author(s):  
Jiangshan Lian ◽  
Xi Jin ◽  
Shaorui Hao ◽  
Huan Cai ◽  
Shanyan Zhang ◽  
...  
Keyword(s):  
Clinical Features ◽  
Medical Records ◽  
Older Patients ◽  
Chronic Obstructive ◽  
Older Patient ◽  
Obstructive Pulmonary Disease ◽  
Younger Patients ◽  
Clinical Type ◽  
Treatment Data ◽  
Critical Type

Abstract Background The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to public health in China, with high contagious capacity and varied mortality. This study aimed to investigate the epidemiological and clinical characteristics of older patients with COVID-19 outside Wuhan. Methods A retrospective study was performed, with collecting data from medical records of confirmed COVID-19 patients in Zhejiang province from 17 January to 12 February 2020. Epidemiological, clinical, and treatment data were analyzed between older (≥ 60 years) and younger (&lt; 60 years) patients. Results A total of 788 patients with confirmed COVID-19 were selected; 136 were older patients with corresponding mean age of 68.28 ± 7.31 years. There was a significantly higher frequency of women in older patient group compared with younger patients (57.35% vs 46.47%, P = .021). The presence of coexisting medical conditions was significantly higher in older patients compared with younger patients (55.15% vs 21.93%, P &lt; .001), including the rate of hypertension, diabetes, heart disease, and chronic obstructive pulmonary disease. Significantly higher rates of severe clinical type (older vs younger groups: 16.18% vs 5.98%, P &lt; .001), critical clinical type (8.82% vs 0.77%, P &lt; .001), shortness of breath (12.50% vs 3.07%, P &lt; .001), and temperature of &gt; 39.0°C (13.97% vs 7.21%, P = .010) were observed in older patients compared with younger patients. Finally, higher rates of intensive care unit admission (9.56% vs 1.38%, P &lt; .001) and methylprednisolone application (28.68% vs 9.36%, P &lt; .001) were also identified in older patients compared with younger ones. Conclusions The specific epidemiological and clinical features of older COVID-19 patients included significantly higher female sex, body temperature, comorbidities, and rate of severe and critical type disease.

Bilateral facial palsy in an older person

2020 ◽  
Vol 49 (5) ◽  
pp. 887-888
Author(s):  
Jean-Loup Méreaux ◽  
Benjamin Hébant ◽  
Nicolas Magne ◽  
Gérald Quesney ◽  
Romain Lefaucheur
Keyword(s):  
Infectious Disease ◽  
Lyme Disease ◽  
Facial Palsy ◽  
Related Species ◽  
Older Patients ◽  
Clinical Signs ◽  
Older Person ◽  
Older Patient ◽  
Infected Tick ◽  
Outdoor Activities

Abstract Lyme disease is an infectious disease caused by the Borrelia burgdorferi spirochetes and other related species that are transmitted through an infected tick bite. We report the case of an older patient presenting with bilateral facial palsy due to Lyme disease. Multiple non-specific clinical signs preceded facial palsy with falls, fatigue and pain of both legs especially during the night. Our case illustrates the difficulty to diagnose this infectious disease, especially in older patients who have rare outdoor activities and a low risk of tick exposure.

scholarly journals How We Care for an Older Patient With Cancer

2017 ◽  
Vol 13 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Armin Shahrokni ◽  
Soo Jung Kim ◽  
George J. Bosl ◽  
Beatriz Korc-Grodzicki
Keyword(s):  
Predictive Models ◽  
Older Patients ◽  
Process Development ◽  
Adverse Outcomes ◽  
Added Value ◽  
Cancer Center ◽  
Multiple Chronic Conditions ◽  
Older Patient ◽  
Improve Patient Survival ◽  
Patients With Cancer

As the number of older patients with cancer is increasing, oncology disciplines are faced with the challenge of managing patients with multiple chronic conditions who have difficulty maintaining independence, who may have cognitive impairment, and who also may be more vulnerable to adverse outcomes. National and international societies have recommended that all older patients with cancer undergo geriatric assessment (GA) to detect unaddressed problems and introduce interventions to augment functional status to possibly improve patient survival. Several predictive models have been developed, and evidence has shown correlation between information obtained through GA and treatment-related complications. Comprehensive geriatric evaluations and effective interventions on the basis of GA may prove to be challenging for the oncologist because of the lack of the necessary skills, time constraints, and/or limited available resources. In this article, we describe how the Geriatrics Service at Memorial Sloan Kettering Cancer Center approaches an older patient with colon cancer from presentation to the end of life, show the importance of GA at the various stages of cancer treatment, and how predictive models are used to tailor the treatment. The patient’s needs and preferences are at the core of the decision-making process. Development of a plan of care should always include the patient’s preferences, but it is particularly important in the older patient with cancer because a disease-centered approach may neglect noncancer considerations. We will elaborate on the added value of co-management between the oncologist and a geriatric nurse practitioner and on the feasibility of adapting elements of this model into busy oncology practices.

scholarly journals Factors to Improve Quality for Older Patients in the Emergency Department: A Qualitative Study of Patient Trajectory

2021 ◽  
Author(s):  
Isabelle De Brauwer ◽  
Pascale Cornette ◽  
William D’Hoore ◽  
Vincent Lorant ◽  
Franck Verschuren ◽  
...  
Keyword(s):  
Emergency Department ◽  
Qualitative Study ◽  
Older People ◽  
Older Patients ◽  
Inductive Reasoning ◽  
Basic Needs ◽  
Organizational Factors ◽  
Care Quality ◽  
Process Of Care ◽  
Patient Centered

Abstract BackgroundManaging older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, in order to fine-tune future interventions for older people, taking into account the naturalistic context of the ED.Methods. This is a qualitative study of some 450 hours of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes.Results Four themes emerged: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients: unwelcome in EDs? ConclusionsThe overall process of care was based on an organ- and flow-centered paradigm, which ignored older people’s specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.

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