scholarly journals Relationship between whether the planned discharge destination is decided and locomotive syndrome for admitted patients in psychiatric long-term care wards

2020 ◽  
Vol 23 (2) ◽  
pp. 180-187
Author(s):  
Munetsugu KOTA ◽  
Sae UEZONO ◽  
Yusuke ISHIBASHI ◽  
Sousuke KITAKAZE ◽  
Hideki ARAKAWA
Keyword(s):  
Long Term Care ◽  
Discharge Destination ◽  
Locomotive Syndrome ◽  
Term Care

scholarly journals 88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Edel McDaid ◽  
Elaine Ross ◽  
Lisa Cogan
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Long Term Care ◽  
Discharge Destination ◽  
Clinical Frailty Scale ◽  
Geriatric Population ◽  
Term Care ◽  
Geriatric Unit ◽  
Post Acute Care

Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.

scholarly journals Beta Blockade and Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 10 (1) ◽  
pp. 155-163 ◽  
Author(s):  
Melody M. Chang ◽  
Ronak N. Raval ◽  
Jessie J. Southerland ◽  
Dare A. Adewumi ◽  
Khaled A. Bahjri ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Long Term Care ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Beta Blockers ◽  
Retrospective Chart Review ◽  
Beta Blockade ◽  
Discharge Destination ◽  
Term Care

Background: Aneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death. Methods: Retrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio. Results: Of the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)). Conclusion: Post-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths.

scholarly journals Temporal Trends in Case Fatality, Discharge Destination, and Admission to Long-term Care After Acute Stroke

Neurology ◽  
2021 ◽  
Vol 96 (16) ◽  
pp. e2037-e2047 ◽  
Author(s):  
Raed A. Joundi ◽  
Eric E. Smith ◽  
Amy Y.X. Yu ◽  
Mohammed Rashid ◽  
Jiming Fang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Long Term Care ◽  
Case Fatality ◽  
Relative Reduction ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Term Care ◽  
Stroke Type

ObjectiveTo determine contemporary trends in case fatality, discharge destination, and admission to long-term care after acute ischemic stroke and intracerebral hemorrhage (ICH) using a large, population-based cohort.MethodsWe used linked administrative data to identify all emergency department visits and hospital admissions for first-ever ischemic stroke or ICH in Ontario, Canada, from 2003 to 2017. We calculated crude and age-/sex-standardized risk of death at 30 days and 1 year from stroke onset. We stratified crude trends by stroke type, age, and sex and used the Kendall τ-b correlation coefficient to evaluate the significance of trends. We determined trends in discharge home and to rehabilitation and admission to long-term care at 1 year. We used Cox proportional hazard and logistic regression models to assess whether trends in outcomes persisted after adjustment for baseline factors, estimated stroke severity, and use of life-sustaining care.ResultsThere were 163,574 people with acute ischemic stroke or ICH across the study period. Between 2003 and 2017, age-/sex-standardized 30-day stroke case fatality decreased from 20.5% to 13.2% (7.3% absolute and 36% relative reduction) while that at 1 year decreased from 32.2% to 22.8% (9.3% absolute and 29% relative reduction). Findings were consistent across age, sex, and stroke type, and after adjustment for comorbid conditions, stroke severity, and use of life-sustaining care. There was a reduction in long-term care admission after ischemic stroke and an increase in discharge home or to rehabilitation for both stroke types.ConclusionWe observed substantial reductions in acute stroke case fatality from 2003 to 2017 with a concurrent increase in discharge to home or rehabilitation and a decrease in long-term care admissions, suggesting continuous improvements in stroke systems of care.

Working With Resistance and Encouraging Buy-In to New Programs

2011 ◽  
Vol 16 (1) ◽  
pp. 18-21
Author(s):  
Sara Joffe
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Optimal Outcomes ◽  
Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

Feeding Dependency Issues in the Long-Term Care Environment

2001 ◽  
Vol 10 (1) ◽  
pp. 19-24
Author(s):  
Carol Winchester ◽  
Cathy Pelletier ◽  
Pete Johnson
Keyword(s):  
Long Term Care ◽  
Term Care ◽  
Care Environment

Communication Disordered: Program Implementation in Long-Term Care

2016 ◽  
Vol 1 (15) ◽  
pp. 64-67
Author(s):  
George Barnes ◽  
Joseph Salemi
Keyword(s):  
Program Implementation ◽  
Long Term Care ◽  
Family Satisfaction ◽  
Regulatory Compliance ◽  
Care Staff ◽  
Term Care ◽  
Staff Members ◽  
Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

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