scholarly journals Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study

2019 ◽  
Vol 7 (15) ◽  
pp. 1-174 ◽  
Author(s):  
Simon Paul Conroy ◽  
Martin Bardsley ◽  
Paul Smith ◽  
Jenny Neuburger ◽  
Eilís Keeble ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Frailty Index ◽  
Large Data ◽  
Acute Hospital ◽  
Mixed Methods Study ◽  
Acute Hospitals ◽  
The Uk

BackgroundThe aim of this study was to provide high-quality evidence on delivering hospital-wide Comprehensive Geriatric Assessment (CGA).Objective(s)(1) To define CGA, its processes, outcomes and costs in the published literature, (2) to identify the processes, outcomes and costs of CGA in existing hospital settings in the UK, (3) to identify the characteristics of the recipients and beneficiaries of CGA in existing hospital settings in the UK and (4) to develop tools that will assist in the implementation of hospital-wide CGA.DesignMixed-methods study combining a mapping review, national survey, large data analysis and qualitative methods.ParticipantsPeople aged ≥ 65 years in acute hospital settings.Data sourcesLiterature review – Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE and EMBASE. Survey – acute hospital trusts. Large data analyses – (1) people aged ≥ 75 years in 2008 living in Leicester, Nottingham or Southampton (development cohort,n = 22,139); (2) older people admitted for short stay (Nottingham/Leicester,n = 825) to a geriatric ward (Southampton,n = 246) or based in the community (Newcastle,n = 754); (3) people aged ≥ 75 years admitted to acute hospitals in England in 2014–15 (validation study,n = 1,013,590). Toolkit development – multidisciplinary national stakeholder group (co-production); field-testing with cancer/surgical teams in Newcastle/Leicester.ResultsLiterature search – common outcomes included clinical, operational and destinational, but not patient-reported, outcome measures. Survey – highly variable provision of multidisciplinary assessment and care across hospitals. Quantitative analyses – in the development cohort, older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use than older people without a frailty diagnosis. Patients with the highest 20% of hospital frailty risk scores had increased odds of 30-day mortality [odds ratio (OR) 1.7], long length of stay (OR 6.0) and 30-day re-admission (OR 1.5). The score had moderate agreement with the Fried and Rockwood scales. Pilot toolkit evaluation – participants across sites were still at the beginning of their work to identify patients and plan change. In particular, competing definitions of the role of geriatricians were evident.LimitationsThe survey was limited by an incomplete response rate but it still provides the largest description of acute hospital care for older people to date. The risk stratification tool is not contemporaneous, although it remains a powerful predictor of patient harms. The toolkit evaluation is still rather nascent and could have meaningfully continued for another year or more.ConclusionsCGA remains the gold standard approach to improving a range of outcomes for older people in acute hospitals. Older people at risk can be identified using routine hospital data. Toolkits aimed at enhancing the delivery of CGA by non-specialists can be useful but require prolonged geriatrician support and implementation phases. Future work could involve comparing the hospital-based frailty index with the electronic Frailty Index and further testing of the clinical toolkits in specialist services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 161
Author(s):  
Catriona Young ◽  
Alison I. C. Donaldson ◽  
Christine H. McAlpine ◽  
Marc Locherty ◽  
Adrian D. Wood ◽  
...  
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Rural Areas ◽  
Service Access ◽  
Front Door ◽  
Scottish Highlands ◽  
Electronic Data Capture System ◽  
Acute Hospitals ◽  
Key Aspects

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the ‘front door’. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.

scholarly journals Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study

2019 ◽  
Vol Volume 14 ◽  
pp. 2223-2237 ◽  
Author(s):  
Christine Toye ◽  
Susan Slatyer ◽  
Su Kitchen ◽  
Katharine Ingram ◽  
Mary Bronson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Acute Hospital ◽  
Mixed Methods Study ◽  
Falls Risk

scholarly journals Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Olav Sletvold ◽  
Jorunn L Helbostad ◽  
Pernille Thingstad ◽  
Kristin Taraldsen ◽  
Anders Prestmo ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment

scholarly journals Consent for the use of human biological samples for biomedical research: a mixed methods study exploring the UK public's preferences

BMJ Open ◽  
2013 ◽  
Vol 3 (8) ◽  
pp. e003022 ◽  
Author(s):  
Celine Lewis ◽  
Margaret Clotworthy ◽  
Shona Hilton ◽  
Caroline Magee ◽  
Mark J Robertson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Biomedical Research ◽  
Biological Samples ◽  
Mixed Methods Study ◽  
The Uk

scholarly journals Ringing the changes: the role of telephone communication in a helpline and befriending service targeting loneliness in older people

2018 ◽  
Vol 39 (7) ◽  
pp. 1528-1551 ◽  
Author(s):  
CLAIRE PRESTON ◽  
STEPHEN MOORE
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Thematic Analysis ◽  
Emotional Support ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Voice Communication ◽  
Telephone Communication ◽  
The United Kingdom

ABSTRACTThe drive to deliver services addressing loneliness in older people by telephone and online makes it increasingly relevant to consider how the mode of communication affects the way people interact with services and the capacity of services to meet their needs. This paper is based on the qualitative strand of a larger mixed-methods study of a national phoneline tackling loneliness in older people in the United Kingdom. The research comprised thematic analysis of four focus groups with staff and 42 semi-structured interviews with callers. It explored the associations between telephone-delivery, how individuals used the services and how the services were able to respond. To understand these associations, it was useful to identify some constituent characteristics of telephone communication in this context: namely its availability, reach and non-visual nature. This enabled various insights and comparison with other communication media. For example, the availability of the services attracted people seeking frequent emotional support but this presented challenges to staff. More positively, the ability of the services to connect disparate individuals enabled them to form different kinds of satisfying relationships. The evolution of mixed communication forms, such as internet-based voice communication and smartphone-based visual communication, makes analysis at the level of a technology's characteristics useful. Such a cross-cutting perspective can inform both the design of interventions and assessment of their suitability for different manifestations of loneliness.

scholarly journals Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Nicola Veronese ◽  
Lee Smith ◽  
Ekaterini Zigoura ◽  
Mario Barbagallo ◽  
Ligia J. Dominguez ◽  
...  
Keyword(s):  
Older People ◽  
Fracture Risk ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Prognostic Index ◽  
Knee Oa ◽  
Increased Risk ◽  
Cox's Regression ◽  
Clinical Fractures ◽  
Osteoarthritis Initiative

Abstract Summary In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. Purpose Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. Methods Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox’s regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. Results The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11–2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008–1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. Conclusion Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

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