Abstract Background Delirium, a sudden and acute state of confusion, is known to be more prevalent in hospitalised older adults with dementia and is associated with lower levels of functioning after the delirium episode; yet, the literature on estimates of delirium prevalence in community‐dwelling older adults with dementia is scarce. The aim of this study was to define and determine the frequency of delirium‐like symptoms in two different samples of community‐dwelling persons living with dementia, as reported by their family caregivers. ‘Delirium‐like symptoms’ is a concept that specifies an occurrence of cognitive and behavioural symptoms, provoking suspicion of delirium, that represent a sudden and unusual deleterious change in a community‐dwelling person living with dementia that can be identified by family caregivers and prompt healthcare seeking behaviours. Methods The frequencies of delirium‐like symptoms were assessed from two intensive longitudinal 21‐day diary studies. Caregivers reported on presence of sudden and unusual cognition and behaviours each day. Descriptive statistics were used to determine the number of caregivers who reported delirium‐like symptoms. Results Family caregivers ( n = 50, n = 102) were predominately non‐Hispanic White (75%, 61%), female (94%, 85%), and a child (60%, 59%) of the care‐recipient and completed 1389 and 1739 diaries from the first and second study respectively. Caregivers reported delirium‐like symptoms for 12 (24%) and 27 (27%) of care‐recipients. Conclusion Other studies of delirium in community‐dwelling persons living with dementia have reported similar rates. More research is needed to understand the dynamic context of delirium in community settings to improve the care provided to them by their family caregivers and clinicians in services such as home, primary, and specialty healthcare.
Abstract Hospitalization of older adults with cognitive impairment (CI) has been associated with higher risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to meet the unique hospital care needs of older adults and have been associated with reductions in functional decline and readmissions. The Virtual ACE intervention was developed to disseminate ACE principles across hospital units. Virtual ACE included training interprofessional providers to utilize screens and care protocols to optimize care for older adults on eight units at a large academic medical center. We conducted a preliminary analysis of mobility and patient outcomes before and after Virtual ACE among 192 older adults with CI on hospital admission. Chi-Square tests were used to examine the associations between Virtual ACE and patient outcomes. There were statistically significant pre vs. post improvements in patients’ mobility from bed to chair (30% vs. 51%, p=0.011) and on the unit hallway (12% vs. 27%, p=0.046). Although not statistically significant, there were also improvements in hospital room mobility (39% vs. 50%, p=0.214) and documentation of activities of daily living (ADL) screens (70% vs. 80%, p=0.196). There were non-significant reductions in pressure ulcer prevalence (26% vs. 22%) and restraint use (5% vs. 0%) during the hospital stay. Pain was similar before and after Virtual ACE. Virtual ACE was associated with increased mobility and slight reductions in adverse outcomes. As increased hospital mobility improves patient functioning post-discharge, Virtual ACE has the potential to maintain function and enhance outcomes in hospitalized older adults with CI.
Abstract Background Patients' views are becoming increasingly important in the current health system. They provide information on effectiveness of healthcare and how it may be improved. This study aimed to measure patients' satisfaction with care received for treatment of oesophageal and gastric cancer, and to identify areas that contribute most to overall satisfaction scores. Methods Consecutive inpatients with oesophageal and gastric cancer treated in one surgical unit were recruited prospectively during a 2-year period. The European Organization for Research and Treatment of Cancer ‘satisfaction with in-hospital care’ questionnaire (QLQ-SAT32) was completed following discharge. Scores ranged from 0 to 100 for each satisfaction scale. Univariable and multivariable analysis was used to define the relationships between the different dimensions of satisfaction with care and the overall score. Results Ninety-one patients (mean age 67 years, 60 men) completed the questionnaire a mean of 40 days after treatment. The highest scores were for doctors (mean 72), nurses (mean 67) and overall satisfaction (mean 68). Univariable analysis showed that all dimensions of satisfaction with care contributed significantly to overall satisfaction (P < 0·001). Multivariable analyses, however, showed that most of the variation in overall satisfaction could be attributed to levels of satisfaction with doctors, nurses, and hospital comfort and cleanliness. Conclusion Satisfaction with care in these surgical patients was high and could be measured using a multidimensional instrument. Overall satisfaction was not influenced equally by all aspects of care. The strongest contributors to overall satisfaction in this study were doctors, nurses and hospital cleanliness.
Abstract Attrition is an issue for all longitudinal studies. One concern with intensive protocols with many repeated measures is that participants will drop out before completing the protocol, or will not complete enough of the surveys to provide meaningful data. Features of the study design can be important in increasing compliance with study participations. These features include incentives, survey windows, clear direction, ease of use of the data collection platform, and reminder protocols. This presentation examines compliance, defined as completion of >50% of all surveys, among 3 different micro-longitudinal daily diary studies. Compliance was high for all three studies (78%, 88%, 89%). The lowest compliance rate of 78% was an 8-day protocol with four diaries each day; three diaries were sent out randomly each of the eight days and the one nightly recap was sent at the same time each night. This suggests having multiple surveys in a single day reduce compliance with the study protocol. Compliance did not vary by other study features such as incentives, reminder method or length of the study. For daily diary studies, findings suggest that by doing once-a-day surveys, data collection protocols can be longer and total incentives ranging from $82-$91 are acceptable for maintaining high compliance.
"QIM21-084: Perceived Needs and Patient Satisfaction of Psychosocial Distress Screening and Management in Inpatient Hematology Oncology Specialty Care" published on 17 Mar 2021 by National Comprehensive Cancer Network.
There are two public inpatient units devoted to elder care, which provide services for approximately 360 patients per year, in Southern Tasmania. These are the Geriatric Evaluation and Management Unit (GEM) and the Transitional Care Unit (TCU). Patients with dementia are admitted to these units. Both wards are staffed with multidisciplinary medical and allied health teams. At present there is no means of utilizing consenting patients' clinical information for research purposes. Senior agency staff and clinical researchers have recognized this opportunity and committed to developing a purpose designed data management system. The Wicking Dementia Research and Education Centre (WDREC), based within the Menzies Research Institute, University of Tasmania have appointed a Project Coordinator to develop a database that will facilitate new avenues for clinical research and may be of use to the health service in areas of practice and policy development. The database will collate existing clinical assessment information gathered by the multidisciplinary team on these wards, record patients' consent to involvement in future research and facilitate reporting on service performance issues. This project will be undertaken over the next 12 months. There are likely to be a number of benefits flowing from this project for clinical staff and researchers interested in aged care and dementia. These include the convenience of a single point of access to comprehensive data describing service performance, patients' clinical information including assessment results and summary information for specific clinical research projects. This information may be provided in routine reports and on an “on demand” basis to appropriate staff. This exciting project will place these clinical services and WDREC researchers in a position to be able to conduct a variety of valuable clinical research projects that are likely to enhance service provision and improve the care of older adults in the future.
Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population. Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management. The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings. ClinicalTrials.gov Registration Number: NCT02069015 . Registered February 19, 2014.
