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The patient-centred management of people with cognitive impairment admitted to acute health care facilities can be challenging. The TOP5 intervention utilises carers’ expert biographical and social knowledge of the patient to facilitate personalised care. The purpose of this paper is to explore whether involvement of carers in the TOP5 initiative could improve patient care and healthcare delivery.

A small-scale longitudinal study was undertaken in two wards of one acute teaching hospital. The wards admitted patients with cognitive impairment, aged 70 years and over, under geriatrician care. Data for patient falls, allocation of one-on-one nurses (“specials”), and length-of-stay (LOS) over 38 months, including baseline, pilot, and establishment phases, were analysed. Surveys of carers and nursing staff were undertaken.

There was a significant reduction in number of falls and number of patients allocated “specials” over the study period, but no statistically significant reduction in LOS. A downward trend in complaints related to communication issues was identified. All carers (n=43) completing the feedback survey were satisfied or very satisfied that staff supported their role as information provider. Most carers (90 per cent) felt that the initiative had a positive impact and 80 per cent felt that their loved one benefitted. Six months after implementation of the initiative, 80 per cent of nurses agreed or strongly agreed that it was now easier to relate to carers of patients with cognitive impairment. At nine-ten months, this increased to 100 per cent.

Actively engaging carers in management of people with cognitive impairment may improve the patient, staff, and carer journeys, and may improve outcomes for patient care and service delivery.

Partnership is both a goal and an approach to family-centered care (FCC). Family members play an important role alongside the health-care team when an older family member is admitted to the hospital. Family involvement in care for an older person forms a partnership approach where health professionals and the family engage collaboratively in care. This enhances the quality of care and family satisfaction with care. The purpose of this paper is to highlight the potential areas of partnerships of family members with health-care professionals while caring for older people based on the perspective of FCC.

A literature review was carried out.

The findings of this study focus on how healthcare professionals can listen to, respect the perspectives of family members, and share useful information with the family while caring for an older person. Family participation in providing care and collaboration between healthcare professionals and families is a seminal goal strategy in caring for older people during hospitalization. It is helpful to family members as a way of training and preparing them to assist their loved one after hospital discharge. Furthermore, it can establish a good relationship between healthcare professionals and families.

Partnership between health-care professionals and families helps and supports the older people and the family in managing the health condition the following discharge from the hospital.

The purpose of this paper is to determine the prevalence of polypharmacy and drug–drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs.

For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models.

On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant.

Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

Frailty is a geriatric syndrome which can be reversible or less severe through appropriate nutritional interventions. In the present study, to test the efficiency of individualized nutritional intervention was conducted a comprehensive assessment of the nutritional status of frail older adults and evaluation of the effect of nutritional intervention on the nutritional status of pre-frail older patients.

Frail older adults (n = 43; mean age 84.6 ± 6.4 years old; 81.4% women) had nutritional status assessed using nutritional anthropometry, body composition, and food frequency questionnaire. Pre-frail patients (n = 16; mean age 68.4 ± 5.5 years old; 81.3% women) for eight weeks were consuming 1.0 g protein/kg BW/day. Robust older adults formed a control group (n = 29; mean age 69.3 ± 5.3 years old; 82.8% women).

Frail older adults had weight and muscle mass loss, and their diet variety was sufficient. After the intervention, pre-frail patients increased their protein consumption by 25.8% (P = 0.002). An increase in lean body mass (+1.0 kg), skeletal muscle mass (+0.3 kg) and improvement in physical performance was also observed.

An individual diet for pre-frail older adults can reverse weight loss and increase lean body mass, furthermore preventing or delaying the development of frailty syndrome. Moreover, increased protein consumption improves physical performance of pre-frail older adults.

Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person’s medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA.

The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up.

The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education.

Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.

Using a risk and vulnerability framework, the purpose of this paper is to describe the characteristics of older adults that Adult Protective Services (APS) substantiated for neglect by caregivers, their caregivers and the interrelationships between them.

The paper uses a qualitative study of 21 APS case record narratives using a template analysis.

Neglect related to withholding or refusing medical care was the most common. The older adults had multiple health conditions and geriatric syndromes. Caregivers had difficulties in carrying out caregiving role due to health and mental health issues, work responsibilities and lack of insight into older adults’ needs. The refusal to access or accept services by both the older adults and the caregivers was a predominant theme.

The sample size was small, limited to one geographical area, and non-representative of all neglect cases. The data were extracted from written case narratives and not directly from the older adults and their family members. Case records varied in the case detail provided.

To protect vulnerable older adults and improve quality of life, APS involvement in cases of caregiver neglect needs strategies to get people to accept help and access services to address multiple health and psychosocial problems for both older adult victims and their caregivers.

This study provides in-depth information on APS cases involving caregiver neglect that add to understanding of this complex problem and points to areas for further study.

This study aims to examine the relationship between neutrophil to lymphocyte ratio (NLR), handgrip strength (HGS) and nutritional status in non-critically ill patients and outpatients.

A cross-sectional study was conducted on 80 geriatric patients. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form, Geriatric Nutritional Risk Index, some anthropometric and biochemical parameters. NLR was calculated from the complete blood count results. Data were analyzed using SPSS 24.0.

While 38.3% of patients were malnourished or at risk of malnutrition, 61.7% had normal nutritional status. Mini Nutritional Assessment Short Form was not correlated with NLR, whereas it showed a weak positive correlation with HGS. According to the logistic regression analysis, age, HGS, hemoglobin and platelet to lymphocyte ratio were significant independent factors for predicting malnutrition or risk of malnutrition. The receiver operator characteristic curve analysis showed that the optimum HGS cut-off point for patients with malnourished or at risk of malnutrition was 13.2. In conclusion, HGS was associated with the nutritional status. NLR was not associated with nutritional status but associated with nutritional risk.

It is well known that malnutrition is a serious health problem among older adults, and it is important to assess the nutritional status of older adults because of the adverse health effects. In addition, to the best of the authors’ knowledge, this is the first study to determine the relationship between NLR, HGS and nutritional status in non-critically ill patients and outpatients.

The purpose of this study is to continue research and development of the ECAD-P learning system with an emphasis on developing a scalable unit for testing in a larger number of more diverse correctional settings. There are almost 2.3 million US persons incarcerated. Geriatric and end-of-life (EOL) care in corrections is not as equitable as care in the free world. Technological delivery of geriatric training to staff through computer-based learning (CBL) offers a novel approach to improve care and reduce disparities among those who are most vulnerable during confinement.

This mixed methods study built an interactive CBL for multidisciplinary staff to address EOL and geriatric issues in prisons. The CBL was iteratively built and tested prior to launching a full-scale evaluation using a pre/post-intervention design.

Evaluation of the CBL occurred at 7 sites (i.e. 6 state prisons and 1 prison health-care vendor). A total of 241 staff were recruited with 173 completing post-tests. Outcomes were knowledge acquisition regarding care for aging and dying incarcerated persons (i.e. cognitive measure) and attitudes, motivations and values for providing care (i.e. affective measure). Cognitive and affective post-tests were significantly better than at pre-test (all ps < 0.01). ANCOVAs revealed no significant differences for sex or ethnicity.

Outcomes reveal that the CBL is acceptable, feasible and usable in corrections. Staff improved their knowledge after receiving the training. Correctional settings face increasing pressures to better address the health care and management needs of aged, chronically ill and dying incarcerated persons. This e-learning holds promise to contribute to better preparation of corrections staff to effectively care for these populations.

The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives.

This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions.

This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking.

Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts.

The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these “grass-root” initiatives engender and how they are consolidated.

The acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.

This is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.

A total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.

Limitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.

This is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.