Search results

This study aims first, to provide a typology of complaints concerning the treatment of elderly patients in geriatric wards; second, to estimate reported satisfaction with treatment; and third, to assess the link between verbal concerns and satisfaction.

Using the “Survey of Geriatric Wards, 2019” a sample of 4,725 family members of patients, hospitalized in 99 geriatric wards in Israel were asked to rate their overall satisfaction with treatment; they also were asked to provide verbal information on the hospitalization experience through an open-ended question. A content analysis was applied to the verbal answers, to classify them into distinct qualitative categories; a regression analysis was applied to examine the impact of the concerns on the level of patient satisfaction, net of patient’s characteristics.

Level of satisfaction among family members is very high (8.16 on a scale from 1–10), with only very few expressing verbal concerns (2.3%). Content analysis reveals five reoccurring themes: physical violence (33.3%), verbal violence (19.2%), discrimination (21.2%), lack of dignified hospitalization conditions (8.1%) and communication (18.2%). Further analysis reveals that satisfaction among those who complained, especially about interpersonal relations, is considerably and significantly lower than others.

Despite high levels of satisfaction with medical care in geriatric wards, the findings underscore voiced complaints as major source for explaining dis-satisfaction with hospitalization. Complaints in the realm of interpersonal relations, especially regarding verbal violence, discrimination and communication, seem to be most consequential for lowering levels of satisfaction with treatment.

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.

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.

The paper problematizes previous research on accountingisation, where the role of accounting in determining the scope of professional work is understood in relation to a professional/economic dichotomy and a model of episodic change. The purpose of this paper is to investigate everyday professional work in established new public management (NPM) settings, and proposes a new conceptual framework to analyze the role of accounting therein. The aim is to enable future investigations into how, when and where a situated “bottom line” emerges, by conceptualizing professional work as a process of calculation.

Qualitative data from case studies of two tertiary level geriatric organizations using observations of 33 employees and four interviews. Data related to patient discharge, and the management of the discharge processes, were analyzed.

Few visible trade-offs between distinctly professional or economic considerations were observed. Rather, the qualification of patients’ status and evaluation of their dischargeability centered on debates over treatment time. Time therefore operated as a situated “bottom line,” to which various other concerns were emergently linked in a process of calculation. Professional practitioners seldom explicitly evoke accounting concepts and technologies, but these were implicated in the ongoing translation of each patient into something temporarily stable, calculable and thus actionable for the professionals involved in their care. The study’s findings have implications for the conceptual understanding of professional work in established NPM settings.

Case study research is context-specific and the role of accounting in professional work will vary due to the professional groups and accounting technologies involved.

The study’s findings have implications for how to influence professional behavior through interventions in the existing landscape of accounting technologies. The possibility to change behavior through the introduction or removal of individual accounting technologies is questioned.

To date, research on the role of accounting in determining the scope of professional work has assumed a professional/economic dichotomy and studied episodic change linked to accounting-oriented reforms. This paper analyses the role of accounting as an on-going process with emergent boundaries between professional and economic considerations.

Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut‐off in chronological age, it recognises that most older people, especially the ‘young‐old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients ‐ those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old‐old’. This population is characterised by non‐specific presentation of illness, functional dependency and a need for a multidisciplinary approach to care and judicious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlight the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.

This quantitative phase of a mixed-methods study aims to describe the effect of the Transitional Care Bridge (TCB) programme on functional decline, mortality, health-care utilisation and health outcomes compared to usual care in a regional hospital in the Netherlands.

In a pre- and post-cohort study, patients aged ≥70 years, admitted to the hospital for ≥48 h and discharged home with an Identification of Seniors at Risk score of ≥2, were included. The TCB programme, started before discharge, encompassed six visits by the community nurse (CN). Data were obtained from the hospital registry and by three questionnaires over a three months period, addressing activities of daily living (ADL), self-rated health, self-rated quality of life and health-care utilisation.

In total, 100 patients were enrolled in this study, 50 patients in the TCB group and 50 patients in the usual care group. After three months, 36.7% was dependent on ADL in the TCB group compared to 47.1% in the usual care group. Mean number of visits by the CN in the TCB group was 3.8. Although the TCB group had a lower mortality, this study did not find any statistically significant differences in health outcomes and health-care utilisation.

Challenges in the delivery of the programme may have influenced patient outcomes. More research is needed on implementation of evidence-based programmes in smaller research settings. A qualitative phase of the study needs to address these outcomes and explore the perspectives of health professionals and patients on the delivery of the programme.

This study provides valuable information on the transitional care programme in a smaller setting.

According to literature, interruptions during drug administration lead to a significant proportion of medication errors. Evidence on the effectiveness of interventions to reduce interruption is still limited. The purpose of this paper is to explore main reasons for interruptions during drug administration rounds in a geriatric ward of an Italian secondary hospital and test the effectiveness of a combined intervention.

This is a pre and post-intervention observational study based on direct observation. All nurse staff (24) participated to the study that lead to observe a total of 44 drug dispensing rounds with 945 drugs administered to 491 patients in T0 and 994 drugs to 506 patients in T1.

A significant reduction of raw number of interruptions (mean per round from 17.31 in T0 to 9.09 in T1, p<0.01), interruptions/patient rate (from 0.78 in T0 to 0.40 in T1, p<0.01) and interruptions/drugs rate (from 0.44 in T0 to 0.22 in T1, p<0.01) were observed. Needs for further improvements were elicited (e.g. a greater involvement of support staff).

Nurse staff should be adequately trained on the risks related to interruptions during drug administration since routine activity is at high risk of distractions due to its repetitive and skill-based nature.

A strong involvement of both MB and leadership, together with the frontline staff, helped to raise staff motivation and guide a bottom-up approach, able to identify tailored interventions and serve concurrently as training instrument tool.

This study aims to review the presentation of substance use disorders in older adults, how addiction intertwines with neurocognitive disorders and how to approach this vulnerable population.

Electronic data searches of PubMed, Medline and the Cochrane Library (years 2000–2021) were performed using the keywords “neurocognitive,” “dementia,” “substance use,” “addiction,” “older adults” and “elderly.” The authors, in consensus, selected pivotal studies and conducted a narrative synthesis of the findings.

Research about substance use disorders in older adults is limited, especially in those with superimposed neurocognitive disorders. Having dual diagnoses can make the identification and treatment of either condition challenging. Management should use a holistic multidisciplinary approach that involves medical professionals and caregivers.

This review highlights some of the intertwining aspects between substance use disorders and neurocognitive disorders in older adults. It provides a comprehensive summary of the available evidence on treatment in this population.

Senior citizen falls are one of the highest-cost factors of healthcare within this population group. Various approaches for automatic fall detection exist. However, little is known about the seniors’ acceptance of these systems. The purpose of this paper is to investigate the acceptance of automatic fall detection devices as well as the technological commitment and the health status in community-dwelling adults with a predefined risk of falling.

Seniors with a risk of falling were equipped with either an accelerometer or an accelerometer with an additional visual and optical fall detection system in a sub-group of the study population for a period of eight weeks. Pre- and post-study questionnaires were used to assess attitudes and acceptance toward technology.

In total, 14 subjects with a mean age of 75.1 years completed the study. Acceptance toward all sensors was high and subjects were confident in their ability to handle technology. Medical assessments showed only very mild physical and no mental impairments. Measures that assured subjects privacy protection were welcomed. Sensor technology should be as unobtrusive as possible.

Privacy protection and uncomplicated use of the fall detection equipment led to high acceptance in seniors with high-technical commitment and good health status. Issues to further improve acceptance could be identified. Future research on different populations is necessary.