RESUMO
BACKGROUND: National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS: An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS: Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION: Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.
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Idoso Fragilizado , Fragilidade , Avaliação Geriátrica , Pessoal de Saúde , Humanos , Brasil/epidemiologia , Masculino , Feminino , Idoso , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/terapia , Avaliação Geriátrica/métodos , Inquéritos e Questionários , Pessoa de Meia-Idade , Adulto , Idoso de 80 Anos ou mais , Gerenciamento ClínicoRESUMO
BACKGROUND: Care homes are increasingly important settings for intervention research to enhance evidence-informed care. For such research to demonstrate effectiveness, it is essential that measures are appropriate for the population, setting and practice contexts. OBJECTIVE: To identify care home intervention studies and describe the resident outcome measures used. DESIGN: Scoping review. METHODS: We reviewed international care home research published from 2015 to August 2022. We searched MEDLINE, EMBASE, CINAHL and ASSIA. We included any intervention study conducted in a care home, reporting resident outcomes. We extracted resident outcome measures, organised these using the domains of an adapted framework and described their use. RESULTS: From 7,330 records screened, we included 396 datasets reported in 436 publications. These included 12,167 care homes and 836,842 residents, with an average of 80 residents per study. The studies evaluated 859 unique resident outcomes 2,030 times using 732 outcome measures. Outcomes were evaluated between 1 and 112 times, with 75.1% of outcomes evaluated only once. Outcome measures were used 1-120 times, with 68.4% of measures used only once. Only 14 measures were used ≥20 times. Functional status, mood & behaviour and medications were the commonest outcome domains assessed. More than half of outcomes were assessed using scales, with a fifth using existing records or administrative data. CONCLUSIONS: There is significant heterogeneity in the choice and assessment of outcomes for intervention research in care homes. There is an urgent need to develop a consensus on useful and sensitive tools for care homes, working with residents, families and friends and staff.
Assuntos
Instituição de Longa Permanência para Idosos , Internacionalidade , Avaliação de Resultados em Cuidados de Saúde , Pesquisa , Idoso , Humanos , Prática Clínica Baseada em Evidências , Conjuntos de Dados como Assunto , Projetos de PesquisaRESUMO
BACKGROUND: Care homes provide long term care for older people. Countries with standardised approaches to residents' assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents' everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. METHODS: The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders' consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. RESULTS: Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents' data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents' care CONCLUSIONS: Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. REGISTRATION: PROSPERO registration number CRD42020171323.
Assuntos
Assistência de Longa Duração , Motivação , Idoso , HumanosRESUMO
BACKGROUND: Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group. METHODS: MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term 'non-weight bearing'. All study types were included. Analysis was by narrative synthesis. RESULTS: No papers were identified from a search using the key phrase 'non-weight bearing'. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing. DISCUSSION: These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process.
Assuntos
Fraturas Ósseas , Fragilidade , Idoso , Consenso , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Fragilidade/diagnóstico , Fragilidade/terapia , Humanos , Extremidade Inferior , Estado NutricionalRESUMO
BACKGROUND: informal carers of people with dementia are at greater risk of anxiety and depressive disorders if they find caregiving to be a burden. The aim of this study was to use a network analysis of cross-sectional data to investigate the relationships between anxiety and depressive symptoms in family carers of older people with dementia who experience burden. METHODS: sixty family carers exhibiting high levels of burden using the Zarit Burden Interview were included in the study. Participants completed the Hospital Anxiety and Depression Scale. The network analysis identified the depression and anxiety symptom network using features including a topological graph, network centrality metrics and community analysis. The network was estimated through the graphical LASSO technique in combination with a walktrap algorithm to obtain the clusters within the network and the connections between the nodes (symptoms). A directed acyclic graph was generated to model symptom interactions. RESULTS: the resulting network architecture shows important bridges between depression and anxiety symptoms. Lack of pleasure and loss of enjoyment were identified as potential gateway symptoms to other anxiety and depression symptoms and represent possible therapeutic targets for psychosocial interventions. Fear and loss of optimism were highly central symptoms, indicating their importance as warning signs of more generalised anxiety and depression. CONCLUSIONS: this network analysis of depressive and anxiety symptoms in overburdened family carers provides important insights as to what symptoms may be the most important targets for behavioural interventions.
Assuntos
Cuidadores , Demência , Idoso , Ansiedade/diagnóstico , Sobrecarga do Cuidador , Estudos Transversais , Demência/diagnóstico , Demência/terapia , Depressão/diagnóstico , Humanos , Transtornos do HumorRESUMO
Background: Dementia training for Brazilian general practitioners (GPs) is underdeveloped. We investigated knowledge and attitudes to dementia management among Brazilian GPs and compared these with previous UK findings to inform future decisions about how training is structured.Methods: A total of 115 Brazilian GPs were asked to complete a Portuguese translation of a questionnaire previously used in the UK. This comprised a 14-item multiple-choice knowledge quiz, and a 5-point Likert-scale questionnaire assessing attitudes across 10 dementia management domains. Exploratory factorial analysis was conducted for attitudes.Results: Attitudes toward dementia demonstrated the same underlying factor structure, "heartsink" and "heartfelt" factors, in Brazil as in previous UK studies, explaining 61.6% of variance in responses. Knowledge scores were negatively correlated with heartfelt and heartsink factors.Conclusions: Greater knowledge about dementia was associated with some pessimism about dementia care. The similarity in the structure of attitudes toward dementia management between Brazilian and UK GPs provides a starting point for shared educational approaches targeting attitudes.
Assuntos
Atitude do Pessoal de Saúde , Demência/terapia , Clínicos Gerais/psicologia , Geriatria/educação , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Brasil , Competência Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Reino UnidoRESUMO
BACKGROUND: foot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes. METHODS: systematic review and meta-analysis. We searched multiple electronic databases with no language restrictions. Randomised or quasi-randomised-controlled trials documenting podiatry interventions in older people (aged 60+) were included. Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane Risk of Bias tool. TiDieR guidelines guided data extraction and where suitable statistical summary data were available, we combined the selected outcome data in pooled meta-analyses. RESULTS: from 35,857 titles and 5,201 screened abstracts, nine studies involving 6,502 participants (range 40-3,727) met the inclusion criteria. Interventions were single component podiatry (two studies), multifaceted podiatry (three studies), or multifactorial involving other components and referral to podiatry component (four studies). Seven studies were conducted in the community and two in care homes. Quality assessment showed overall low risk for selection bias, but unclear or high risk of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate. CONCLUSIONS: multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data. PROSPERO REGISTRATION NUMBER: CRD42017068300.
Assuntos
Acidentes por Quedas/prevenção & controle , Podiatria/métodos , Idoso , Doenças do Pé/terapia , HumanosRESUMO
This commentary discusses the perception of frailty by different key stakeholders-most notably older people. It considers the need to integrate predominantly medically driven understandings of frailty within a wider conceptual framework. This is imperative if the potential of frailty as a construct, around which the optimisation of health and well-being of older people can take place, is to be realised.
Assuntos
Envelhecimento , Idoso Fragilizado , Fragilidade/diagnóstico , Terminologia como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Atitude do Pessoal de Saúde , Fragilidade/epidemiologia , Fragilidade/fisiopatologia , Fragilidade/psicologia , Avaliação Geriátrica , Humanos , Percepção , Opinião PúblicaRESUMO
Background: registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. Methods: a two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. Results: twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further 10 competencies did not reach consensus. Conclusion: the output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group.
Assuntos
Competência Clínica/normas , Técnica Delphi , Educação de Pós-Graduação em Enfermagem/normas , Instituição de Longa Permanência para Idosos/normas , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/normas , Casas de Saúde/normas , Mobilidade Ocupacional , Consenso , Currículo/normas , Grupos Focais , Humanos , Participação dos Interessados , Reino UnidoRESUMO
Background: studies have sought to identify the possible determinants of medical students' and doctors' attitudes towards older patients by examining relationships with a variety of factors: demographic, educational/training, exposure to older people, personality/cognitive and job/career factors. This review collates and synthesises these findings. Methods: an electronic search of 10 databases was performed (ABI/Inform, ASSIA, British Nursing Index, CINAHL, Informa Health, Medline, PsycINFO, Science Direct, Scopus, and Web of Science) through to 7 February 2017. Results: the main search identified 2,332 articles; 37 studies met the eligibility criteria set. All included studies analysed self-reported attitudes based on correlational analyses or difference testing, therefore causation could not be determined. However, self-reported positive attitudes towards older patients were related to: (i) intrinsic motivation for studying medicine, (ii) increased preference for working with older patients and (iii) good previous relationships with older people. Additionally, more positive attitudes were also reported in those with higher knowledge scores but these may relate to the use of a knowledge assessment which is an indirect measure of attitudes (i.e. Palmore's Facts on Aging Quizzes). Four out of the five high quality studies included in this review reported more positive attitudes in females compared to males. Conclusion: this article identifies factors associated with medical students' and doctors' positive attitudes towards older patients. Future research could bring greater clarity to the relationship between knowledge and attitudes by using a knowledge measure which is distinct from attitudes and also measures knowledge that is relevant to clinical care.
Assuntos
Etarismo , Envelhecimento/psicologia , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Estudantes de Medicina/psicologia , Fatores Etários , Feminino , Humanos , Masculino , Motivação , Relações Médico-Paciente , Médicas/psicologia , Fatores SexuaisRESUMO
Background: there is concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field-in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective: to explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design: an online survey was sent to all UK higher medical trainees in geriatric medicine. Methods: survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results: two hundred and sixty-nine responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions: there are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take.
Assuntos
Atitude do Pessoal de Saúde , Escolha da Profissão , Educação de Pós-Graduação em Medicina , Geriatras/educação , Geriatria/educação , Emoções , Geriatras/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Satisfação no Emprego , Inquéritos e Questionários , Fatores de Tempo , Reino UnidoRESUMO
There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50-74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty.
Assuntos
Educação Médica Continuada/normas , Avaliação Educacional/métodos , Geriatria/educação , Idoso , Competência Clínica/normas , Currículo/normas , Técnica Delphi , Avaliação Educacional/normas , Europa (Continente) , Geriatria/normas , HumanosRESUMO
In this paper, we outline the relationship between the need to put existing applied health research knowledge into practice (the 'know-do gap') and the need to improve the evidence base (the 'know gap') with respect to the healthcare process used for older people with frailty known as comprehensive geriatric assessment (CGA). We explore the reasons for the know-do gap and the principles of how these barriers to implementation might be overcome. We explore how these principles should affect the conduct of applied health research to close the know gap. We propose that impaired flow of knowledge is an important contributory factor in the failure to implement evidence-based practice in CGA; this could be addressed through specific knowledge mobilisation techniques. We describe that implementation failures are also produced by an inadequate evidence base that requires the co-production of research, addressing not only effectiveness but also the feasibility and acceptability of new services, the educational needs of practitioners, the organisational requirements of services, and the contribution made by policy. Only by tackling these issues in concert and appropriate proportion, will the know and know-do gaps for CGA be closed.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Avaliação Geriátrica/métodos , Geriatria/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Modelos Organizacionais , Lacunas da Prática Profissional/organização & administração , Pesquisa Translacional Biomédica/organização & administração , Idoso , Competência Clínica , Prestação Integrada de Cuidados de Saúde/normas , Medicina Baseada em Evidências , Geriatria/normas , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/normas , Humanos , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Lacunas da Prática Profissional/normas , Pesquisa Translacional Biomédica/normasRESUMO
OBJECTIVES: to describe the views of healthcare workers on the facilitators of communication with people with dementia in a care setting. DESIGN: thematic analysis of semi-structured interviews. SETTING: all participants were interviewed in their place of work. PARTICIPANTS: sixteen healthcare workers whose daily work involves interacting with people with dementia. RESULTS: four overarching categories of themes were identified from the interviews that impact on communication: the attributes of a care worker, communication strategies used, organisational factors and the physical characteristics of the care environment. CONCLUSION: many strategies used by healthcare workers to facilitate communication have not yet been studied in the research literature. Participants' views on training should be incorporated into future dementia training programmes.
Assuntos
Atitude do Pessoal de Saúde , Comunicação , Demência/terapia , Geriatria , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Relações Profissional-Paciente , Competência Clínica , Demência/diagnóstico , Demência/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Equipe de Assistência ao Paciente , Recursos Humanos , Local de TrabalhoRESUMO
BACKGROUND: advanced nurse practitioners (ANPs) are experienced nurses who undertake some activities traditionally performed by medical staff. There are four pillars of advanced practice: advanced clinical skills, leadership, education and research. ANPs are starting to specialise in the management of older adults with frailty in the acute hospital. However, the role and competencies required for this have not been well defined. This study aimed to establish an expert consensus on the role description and essential competencies for ANPs working with older people with frailty to develop a curriculum. METHODS: a literature review and workshops including multi-professional and lay representatives generated a role description and a list of 69 competencies. A modified Delphi process was then conducted with three rounds involving a panel of 31 experts including representatives from the RCN, BGS Education and Training Committee, BGS Senior Nurses and Practitioners Group, Chartered Society of Physiotherapy Older People Network, College of Occupational Therapists Older People Specialist Section and lay representatives. Consensus on the statements was established by 70% panel agreement. RESULTS: the role description reached 100% agreement within three rounds. Twenty-five essential competencies were agreed after Round 1, increasing to 43 after Round 2 and 49 after Round 3. CONCLUSION: this Delphi study has allowed, for the first time, a national panel of clinical experts and lay representatives to refine and agree a set of competencies for ANPs working with older people with frailty. It is the first step towards ensuring consistency in the training of ANPs in geriatric medicine.
Assuntos
Técnica Delphi , Educação de Pós-Graduação em Enfermagem/métodos , Idoso Fragilizado , Geriatria/educação , Hospitalização , Profissionais de Enfermagem/educação , Ensino/métodos , Fatores Etários , Idoso , Competência Clínica , Consenso , Currículo , Educação de Pós-Graduação em Enfermagem/normas , Geriatria/normas , Guias como Assunto , Humanos , Profissionais de Enfermagem/normas , Papel do Profissional de Enfermagem , Desenvolvimento de Programas , Ensino/normasRESUMO
The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life. It is therefore possible that excessive BP lowering in older people with dementia might harm cognition. From the existing literature, there is no direct evidence of benefit or harm from treating hypertension in people with dementia. So what practical steps can the clinician take? Assess capacity, establish patient preferences when making treatment decisions, use ambulatory monitoring to thoroughly assess BP, individualise and consider deprescribing where side effects (e.g. hypotension) outweigh the benefits. Future research might include pragmatic randomised trials of targeted deprescribing, which include patient-centred outcome measures to help support decision-making and studies to address mechanistic uncertainties.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Demência/fisiopatologia , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Comorbidade , Demência/diagnóstico , Demência/epidemiologia , Demência/psicologia , Nível de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: delirium is common and serious, yet frequently missed by medical staff. It is known that delirium is widely taught and examined in UK medical schools; however, what is taught, and how such teaching is delivered, remains unknown. The primary aim of this study was to determine the content of UK undergraduate medical education about delirium and establish how it is delivered. A secondary aim was to highlight and share examples of gold-standard teaching on delirium. METHODS: all UK undergraduate medical schools were invited to complete a survey. Schools were asked to describe how delirium was taught and to provide delirium-related learning outcomes. Learning outcomes were mapped to the three overarching themes outlined in Tomorrow's Doctors (knowledge, skills and attitudes). RESULTS: 24/31 schools (77%) provided responses. In line with previous work, delirium was widely taught and examined. 18/24 schools reported at least one learning outcome that mapped to the knowledge domain, 19/24 for the skills domain and 2/24 for the attitudes domain. 4/24 evaluated the impact of sessions and 3/24 involved patients and the public in teaching. 13/24 schools were confident that exposure to delirium was guaranteed. Innovative teaching methods were reported by a number of schools; weblinks to examples are provided. DISCUSSION: there was widespread failure to address attitudes on delirium within teaching, to evaluate the impact of sessions, to involve patients and the public in teaching and to guarantee exposure to delirium. Future teaching interventions should be directed at attitudinal outcomes, using a synthesis of clinical experience with multidisciplinary interaction and supportive technologies.
Assuntos
Competência Clínica/normas , Delírio/terapia , Educação de Graduação em Medicina/normas , Padrões de Prática Médica/normas , Faculdades de Medicina/normas , Atitude do Pessoal de Saúde , Currículo , Delírio/diagnóstico , Educação de Graduação em Medicina/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aprendizagem , Guias de Prática Clínica como Assunto/normas , Inquéritos e Questionários , Ensino/métodos , Reino UnidoRESUMO
BACKGROUND: UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents' health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. AIM: to describe in detail the health status and healthcare resource use of UK care home residents DESIGN AND SETTING: a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. METHOD: Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. RESULTS: out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. CONCLUSION: residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.
Assuntos
Envelhecimento , Avaliação Geriátrica , Recursos em Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos , Casas de Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Cognição , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Comorbidade , Atenção à Saúde , Feminino , Alocação de Recursos para a Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Saúde Mental , Testes Neuropsicológicos , Avaliação Nutricional , Estado Nutricional , Polimedicação , Medicina Estatal , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
INTRODUCTION: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. METHODS: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. RESULTS: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. DISCUSSION: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe.
Assuntos
Técnica Delphi , Educação de Graduação em Medicina , Geriatria/educação , Competência Clínica , Consenso , Currículo , Educação de Graduação em Medicina/normas , Europa (Continente) , Geriatria/normas , Humanos , AprendizagemRESUMO
INTRODUCTION: national reports have highlighted deficiencies in care provided to older surgical patients and suggested a role for innovative, collaborative, inter-specialty models of care. The extent of geriatrician-led perioperative services in the UK (excluding orthogeriatric services) has not previously been described. This survey describes current services and explores barriers to further development. METHODS: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care and organisational issues. Responses were analysed descriptively. RESULTS: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric medicine services included funding, workforce issues and a lack of inter-specialty collaboration. CONCLUSION: a national appetite exists to provide geriatrician-led services to older surgical patients yet the majority of existing services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests that funding for geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination of experiential knowledge and published resources, collaboration with commissioners and empirical research to overcome the barriers described.