Collaboration Between Relatives of Older Patients and Nurses in Acute Medical Wards: Confirmatory Factor Analysis of the Revised Family Collaboration Scale.

BACKGROUND: Relatives of older people are often involved in their care prior to hospital admission, and may hold valuable knowledge which, if involved, could improve decision-making related to care. Hence, collaboration is required and to monitor this, valid and feasible instruments are needed. The Family Collaboration Scale (FCS) was developed for this purpose, and has been found valid and reliable. Our study tested a shorter version, while assessing collaboration between nurses and 388 relatives. RESULTS: The study provided support for reliability and construct validity of the revised scale. Its feasibility may benefit from adjustments, as older relatives, those with less education and those delivering extensive help, were less likely to complete the scale. Collaboration was rated as poor to average. Poor collaboration was significantly more often reported by women and relatives reporting guilt and powerlessness.

Acute hospitalization of the older patient: changes in muscle strength and functional performance during hospitalization and 30 days after discharge.

OBJECTIVE: Acute hospitalization of older patients may be associated with loss of muscle strength and functional performance. The aim of this study was to investigate the effect of acute hospitalization as a result of medical disease on muscle strength and functional performance in older medical patients. DESIGN: Isometric knee-extension strength; handgrip strength; and functional performance, that is, the Timed Up and Go test, were assessed at admission, at discharge, and 30 days after discharge. Twenty-four-hour mobility was measured during hospitalization. RESULTS: The mean (SD) age was 82.7 (8.2) years, and the median length of stay was 7.5 days (interquartile range, 4.25-11). Knee-extension strength did not change over time (1.0 [N·m]/kg, 1.1 [N·m]/kg, and 1.1 [N·m]/kg, P = 0.138), as did handgrip strength (24.2 kg, 23.3 kg, and 23.5 kg, P = 0.265). The Timed Up and Go test improved during hospitalization, from 17.3 secs at admission to 13.3 secs at discharge (P = 0.003), but with no improvement at the 30-day follow-up (12.4 secs, P = 0.064). The median times spent in lying, sitting, and standing/walking were 17.4 hrs per day, 4.8 hrs per day, and 0.8 hrs per day, respectively. CONCLUSIONS: Muscle strength did not change during hospitalization and 30 days after discharge in the acutely admitted older medical patients. Despite a low level of mobility during hospitalization, functional performance improved significantly during hospitalization, without further improvement.

Elderly patients with community-acquired pneumonia are not treated according to current guidelines.

INTRODUCTION: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance with guidelines for treatment and care of patients with CAP. MATERIAL AND METHODS: A retrospective nationwide study examining 100 patient records from 20 Danish hospitals regarding patients 65 years and older admitted for CAP. RESULTS: A total of 74 patients with a mean age 81.6 years were included. The mean length of stay was 9.2 days, 30- and 90-day mortality rates were 12.2 and 17.6% and readmission rates 4% (seven days) and 9.5% (30 days). Severity assessment was made in two cases. Observations of vital parameters were unsystematic and the respiratory rate was measured only in six cases. Diagnostic tests and treatment initiation were mostly in accordance with guidelines. The mean number of days on intravenous antibiotics was 5.5. Nutrition and mobilisation were neglected or only sporadically addressed. No systematic plan for treatment and care was found. CONCLUSION: While medical treatment mainly concurred with guidelines, a potential for reduced costs by early discharge planning and use of systematic assessment tools for site-of-care and treatment decisions was indicated. The lack of systematic interventions in the prevention and treatment of malnutrition and functional decline constitutes a threat to a successful final patient outcome. FUNDING: The Danish Ministry of Health funded the study. TRIAL REGISTRATION: The Danish Data Register approved the project (J. No. 2010-41-5358).