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1.
Enferm. clín. (Ed. impr.) ; 29(6): 381-384, nov.-dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184660

RESUMO

El envejecimiento unido a la multimorbilidad, la polimedicación y a diversos factores sociales se conforma como uno de los determinantes que conducen a aumentar la complejidad de la atención en las personas mayores y a dificultar, por tanto, el aportar respuestas eficaces desde los sistemas sanitarios a sus necesidades. Para afrontar este nuevo y creciente escenario del cuidado a la persona mayor, es necesario que los sistemas formales de atención, sanitario y social, definan puestos de trabajo específicos para que las especialistas en enfermería geriátrica, formadas para abordar las necesidades de las personas mayores desde una perspectiva de la atención integral, tanto en el envejecimiento saludable como en los diferentes problemas de salud de este grupo poblacional, caracterizado por las propias consecuencias del envejecimiento y la cronicidad hacia la dependencia, desarrollen las competencias que la ley establece en el marco de un equipo interdisciplinar, para las que han sido formadas y acreditadas, sumando así valor en la respuesta que los sistemas sanitario y social han de aportar a este creciente problema de la tríada «envejecimiento-cronicidad-dependencia»


Aging together with multimorbidity, polymedication and various social factors are some of the determinants that lead to increasing complexity of care in the elderly, thus making it difficult for health systems to meet their needs. To approach this new and growing scenario of care for the elderly, the formal health and social care systems must define specific jobs for geriatric nursing specialists trained to address the needs of older people from a perspective of comprehensive care, both for healthy aging, and for the different health problems of this population group, characterized by the consequences of aging and chronicity, towards dependence, and develop the powers established by law in the framework of an interdisciplinary team, for those who have been trained and accredited, thus adding value to the response that health systems have to provide for this growing problem of the 'aging-chronicity-dependence' triad


Assuntos
Humanos , Enfermagem Geriátrica/métodos , Papel do Profissional de Enfermagem , Serviços de Saúde para Idosos , Enfermagem Geriátrica/organização & administração , Idoso Fragilizado
2.
Artigo em Russo | MEDLINE | ID: mdl-31765539

RESUMO

In recent years, the concept of nursing process has been actively introduced. It is especially important in geriatric practice, where the issues of nursing support prevail over those in the young and middle age. There are forms of organization of care, where it is the average medical staff is leading in the provision of medical care (hospices, nursing care hospitals, homes for the elderly, etc.). In these conditions, the responsibility of nurses in making and implementing medical decisions in the event of emergency conditions increases.


Assuntos
Enfermagem Geriátrica , Idoso , Tomada de Decisões , Serviços Médicos de Emergência , Enfermagem Geriátrica/organização & administração , Humanos , Federação Russa
4.
J Gerontol Nurs ; 45(5): 39-45, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31026331

RESUMO

The current study aimed to evaluate the multidimensional effects of an interdisciplinary care team in patients with Alzheimer's disease (AD). A total of 129 patients with AD were randomly assigned to an interdisciplinary care group (n = 69) or usual care group (n = 60). Behavioral and psychological symptoms of patients with AD were measured during a 6-month treatment period. No differences were found in the baseline characteristics between the interdisciplinary care and usual care groups. Compared to usual care, interdisciplinary care greatly increased patients' activities of daily living (ADL) scores when measured at 3 and 6 months (p < 0.001). Findings provide evidence that an interdisciplinary care team approach is beneficial in improving ADL performance; thus, an interdisciplinary care team should be implemented in the care arrangements for patients with AD. [Journal of Gerontological Nursing, 45(5), 39-45.].


Assuntos
Atividades Cotidianas , Doença de Alzheimer/enfermagem , Progressão da Doença , Enfermagem Geriátrica/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Enfermagem Psiquiátrica/organização & administração , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Estudos Interdisciplinares , Masculino
5.
J Clin Nurs ; 28(15-16): 2911-2923, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017321

RESUMO

AIMS AND OBJECTIVES: To assess Norwegian advanced geriatric nurses' (AGNs) use of their knowledge and skills, and factors that may influence AGNs' opportunities to use their knowledge and skills to reach their full potential. BACKGROUND: Despite the need for nurses with advanced knowledge and skill in the care of older adults, the introduction of new advanced nursing roles has been challenging. Countries in the process of establishing advanced roles need to monitor and identify possible implementation issues. DESIGN: A cross-sectional descriptive survey. METHODS: We invited the total population of AGNs in Norway (n = 26) and some of their colleagues (n = 465) to answer an online questionnaire. Twenty-three (88.5%) of the AGNs and 195 (42.0%) of the invited colleagues completed and submitted the questionnaires. The data were analysed with descriptive statistics. STROBE guidelines were used in reporting this study. RESULTS: Of the AGNs, 16 (69.6%) used their knowledge and skills to their full potential when providing direct care. However, a minority used their knowledge and skills to their full potential when proving indirect care (n = 11, 47.8%), teaching/supervision (n = 11, 47.8%) and coordination (n = 5, 21.8%). A total of 47 (24.1%) colleagues experienced the AGNs' scope of practice as completely clear, and 52 (26.6%) collaborated with the AGNs several times a week. Of the colleagues, 131 (67.2%) considered the AGNs' role and scope of practice contributed positively to a high degree to health service for older adults. CONCLUSION: The results indicate the need for greater focus on organisational adjustment for the AGNs to utilise their knowledge and skills to their full potential. RELEVANCE TO CLINICAL PRACTICE: There is a need for greater focus on organisational adjustment to integrate AGNs at the workplace, as complete integration may improve the AGNs' use of their knowledge and skills.


Assuntos
Enfermagem Geriátrica/organização & administração , Profissionais de Enfermagem/organização & administração , Papel do Profissional de Enfermagem , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Inquéritos e Questionários
6.
J Gerontol Nurs ; 45(6): 15-21, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30985906

RESUMO

Intentional rounding (IR) is a strategy used by predominately acute care nursing staff to proactively address patients' needs at regular and consistent intervals. The current project piloted the use of IR with certified nursing assistants (CNAs) on a 60-bed unit of a 120-bed skilled nursing facility (SNF). Using a pre/post intervention design and the Plan-Do-Study-Act (PDSA) framework, the authors measured knowledge of IR's "4Ps" (potty, position, possessions, and pain) and the incidence of falls and lost possessions. Uptake of IR over 10 weeks of implementation and CNAs' perceptions of intervention were also assessed. The pilot showed positive outcomes for each of the five aims. Data suggest that IR was well received by CNAs and changed practice patterns regarding quality, safety, and satisfaction. Based on these findings, replication of this project in other SNFs is recommended, given the current small and underpowered study. [Journal of Gerontological Nursing, 45(6), 15-21.].


Assuntos
Enfermagem Geriátrica/organização & administração , Assistentes de Enfermagem , Casas de Saúde , Visitas com Preceptor/organização & administração , Humanos , Assistência de Longa Duração/organização & administração , Projetos Piloto
7.
Scand J Caring Sci ; 33(3): 600-608, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30628730

RESUMO

BACKGROUND: Nurse-to-nurse collaboration between nurses working in hospital and primary health care in the older people care chain is essential to ensure the continuity of care. The nature of good collaboration in this context is understood usually from the perspective of collaborating nurses. However, there seems to be a lack of research about this collaboration from the older patient's perspective who are at the centre of the collaboration. AIMS AND OBJECTIVES: To describe older patient's experiences of the collaboration between hospital and primary healthcare nurses delivering care to older people. DESIGN: A qualitative approach based on a descriptive phenomenological methodology was used. METHODS: Individual interviews were conducted using a purposeful sample of older patients (n = 18) who were cared for both in hospital and primary healthcare organisations. A qualitative data analysis method informed by Giorgi was used. RESULTS: The essence of the experience of nurse-to-nurse collaboration between hospital and primary health care was expressed as follows: the meaning of collaboration; the elements of collaboration valued; the visibility of collaboration; older patient involvement in collaboration; interaction within collaboration; and future expectations of collaboration. CONCLUSIONS: Although nurse-to-nurse collaboration between hospital and primary health care was not often visible to older patients, they highlighted the importance of this collaboration to ensure the continuity of care. The participants would have liked to be part of the collaborating group, at the centre of care, cared for by motivated nurses who had a clear understanding of their patients' health status. This study emphasises the need for improving collaboration between hospital and primary healthcare nurses by making it more visible and facilitating older patients' participation. The results demonstrate the need to understand patient perspectives in the development of care and the services provided for older people.


Assuntos
Enfermagem Geriátrica/organização & administração , Colaboração Intersetorial , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente , Atenção Primária à Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pesquisa Qualitativa
8.
Issues Ment Health Nurs ; 40(2): 118-123, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30605357

RESUMO

Anxiety in older age is a worldwide problem and co-associated with other mental health problems, physical health conditions, disability, reduced quality of life and increased healthcare utilisation. Yet the symptoms of anxiety are often unrecognised in older people, challenging early diagnosis and increasing the risk of older people developing more chronic and disabling illness. This article reports on research led by mental health nurses and a primary care nurse that supported primary care practitioners to undertake a routine assessment of anxiety in older people in Australia. The Geriatric Anxiety Inventory-Short Form was incorporated into the annual, in-depth 75 years and older, health assessment that is undertaken in primary care settings and funded by Australia's Medicare. An initial feasibility study demonstrated good acceptance levels of the routine assessment by the primary care practitioners. These findings suggest fertile ground for the everyday use of the routine assessment in primary care settings in Australia, with transferability internationally in low-, middle- and high-income global communities. Mental health nurses can play a key role in supporting primary care nurses to recognise and respond to anxiety in older people. Illness prevention and health promotion activities are low cost and have the potential to make a difference worldwide to the health of people across the lifespan.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Enfermagem Geriátrica/organização & administração , Papel do Profissional de Enfermagem , Atenção Primária à Saúde/organização & administração , Enfermagem Psiquiátrica/organização & administração , Fatores Etários , Idoso , Austrália , Feminino , Humanos , Masculino , Fatores de Risco
9.
J Clin Nurs ; 28(1-2): 221-234, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30039614

RESUMO

OBJECTIVES: To examine nursing staffs' geriatric knowledge, perceptions about interprofessional collaboration and patient-centred care, and perceived learning needs related to working with hospitalised older people. METHOD: A triangulation mixed methods design was used. A survey was administered to nursing staff that contained the Knowledge About Older Patients Quiz, the patient-centered Care measure and the Modified Index of Interdisciplinary Collaboration measure. Interviews were conducted to understand nursing staffs' learning needs. Survey data were analysed using descriptive statistics. Interview data were analysed using content analysis. Survey and interview data were then compared and contrasted. RESULTS: Twenty-two nursing staff (response rate 26%) completed surveys and 14 participated in interviews. The mean knowledge about older patients score was 22.95, indicating moderately high gerontological knowledge. The mean scores on the patient-centered Care measure and Modified Index of Interdisciplinary Collaboration were moderately high at 3.75 and 3.86, respectively. Themes developed from analysis of the interview data were as follows: complex vulnerable population, clinical care concerns and working as a team. In spite of scores on knowledge surveys, nursing staff identified learning needs related to managing the responsive behaviours of older patients with cognitive impairment, chemical and physical restraints, mobility and continence. CONCLUSIONS: There was an incongruence between survey and interview data as nursing staff reported gaps in their knowledge despite moderately high scores on the Knowledge about Older People Quiz. Further research is needed to understand additional factors that influence nurses' educational needs.


Assuntos
Educação Continuada em Enfermagem/métodos , Enfermagem Geriátrica/educação , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Desenvolvimento de Pessoal/métodos , Idoso , Canadá , Feminino , Enfermagem Geriátrica/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Restrição Física
10.
Clin J Oncol Nurs ; 22(6): 26-35, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30452017

RESUMO

BACKGROUND: Treatment advances offer options for cancer treatment in older adults that are less invasive and have fewer side effects. Geriatric assessment is a key component of treatment planning to identify functional and physiologic status and is the basis of decision making. OBJECTIVES: This article discusses the role of geriatric assessment, treatment options (e.g., surgical, chemotherapy, radiation therapy), survivorship issues, and palliative care strategies for older adults with cancer. METHODS: Literature was reviewed to identify geriatric assessment implications, current treatment strategies, and survivorship and palliative care interventions for older adults with cancer based on a case study approach. FINDINGS: Geriatric assessment is key to identifying deficits and disabilities in older adults with cancer and is a critical component in oncology treatment planning. Evidence-based, less invasive treatment options are available and offer older adults more tolerable oncologic therapies.


Assuntos
Avaliação Geriátrica/métodos , Enfermagem Geriátrica/organização & administração , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Cuidados Paliativos/métodos , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Terapia Combinada , Medicina Baseada em Evidências , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Equipe de Assistência ao Paciente/organização & administração , Pneumonectomia/métodos , Prognóstico , Medição de Risco , Análise de Sobrevida , Sobrevivência
11.
Clin J Oncol Nurs ; 22(6): 8-18, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30452021

RESUMO

BACKGROUND: Frailty is defined as a disability in those of advanced age, often with comorbidities, poor nutritional status, cognitive decline, and reduced functional status. OBJECTIVES: The purpose of this article is to discuss the concept of frailty, assess the use of a comprehensive geriatric assessment (CGA), and understand the implications for treatment to maintain or enhance physical, functional, and cognitive health of older adult patients with cancer. METHODS: Literature about frailty in older adult patients diagnosed with cancer was reviewed to determine evidence-based assessment and treatment options. FINDINGS: About half of all older adult patients with cancer experience some degree of frailty. CGA is a useful way to evaluate frailty and the extent of limitations. Many frailty-specific tools have been developed. Evidence-based strategies are available to address limitations associated with frailty in older adult patients with cancer.


Assuntos
Atividades Cotidianas , Fragilidade/diagnóstico , Fragilidade/enfermagem , Avaliação Geriátrica/métodos , Neoplasias/terapia , Avaliação em Enfermagem/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Tomada de Decisões , Medicina Baseada em Evidências , Feminino , Enfermagem Geriátrica/organização & administração , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Neoplasias/diagnóstico , Índice de Gravidade de Doença
12.
J Nurs Scholarsh ; 50(5): 513-521, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30051573

RESUMO

PURPOSE: To test the relationships between the geriatric practice environment, geriatric nursing practice, and overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics. DESIGN: A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada. METHODS: Participants (N = 2,005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling. FINDINGS: Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (ß = 0.52) and overall quality of care (ß = 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (ß = -0.02). Final model fit was acceptable, with the root mean square error of approximation = 0.07, comparative fit index = 0.93, and Tucker-Lewis Index = 0.87. CONCLUSIONS: A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice. CLINICAL RELEVANCE: The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.


Assuntos
Enfermagem Geriátrica/normas , Serviços de Saúde para Idosos/normas , Qualidade da Assistência à Saúde/normas , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Enfermagem Geriátrica/organização & administração , Humanos , Masculino , Recursos Humanos de Enfermagem no Hospital , Ontário , Inquéritos e Questionários
13.
Int J Health Plann Manage ; 33(4): e1100-e1111, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30052282

RESUMO

BACKGROUND: Community Nurse Supporting Elderly iN a changing SOciety is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship, and this work highlights the necessary conditions for the existence of these entrepreneurial initiatives on the market, with community nurses' services purchased by the public health care system. METHODS: The authors propose a sustainability framework for this project based on three relevant dimensions (ie, health, organisation, and context), highlighting the necessary conditions for continued provision of health services beyond project conclusion. Then, considering the Piedmont Region and those aged 65 or older as target population, health outcomes are analysed, proposing a break-even analysis to calculate expected levels. RESULTS: According to our results, in order to care for 191 977 elderly people for 3 years, a successful pro-active approach is needed to prevent 1657 falls with hip fracture, reducing the prevalence of this adverse outcome by 36%. These are the expected health outcome levels for the existence of a social market, which can be achieved through the successful involvement of local public health organisations and stakeholders. CONCLUSIONS: Policy makers need clear information on the economic impact of extending this new intervention to the whole target population and on the required preconditions for its financial sustainability in terms of health outcomes. However, a participatory process involving all relevant local stakeholders and organisations is crucial to extend current achievements beyond project conclusion.


Assuntos
Enfermagem em Saúde Comunitária , Enfermagem Geriátrica , Envelhecimento Saudável , Idoso , Enfermagem em Saúde Comunitária/economia , Enfermagem em Saúde Comunitária/métodos , Enfermagem em Saúde Comunitária/organização & administração , Enfermagem Geriátrica/economia , Enfermagem Geriátrica/métodos , Enfermagem Geriátrica/organização & administração , Custos de Cuidados de Saúde , Humanos , Itália , Avaliação de Programas e Projetos de Saúde
14.
J Clin Nurs ; 27(21-22): 3872-3881, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29893469

RESUMO

AIMS AND OBJECTIVES: The aim of this literature review is to synthesise and analyse the literature pertinent to the RN's competence and confidence to undertake the leadership role when working in residential aged care facilities after-hours and to determine any association of leadership with quality resident outcomes. BACKGROUND: Registered nurses (RNs) working in Residential Aged Care Facilities are required to undertake complex management tasks including leading nursing care teams, supervising non-nursing staff and allocating workloads according to residents' care needs, staff skills and experience. Registered nurses plan, assess, manage medication, evaluate each resident's care, liaise with doctors and allied health professionals and are responsible for evidence-based practice in accordance with the Nursing Standards for Practice (2016). Researchers have commented that effective nurse leadership can improve quality of care, improved resident outcomes and reduce adverse events. DESIGN: A review of original research papers based on the structured methodology described by Kable, Pich, and Maslin-Prothero (Nurse Education Today, 32, 2012, 878-886). METHODS: The review was conducted according to the 12-step structured framework by Kable et al. (Nurse Education Today, 32, 2012, 878-886). The search included peer-reviewed papers published between 2002-2017 on RN leadership after-hours, factors contributing to or with relationships to nursing leadership. Nineteen papers were found that researched the impact of leadership in aged care settings. RESULTS: The literature review concluded that nursing leadership has been linked to the quality of care and clinical outcomes in the aged care setting. However, RNs in the aged care setting have limited opportunities to develop key leadership competencies and confidence in order to meet the many challenges found in this environment due to lack of access to aged-care-specific leadership education. Minimal publications address the importance of the leadership of after-hours RNs. Results from this literature review will inform future research in this area. CONCLUSION: Nineteen papers identified the leadership required of RNs in aged care settings. However, limited research investigating the association between nursing leadership and clinical outcomes was found. The findings from this literature review suggest that leadership in the aged care setting may be facilitated through specific educational activities such as RN shadowing shifts, continuing professional development, working with peers and by demonstrating and practising leadership competencies. Based on the literature reviewed, a need for more research in this area is required. In a specific manner, research into RN leadership, competence and confidence in aged care facilities after-hours is needed. RELEVANCE TO CLINICAL PRACTICE: Registered nurses working in the aged care setting after-hours need access to leadership education. Better quality of care, improved resident outcomes and reduced adverse events are associated with sound leadership.


Assuntos
Enfermagem Geriátrica/organização & administração , Instituição de Longa Permanência para Idosos , Liderança , Casas de Saúde , Plantão Médico , Competência Clínica , Enfermagem Geriátrica/educação , Humanos , Relações Interprofissionais , Papel do Profissional de Enfermagem
16.
Int J Older People Nurs ; 13(3): e12188, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29527828

RESUMO

BACKGROUND: Care of older adults in the community is becoming increasingly complex. However, nursing staff often has insufficient knowledge and skills to adequately address the needs of frail older adults. There is therefore a need for nurses with advanced qualifications. To meet this need, advanced geriatric nursing has been introduced in Norway. AIMS AND OBJECTIVES: This study aimed to describe the experiences of nurses with their new role as advanced geriatric nurses in care of older adults and to determine what strategies the nurses considered important in the development of their new role. DESIGN: This study applied a descriptive, exploratory design. METHODS: In-depth interviews were conducted with 21 nurses who had undergone an educational programme to become advanced geriatric nurses in Norway in 2016. Content analysis was used to analyse the data. FINDINGS: The participants described a complex and extensive nursing role, which they related to a new understanding of the patients, relatives and the system in which they worked. This new gaze had developed based on a combination of their new knowledge, their skills, experiences and professional interests. The opportunities to use their role depended on their workplace conditions. They related to contextual challenges at their workplace in different ways to optimise the use of their new gaze. CONCLUSIONS: Common for all participants was a broader and deeper understanding of the patient's health and life situation, which guided participants' actions. The key issue in developing the new role was developing effective strategies to foster role integration. IMPLICATIONS FOR PRACTICE: Advanced geriatric nurses should collaborate with their managers to create a role that takes advantage of their knowledge and skills, as well as collaborate with colleagues to enhance understanding of utilisation of their role.


Assuntos
Prática Avançada de Enfermagem/organização & administração , Enfermagem Geriátrica/organização & administração , Papel do Profissional de Enfermagem , Adulto , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Noruega
17.
J Am Geriatr Soc ; 66(3): 446-451, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29473940

RESUMO

This article is based on the M. Powell Lawton Award Lecture that I delivered at the 2016 Gerontological Society of America Annual Meeting. I provide an overview of my journey in geriatric medicine and delirium research. I created new measures, including the Confusion Assessment Method, for identification of delirium; conceptualized a multifactorial risk model; and developed and tested intervention strategies for delirium prevention. The Hospital Elder Life Program arose from this work. In addition, like Dr. Lawton, I am working to apply my work to the policy arena. As the population ages, we face an unprecedented opportunity to realize the full benefit of aging in our society, an untapped resource. The field of aging is facing innumerable challenges in terms of continued stigma and funding shortfalls for clinical care and research. I issue a call to action to clinicians, researchers, and leaders in aging to seize this opportunity to use our know-how and expertise to transform the experience of aging for all.


Assuntos
Delírio/enfermagem , Enfermagem Geriátrica/organização & administração , Serviços de Saúde para Idosos/organização & administração , Assistência Centrada no Paciente/organização & administração , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Delírio/prevenção & controle , Avaliação Geriátrica/métodos , Humanos
19.
J Am Geriatr Soc ; 66(3): 459-466, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29318583

RESUMO

OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period. MEASUREMENTS: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0-30) and 72-hour ED revisits. RESULTS: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: -9.9% risk of inpatient admission, 95% confidence interval (CI) = -12.3% to -7.5%; site 2: -16.5%, 95% CI = -18.7% to -14.2%; site 3: -4.7%, 95% CI = -7.5% to -2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7-2.3%; site 2: 1.4%, 95% CI = 0.7-2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: -7.8%, 95% CI = -10.3% to -5.3%; site 2: -13.8%, 95% CI = -16.1% to -11.6%). CONCLUSION: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Enfermagem Geriátrica/organização & administração , Alta do Paciente/estatística & dados numéricos , Cuidado Transicional/organização & administração , Idoso , Feminino , Avaliação Geriátrica/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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