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1.
Can Fam Physician ; 69(2): 114-124, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36813522

RESUMO

OBJECTIVE: To characterize transitions to acute and residential care and identify variables associated with specific transitions among community-based persons living with dementia (PLWD). DESIGN: Retrospective cohort study using primary care electronic medical record data linked with health administrative data. SETTING: Alberta. PARTICIPANTS: Adults aged 65 years or older living in the community who had been diagnosed with dementia and who saw a Canadian Primary Care Sentinel Surveillance Network contributor between January 1, 2013, and February 28, 2015. MAIN OUTCOME MEASURES: All emergency department visits, hospitalizations, residential care (supportive living and long-term care) admissions, and deaths within a 2-year follow-up period. RESULTS: In total, 576 PLWD were identified who had a mean (SD) age of 80.4 (7.7) years; 55% were female. In 2 years, 423 (73.4%) had at least 1 transition and, of these, 111 (26.2%) had 6 or more. Emergency department visits, including multiple visits, were common (71.4% had ≥1, 12.1% had ≥4). Of those hospitalized (43.8%), nearly all were admitted from the emergency department; the average (SD) length of stay was 23.6 (35.8) days, and 32.9% had at least 1 alternate level of care day. In total, 19.3% entered residential care, most admitted from hospital. Those admitted to hospital and those admitted to residential care were older and had greater historical health system use, including home care. One-quarter of the sample did not have any transitions (or die) during follow-up; they were typically younger and had limited historical health system use. CONCLUSION: Older PLWD experienced frequent, and frequently compound, transitions that have implications for them, their family members, and the health system. There was also a large proportion without transitions suggesting that appropriate supports enable PLWD to do well in their own communities. The identification of PLWD who are at risk of or who make frequent transitions may allow for more proactive implementation of community-based supports and smoother transitions to residential care.


Assuntos
Demência , Serviços de Assistência Domiciliar , Adulto , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Masculino , Estudos Retrospectivos , Alberta , Hospitalização
2.
Am J Gastroenterol ; 117(12): 2017-2024, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36087105

RESUMO

INTRODUCTION: The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess (i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE) and (ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools, and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving. METHODS: Patients were prospectively recruited from 2 tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. The χ 2 test and 1-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]). RESULTS: Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, and 36% with a history of overt hepatic encephalopathy. Thirty percent met MHE criteria on both the psychometric hepatic encephalopathy score and the Stroop app tests. Only 2 patients (3%) were categorized as "unfit to drive" in the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients were scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 [SD 2.1] vs 4.2 [SD 1.6] in those who passed the DCAT, P = 0.01). Older age (odds ratio 1.3; confidence interval 1.1, 1.5; P = 0.001) and MHE by Stroop/psychometric hepatic encephalopathy score (odds ratio 11.0; confidence interval 2.3, 51.8; P = 0.002) were independently predictive of worse performance on the DCAT. DISCUSSION: Worse performance in in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance.


Assuntos
Encefalopatia Hepática , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/psicologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Psicometria , Testes Neuropsicológicos , Modelos Logísticos
3.
Am J Gastroenterol ; 113(10): 1506-1515, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30267028

RESUMO

INTRODUCTION: Hepatic encephalopathy (HE) is the most common potentially modifiable reason for admission in patients with cirrhosis. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for HE. We aimed to assess the utility of a composite score (MoCA-CFS) developed using the Montreal Cognitive Assessment (MoCA) and the Clinical Frailty Scale (CFS) for predicting HE admissions within 6 months. METHODS: Consecutive adult patients with cirrhosis were followed for 6 months or until death/transplant. Patients with overt HE and dementia were excluded. Primary outcome was the prediction of HE-related admissions at 6 months. RESULTS: A total of 355 patients were included; mean age 55.9 ± 9.6; 62.5% male; Hepatitis C and alcohol etiology in 64%. Thirty-six percent of patients had cognitive impairment according to the MoCA (≤24) and 14% were frail on the CFS (>4). The MoCA-CFS independently predicted HE hospitalization within 6 months, a MoCA-CFS score of 1 and 2 respectively increasing the odds of hospitalization by 3.3 (95% CI:1.5-7.7) and 5.7 (95% CI:1.9-17.3). HRQoL decreased with increasing MoCA-CFS. Depression and older age were independent predictors of a low MoCA. CONCLUSIONS: Cognitive and physical frailty are common in patients with cirrhosis. In addition to being an independent predictor of HE admissions within 6 months, the MoCA-CFS composite score predicts impaired HRQoL and all-cause admissions within 6 months. These data support the predictive value of a "multidimensional" frailty tool for the prediction of adverse clinical outcomes and highlight the potential for a multi-faceted approach to therapy targeting cognitive impairment, physical frailty and depression.


Assuntos
Disfunção Cognitiva/diagnóstico , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Encefalopatia Hepática/diagnóstico , Hospitalização/estatística & dados numéricos , Cirrose Hepática/complicações , Idoso , Disfunção Cognitiva/psicologia , Feminino , Fragilidade/psicologia , Avaliação Geriátrica/estatística & dados numéricos , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/psicologia , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
4.
Am Fam Physician ; 96(7): 453-461, 2017 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29094913

RESUMO

Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Coartação Aórtica/complicações , Síndrome de Cushing/complicações , Quimioterapia Combinada , Feminino , Humanos , Hiperaldosteronismo/complicações , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fatores de Risco , Adulto Jovem
5.
Can Fam Physician ; 63(1): e21-e30, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28115457

RESUMO

OBJECTIVE: To examine FPs' training needs for conducting decision-making capacity assessments (DMCAs) and to determine how training materials, based on a DMCA model, can be adapted for use by FPs. DESIGN: A scoping review of the literature and qualitative research methodology (focus groups and structured interviews). SETTING: Edmonton, Alta. PARTICIPANTS: Nine FPs, who practised in various settings, who chose to attend a focus group on DMCAs. METHODS: A scoping review of the literature to examine the current status of physician education regarding assessment of decision-making capacity, and a focus group and interviews with FPs to ascertain the educational needs of FPs in this area. MAIN FINDINGS: Based on the scoping review of the literature, 4 main themes emerged: increasing saliency of DMCAs owing to an aging population, suboptimal DMCA training for physicians, inconsistent approaches to DMCA, and tension between autonomy and protection. The findings of the focus groups and interviews indicate that, while FPs working as independent practitioners or with interprofessional teams are motivated to engage in DMCAs and use the DMCA model for those assessments, several factors impede their conducting DMCAs. The most notable barriers were a lack of education, isolation from interprofessional teams, uneasiness around managing conflict with families, fear of liability, and concerns regarding remuneration. CONCLUSION: This pilot study has helped to inform ways to better train and support FPs in conducting DMCAs. Family physicians are well positioned, with proper training, to effectively conduct DMCAs. To engage FPs in the process, however, the barriers should be addressed.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Adulto , Alberta , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Projetos Piloto , Pesquisa Qualitativa
6.
Can Fam Physician ; 60(11): e521-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25551143

RESUMO

PROBLEM ADDRESSED: The population is aging rapidly and there are implications for health care delivery in the face of few physicians specializing in care of the elderly (COE). OBJECTIVE OF PROGRAM: To train physicians wishing to provide COE services. PROGRAM DESCRIPTION: The COE program at the University of Alberta in Edmonton is an enhanced skills diploma program lasting 6 months to 1 year, with core program requirements including geriatric inpatient care,geriatric psychiatry, ambulatory care, continuing care, and outreach. There is a longitudinal clinic component and a research project requirement. The program is designed to cover the 85 core competencies in the Can MEDS-Family Medicine roles. CONCLUSION: There is a need for COE physicians to provide clinical care as well as fill educational, administrative, and research roles to meet the health care needs of medically complex seniors. These physicians require alternative funding and a departmental home within a university if they are to provide an academic service.


Assuntos
Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Geriatria/educação , Internato e Residência , Idoso , Alberta , Educação de Pós-Graduação em Medicina/organização & administração , Avaliação Educacional , Humanos , Internato e Residência/organização & administração , Universidades , Recursos Humanos
7.
Can Fam Physician ; 60(5): 457-65, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24829010

RESUMO

OBJECTIVE: To assess the current identification and management of patients with dementia in a primary care setting; to determine the accuracy of identification of dementia by primary care physicians; to examine reasons (triggers) for referral of patients with suspected dementia to the geriatric assessment team (GAT) from the primary care setting; and to compare indices of identification and management of dementia between the GAT and primary care network (PCN) physicians and between the GAT and community care (CC). DESIGN: Retrospective chart review and comparisons, based on quality indicators of dementia care as specified in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, were conducted from matching charts obtained from 3 groups of health care providers. SETTING: Semirural region in the province of Alberta involving a PCN, CC, and a GAT. PARTICIPANTS: One hundred patients who had been assessed by the GAT randomly selected from among those diagnosed with dementia or mild cognitive impairment by the GAT. MAIN OUTCOME MEASURES: Diagnosis of dementia and indications of high-quality dementia care listed in PCN, CC, and GAT charts. RESULTS: Only 59% of the patients diagnosed with dementia by the GAT had a documented diagnosis of dementia in their PCN charts. None of the 12 patients diagnosed with mild cognitive impairment by the GAT had been diagnosed by the PCN. Memory decline was the most common reason for referral to the GAT. There were statistically significant differences between the PCN and the GAT on all quality indicators of dementia, with underuse of diagnostic and functional assessment tools and lack of attention to wandering, driving, medicolegal, and caregiver issues, and underuse of community supports in the PCN. There was higher congruence between CC and the GAT on assessment and care indices. CONCLUSION: Dementia care remains a challenge in primary care. Within our primary care setting, there are opportunities for synergistic collaboration among the health care professionals from the PCN, CC, and the GAT. Currently they exist as individual entities in the system. An integrated model of care is required in order to build capacity to meet the needs of an aging population.


Assuntos
Demência , Atenção Primária à Saúde/métodos , Idoso , Idoso de 80 Anos ou mais , Alberta , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Demência/diagnóstico , Demência/terapia , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Encaminhamento e Consulta , Estudos Retrospectivos
8.
Prof Case Manag ; 29(5): 198-205, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39058563

RESUMO

BACKGROUND: Improving transitions in care is a major focus of health care planning. In the research team's prior intervention study, the length of stay (LOS) was reduced when patients at high risk for readmission were identified early in their acute care stay and received complex management. OBJECTIVE: This study will describe the characteristics of patients receiving complex case management in an urban acute care hospital. PRIMARY PRACTICE SETTING: Acute care hospital. METHODOLOGY AND SAMPLE: This was a retrospective chart review of patients in a previous quality assurance study. A random selection of patients who previously underwent high-risk screening using the LACE (Length of stay; Acuity of the admission; Comorbidity of the patient; Emergency department use) index and received complex case management (the intervention group) were reviewed. The charts of a random selection of patients from the previous comparison group were also reviewed. Patient characteristics were collected and compared using descriptive statistics. RESULTS: In the intervention group, more patients had their family physicians (FPs) documented (93.1% [81/87] vs. 89.2% [66/74]). More patients in the intervention group (89.7% [77/87] vs. 85.1% [63/74]) lived at home prior to admission. More patients in the intervention group had a family caregiver involved (44.8% [39/87] vs. 41.9% [31/74]). At discharge, more patients in the intervention group (87.1% [74/85]) were discharged home compared with the comparison group (78.4% [58/74]). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: (1) Having an identified FP, living at home, and having family caregiver(s) characterized those with lower LOS and discharged home. (2) Case management, risk screening, and discharge planning improve patient outcomes. (3) This study identified the importance of having a FP and engaged family caregivers in improving care outcomes.


Assuntos
Administração de Caso , Humanos , Administração de Caso/normas , Administração de Caso/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Idoso , Tempo de Internação/estatística & dados numéricos , Idoso de 80 Anos ou mais , Adulto , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/normas
9.
Age Ageing ; 42(5): 577-81, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23896609

RESUMO

BACKGROUND: the medical community plays an important role in identifying drivers who may no longer be competent to drive due to illnesses such as dementia. Several office-based cognitive screening tools are currently used by the medical community, e.g. Mini-Mental State Examination, Trail Making Test (TMT), to assist in the identification of cognitively impaired (CI) at-risk drivers. However, the predictive validity of these tools is questionable. OBJECTIVE: to examine the predictive power of the TMT for on-road driving performance. METHODS: data from a prospective sample of CI and healthy older drivers were collected. TMT-A and -B (time and errors) served as predictor variables, with pass/fail on a scientifically based on-road assessment used as the criterion variable. Receiver operating characteristic (ROC) curve analysis was used to assess overall 'diagnostic' accuracy of TMT-A and -B for driving competency. Cut points from previous studies/guidelines were used to assess predictive power. FINDINGS: a total of 134 older drivers (mean age = 75.30; SD = 7.83) participated: 87 healthy controls and 47 CI individuals. All predictor variables, with the exception of TMT-A errors, were significantly correlated with driving outcome. However, results from ROC curve analyses indicated that only TMT-A and -B total time had moderate discriminative abilities. Results also indicate that the power of the TMT is the lowest where physicians need it most (e.g. identifying CI patients whose driving skills have declined to an unsafe level). CONCLUSION: TMT-A and -B outcomes are most likely to be inaccurate in those whose driving competency has declined to an unsafe level, resulting in risks to both individual and public safety.


Assuntos
Envelhecimento/psicologia , Exame para Habilitação de Motoristas , Condução de Veículo/psicologia , Cognição , Disfunção Cognitiva/diagnóstico , Teste de Sequência Alfanumérica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Humanos , Destreza Motora , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Análise e Desempenho de Tarefas , Fatores de Tempo
10.
Artigo em Inglês | MEDLINE | ID: mdl-35886490

RESUMO

Family caregiving is a public health issue because of caregivers' significant contribution to the health and social care systems, as well as the substantial impact that giving and receiving care has on the health and quality of life of care receivers and caregivers. While there have been many studies that associate caregivers' care work, financial difficulty, navigation, and other caregiving factors with family caregivers' psychological distress, we were interested not only in the factors related to family caregiver anxiety but also in hypothesizing how those effects occur. In this study, we used Andrew Hayes' PROCESS moderation analysis to explore the link between caregiver frailty, weekly care hours, and perceptions of financial difficulty, social support, and anxiety. In this analysis, we included 474 caregivers with relatively complete data on all of the variables. In regression analysis after controlling for gender and age, social loneliness (ß = 0.245), frailty (ß = 0.199), financial difficulty (ß = 0.196), care time (ß = 0.143), and navigation confidence (ß = 0.131) were all significant. We then used PROCESS Model 6 to determine the significance of the direct, indirect, and total effects through the serial mediation model. The model pathway from frailty to care time to financial difficulty to social loneliness to anxiety was significant. The proportions of family caregivers who were moderately frail, anxious, and experiencing social loneliness after eighteen months of the COVID-19 pandemic found in this survey should be of concern to policymakers and healthcare providers.


Assuntos
COVID-19 , Fragilidade , COVID-19/epidemiologia , Canadá/epidemiologia , Cuidadores/psicologia , Família/psicologia , Humanos , Análise de Mediação , Pandemias , Qualidade de Vida
11.
Can J Aging ; 41(2): 176-183, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34321124

RESUMO

It is estimated that approximately half of adults, older than 65 years of age, have been prescribed potentially inappropriate medications (PIMs). This study's objective was to determine the prevalence of PIM use among older patients. Two retrospective chart reviews were performed on 200 and 164 older patients who underwent comprehensive geriatric assessments (CGAs) at outpatient geriatrics clinics at the Glenrose Rehabilitation Hospital (Glenrose) in 2012-13 and at the Misericordia Community Hospital (Misericordia) in 2016-17, respectively. Outcome measures included demographics; prevalence of PIM use; common PIMs used; whether PIM use was addressed, and if so, how; and total number of oral medications. At the Glenrose, the prevalence of PIM use was 45 per cent (90/200). Of the 90 patients who had used PIMs, 46.7 per cent (42/90) had at least one of their medications stopped or modified. At the Misericordia, the prevalence of PIM use was 57.3 per cent (94/164). Of the 94 patients who used PIMs, 47.9 per cent (45/94) had at least one of their medications stopped or modified. These results suggest that an increased awareness of PIM among physicians is needed to further decrease PIM use.


Assuntos
Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Humanos , Polimedicação , Prevalência , Estudos Retrospectivos
12.
Healthcare (Basel) ; 10(7)2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35885682

RESUMO

Even before the COVID-19 pandemic, earlier acute care patient discharges, restricted admissions to long-term care, and reduced home care services increased the amount and complexity of family caregivers' care work. However, much less is known about rural caregivers' experiences. Thus, our aim in this sequential mixed-methods study was to understand how COVID-19 affected rural family caregivers. Thematically analyzed interviews and linear regression on survey data were used to understand family caregiver stress. Fourteen rural caregivers participated in interviews. They acknowledged that they benefitted from the circle of support in rural communities; however, they all reported having to cope with fewer healthcare and social services. 126 rural caregivers participated in the online survey. About a third (31%) of these caregivers had moderate frailty, indicating that they could benefit from support to improve their health. In linear regression, frailty, social loneliness, financial hardship, and younger age were associated with caregiver anxiety. Contrary to the qualitative reports that people in rural communities are supportive, over two-thirds of the rural caregivers completing the survey were socially lonely. Rural family caregivers are vulnerable to anxiety and social loneliness due to the nature of caregiving and the lack of healthcare and social service supports in rural areas. Primary healthcare and home care teams are well-positioned to assess caregivers' health and care situation as well as to signpost them to needed supports that are available in their areas.

13.
Health Soc Care Community ; 30(3): 856-868, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34558143

RESUMO

Family caregiving scholars recommend that health providers receive competency-based education to partner with and support family caregivers to care and to maintain their own health. While it may be relatively easy to develop competency-based education for healthcare providers, ensuring widespread uptake and spread and scale of healthcare education is critical to ensuring consistent person-centered support for all family caregivers (FCGs) throughout the care trajectory. The development of novel healthcare innovations requires implementation strategies for uptake and spread, with implementation involving the use of strategies to integrate a novel innovation into healthcare. Research suggests that there are many factors involved in successful implementation and a synthesis of potential factors is warranted. The purpose of this review is to provide an in-depth examination of facilitators, barriers and considerations for implementation of a novel healthcare innovation that will be used to develop an implementation plan for spread and scale of our competency-based education for health providers to learn about person-centered care for FCGs. A systematic review of published and grey literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA [Moher et al., 2015]) guidelines. The systematic review involved searching four databases for original research articles that described barriers, facilitators and/or other considerations when implementing innovations. Twenty-eight articles were included in the qualitative thematic analyses and described three areas of implementation research: barriers, facilitators and recommendations. There were major and parallel themes that emerged under facilitators and barriers. There were a wide variety of strategies that were identified as recommendations. The findings were synthesised into five considerations for implementation: Research and information sharing, intentional implementation planning, organisational underpinnings, creating the clinical context and facilitative training. This review provides an integrative overview of identified facilitators, barriers and recommendations for implementation that may aid in developing implementation strategies that can be tailored to the local context or innovation being implemented.


Assuntos
Atenção à Saúde , Pessoal de Saúde , Instalações de Saúde , Humanos
14.
Artigo em Inglês | MEDLINE | ID: mdl-35162581

RESUMO

BACKGROUND: With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS: This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006-2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS: Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION: This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.


Assuntos
Freiras , Idoso , Tomada de Decisões , Pessoal de Saúde , Hospitais Comunitários , Humanos , Médicos de Família , Estudos Retrospectivos
15.
Artigo em Inglês | MEDLINE | ID: mdl-34639311

RESUMO

We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.


Assuntos
COVID-19 , Cuidadores , Ansiedade/epidemiologia , Humanos , Solidão , Pandemias , SARS-CoV-2
16.
J Prim Care Community Health ; 12: 21501327211044058, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34486428

RESUMO

INTRODUCTION: The Evidence-Based Care of the Elderly Health Guide is a clinical guide with cross-references for care recommendations. This guide is an innovative adaptation of the Rourke Baby Record to support elderly care. In 2003, the guide was published with an endorsement from the Health Care-of-the-Elderly Committee of the College of Family Physicians of Canada. Since then, physicians have used the guide as a checklist and a monitoring tool for care to elderly patients. OBJECTIVE: We will update the 2003 Care-of-the-Elderly Health Guide with current published evidence-based recommendations. METHODS: This was a mixed methods study consisting of (1) the creation of a list of topics and corresponding guidelines or recommendations, (2) two focus group discussions among family physicians (n = 12) to validate the list for relevance to practice, and (3) a modified Delphi technique in a group of ten experts in Care of the Elderly and geriatrics to attain consensus on whether the guidelines/recommendations represent best practice and be included. RESULTS: The initial list contained 43 topics relevant to family practice, citing 49 published guidelines or recommendations. The focus group participants found the list of topics and guidelines potentially useful in clinical practice and emphasized the need for user-friendliness and clinical applicability. In the first online survey of the modified Delphi technique, 93% (63/66) of the references attained consensus that these represented standards of care. The other references (3/66) attained consensus in the second online survey. The final list contained 47 topics, citing 66 references. CONCLUSION: The Care-of-the-Elderly Health Guide is a quick reference to geriatric care, reviewed for relevance by family physicians and a panel of experts. The Guide is intended to be used in primary care practice.


Assuntos
Medicina de Família e Comunidade , Médicos de Família , Idoso , Canadá , Atenção à Saúde , Humanos , Atenção Primária à Saúde
17.
Diseases ; 9(4)2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34698124

RESUMO

COVID-19 has had a negative impact on family caregivers, whether the care receivers lived with the caregiver, in a separate community home, in supportive living, or in long-term care. This qualitative study examines the points of view of family caregivers who care in diverse settings. Family caregivers were asked to describe what could have been done to support them during the COVID-19 pandemic and to suggest supports they need in the future as the pandemic wanes. Thorne's interpretive qualitative methodology was employed to examine current caregiver concerns. Thirty-two family caregivers participated. Family caregivers thought the under-resourced, continuing care system delayed pandemic planning, and that silos in health and community systems made caregiving more difficult. Family caregivers want their roles to be recognized in policy, and they cite the need for improvements in communication and navigation. The growth in demand for family caregivers and their contributions to the healthcare system make it critical that the family caregiver role be recognized in policy, funding, and practice.

18.
Artigo em Inglês | MEDLINE | ID: mdl-33806725

RESUMO

BACKGROUND: Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. METHODS: We adopted an interpretive description design to explore family physicians and primary care team members' perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. RESULTS: Ten physicians and 42 team members participated. We identified three major themes. "Family physicians and primary care teams can be a valuable source of support for family caregivers" highlighted these primary care team members' broad recognition of the need to support family caregiver's health. "What stands in the way" spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, "A structured approach may be a way forward." CONCLUSION: A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.


Assuntos
Cuidadores , Médicos de Família , Grupos Focais , Pessoal de Saúde , Humanos , Atenção Primária à Saúde
19.
J Am Geriatr Soc ; 69(4): E9-E12, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33586782

RESUMO

BACKGROUND/OBJECTIVES: As the elderly population and associated number of persons with dementia increase, so does the need for decision-making capacity assessments (DMCAs). Many healthcare professionals (HCPs), however, do not feel prepared to conduct DMCAs. We have provided 4-h DMCA workshops to HCPs since 2006 and offered physicians either a 3-h or 2-day DMCA workshop from 2013 to present. We evaluated the effectiveness of the workshops on self-reported key concepts of capacity. DESIGN: Pre-/post-test design. SETTING: DMCA workshops for physicians across Canada and HCPs within Alberta. PARTICIPANTS: Two hundred and eighty-one physicians and 835 HCPs. MEASUREMENTS: Pre-/post-workshop ratings on level of comfort with and understanding of 15 core DMCA concepts using 4-point Likert-type items. RESULTS: For the DMCA workshops among physicians, ten 3-h workshops were held in 2014-2015 with 166 participants and seven 2-day workshops, between 2014 and 2018, with 115 participants. With respect to the self-report on core DMCA concepts, at least 62.7% (range: 62.7%-89.6%) of physician participants had higher post-workshop ratings (sign test; p < 0.001) than pre-workshop ratings for all core DMCA concepts. For the DMCA workshops among HCPs, 4-h workshops were delivered to 835 HCP participants from 2008 to 2012. At least 49.6% of participants (range: 49.6%-78.9%) had increased post-workshop ratings (sign test; p < 0.001) for all level of comfort items with and understanding of core DMCA concepts. CONCLUSION: There is a need for DMCA training for physicians and HCPs. The content and method of the workshops are effective at enhancing self-reported level of comfort with and understanding of core DMCA concepts.


Assuntos
Envelhecimento/psicologia , Tomada de Decisões , Educação/métodos , Avaliação Geriátrica/métodos , Pessoal de Saúde/educação , Desenvolvimento de Pessoal/métodos , Idoso , Canadá , Cognição , Escolaridade , Função Executiva , Humanos , Avaliação de Programas e Projetos de Saúde
20.
Can Geriatr J ; 24(1): 26-35, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33680261

RESUMO

BACKGROUND: With an ageing population, the incidence of dementia will increase, as will the number of persons requiring decision-making capacity assessments. For over 10 years, we have trained family physicians in conducting decision-making capacity assessments. Physician feedback post-training, however, has highlighted the need to integrate the decision-making capacity assessment process into the primary care context. The purpose of this study was to develop a decision-making capacity assessment clinical pathway for implementation in primary care. METHODS: A qualitative exploratory case-study design was used to obtain participants' perspectives regarding the utility of a visual algorithm detailing a decision-making capacity assessment clinical pathway for use in primary care. Three focus groups were conducted with family physicians (n=4) and allied health professionals (n=6) in two primary care clinics in Alberta. A revised algorithm was developed based on their feedback. RESULTS: In the focus groups, participants identified inconsistencies and a lack of standardization regarding decision-making capacity assessments within primary care, and provided feedback regarding a decision-making capacity assessment clinical pathway to make it more applicable to primary care. Participants described this pathway as appealing and straightforward; they also made suggestions to make it more primary care-centric. Participants indicated that the presented pathway would improve teamwork and standardization of decision-making capacity assessments within primary care. CONCLUSIONS: Use of a decision-making capacity assessment clinical pathway has the potential to standardize decision-making capacity assessment processes in primary care, and support least intrusive and least restrictive patient outcomes for community-dwelling older adults.

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