Falls Prevention – Review of the evidence on fall prevention in hospitals

Review of the evidence on fall prevention in hospitals , February 2012, RAND

Click on the title above to access the full-text of this paper

Abstract:

To facilitate the development of a hospital falls prevention resource guide, this paper systematically reviews and documents the existing evidence base for interventions to prevent falls in hospitals and provides an overview of the performance of existing tools with known measurement properties. It also identifies a wide variety of tools for the prevention of falls in hospitals.

Lancashire Care staff can either click on the link above, or email: susan.jennings@lancashirecare.nhs.uk

Developing end of life care practice: A guide to workforce development to support social care and health workers to apply the common core principles and competences for end of life care

Developing end of life care practice: A guide to workforce development to support social care and health workers to apply the common core principles and competences for end of life care, National End of Life Programme, February 2012

Click on the title above to access the full-report

Abstract:

This guidance has been developed to ensure that workers involved in supporting someone who is at the end of their life are properly trained to be able to undertake their work effectively and appropriately.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Mindfulness & Bereavement – Care Model

ATTEND: Toward a Mindfulness-Based Bereavement Care Model, Death Studies, 2012, 36(1): 61-82

Abstract:

Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding, this article focuses on attunement as a means to moderate the negative effects of traumatic bereavement, support the framework for posttraumatic growth in the bereaved, improve psychological outcomes for providers, and set the stage for the other aspects of the ATTEND model.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient-centred intervention

Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient-centred intervention, Journal of Advanced Nursing, Volume 68, Number 2, 1 February 2012 , pp. 312-321

Tse, Mimi1 Leung, Rincy; Ho, Suki

Abstract:

Aim.  This article is a report on a study to examine the pain situation, the use of oral analgesics and non-pharmacological strategies and the psychological well-being of older patients living in nursing homes; the relationships between pain and psychological well-being were also explored.

Background. Pain is common among older adults world-wide, and tends to be under-treated. Indeed, the high prevalence of pain may further hinder the fulfilment of psychological needs in a Maslow hierarchy of needs model.

Method. It was a quantitative cross-sectional study; older adults from six nursing homes were invited to join the study in 2007-2009, with a response rate of 100%. Pain was measured using the Geriatric Pain Assessment, happiness using the Subjective Happiness Scale, life satisfaction using the Life Satisfaction Index – A Form, loneliness using the Revised UCLA Loneliness Scale and depression was measured using the Geriatric Depression Scale.

Results. A convenience sample of 302 older patients (213 females and 89 males aged from 60 to 101, mean age of 84·99) joined the study. The majority of them had experienced pain in the previous 3 months, with a pain intensity of 4·51 on a 10-point scale. Pain sites were mainly the knee, back, shoulder and musculoskeletal areas. Only 50% of them took oral analgesics, and 70% used non-pharmacological measures for pain relief. The pain group reported significantly more loneliness and depression when compared with their no-pain counterparts.

Conclusions.  As the number of older patients increases, so does the need for alternative accommodation; thus, pain management education is urgently needed for staff and nursing home residents

Lancashire care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

The many faces of dementia – We give you the information you need to recognize dementia so you can provide the best possible care for your patients

The many faces of dementia, Nursing Made Incredibly Easy! March/April 2012, Vol. 10 (2) p 26–35

Nancy Lerner

Abstract:

Dementia is an umbrella term used to describe a number of diseases caused by the destruction of brain tissue. Once considered an inevitability of aging, dementia can affect adults of any age. We give you the information you need to recognize dementia so you can provide the best possible care for your patients.

Nurses who work in acute care settings frequently encounter individuals experiencing dementia. Because these patients are hospitalized for other acute or chronic conditions, understanding the difference between delirium and the different types of dementia is difficult. As a result, nurses may experience stress when caring for these patients because treatment approaches differ for delirium and dementia. Occurring in adults of all ages, dementia—a global loss of cognitive ability that affects physical, social, and occupational functioning—encompasses many diseases and conditions, including Alzheimer disease (AD), vascular dementia, Parkinson disease (PD), and the less commonly known frontotemporal dementia and Lewy body dementia. Learning how to distinguish between the different types of dementia and recognizing the difference between delirium and various dementias can help reduce this stress.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Delivering the STAR program to care staff can have an impact on the behavioral and psychological symptoms of dementia displayed by care home residents – Staff training using STAR: a pilot study in UK care homes

Staff training using STAR: a pilot study in UK care homes, International Psychogeriatrics, 2012, early view

Judith Goyder, Martin Orrell, Jennifer Wenborn and Aimee Spector

Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT

Abstract:

Background: Symptoms such as depression, anxiety, and behavioral problems are very common in people with dementia living in care homes. Staff training has been identifed as a promising psychosocial intervention. This pilot study investigated the feasibility of implementing the Staff Training in Assisted Living Residences (STAR) program in UK care homes.

Methods: The eight-week STAR program was delivered in two care homes. Twenty-five care staff attended the training. Thirty-two residents, with dementia and clinically significant anxiety, depression, or behavioral problems, were included in the study. Residents and staff were assessed at baseline and eight-week follow-up.

Results: Residents demonstrated significantly reduced symptoms of depression and behavioral problems following the implementation of the program, although resident-rated quality of life and anxiety symptoms did not improve significantly. Staff sense of hopefulness towards people with dementia also improved significantly and staff rated themselves as significantly more competent at forming relationships with residents.

Conclusion: Delivering the STAR program to care staff can have an impact on the behavioral and psychological symptoms of dementia displayed by care home residents. The program was feasible to implement and was rated highly by care staff. A large-scale randomized controlled trial is now required to evaluate the effectiveness of this training intervention.

 

Lancashire care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia

Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia, International Psychogeriatrics, early view, 2012

Claudia Cooper, Naaheed Mukadam, Cornelius Katona, Constantine G. Lyketsos, David Ames, Peter Rabins, Knut Engedal, Carlos de Mendonça Lima, Dan Blazer, Linda Teri, Henry Brodaty and Gill Livingston 

 Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK

Abstract:

Background: People with dementia report lower quality of life, but we know little about what interventions might improve it.

Methods: We systematically reviewed 20 randomized controlled trials reporting the effectiveness of non-pharmacological interventions in improving quality of life or well-being of people with dementia meeting predetermined criteria. We rated study validity with a checklist. We contacted authors for additional data. We calculated standardized mean differences (SMD) and, for studies reporting similar interventions, pooled standardized effect sizes (SES).

Results: Pooled analyses found that family carer coping strategy-based interventions (four studies, which did not individually achieve significance; n = 420; SES 0.24 (range 0.03–0.45)) and combined patient activity and family carer coping interventions (two studies, not individually significant; n = 191; SES 0.84 (range 0.54–1.14)) might improve quality of life. In one high-quality study, a care management system improved quality of life of people with dementia living at home. Group Cognitive Stimulation Therapy (GCST) improved quality of life of people with dementia in care homes.

Conclusion: Preliminary evidence indicated that coping strategy-based family carer therapy with or without a patient activity intervention improved quality of life of people with dementia living at home. GCST was the only effective intervention in a higher quality trial for those in care homes, but we did not find such evidence in the community. Few studies explored whether effects continued after the intervention stopped. Future research should explore the longer-term impact of interventions on, and devise strategies to increase, life quality of people with dementia living in care homes or at home without a family carer.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Chronic Pain in Older Adults: A Controlled Pilot Trial of a Brief Cognitive-Behavioural Group Treatment

Chronic Pain in Older Adults: A Controlled Pilot Trial of a Brief Cognitive-Behavioural Group Treatment, Behavioural and Cognitive Psychotherapy, 2012

Gerhard Andersson

Abstract:

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain.

Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Preventing falls in older people: assessment and interventions

Preventing falls in older people: assessment and interventions, Nursing Standard, 2011 Aug 31-Sep 6; 25(52): 50-5

David Jones & Tracy Whitaker

Nurse consultant in older people and unplanned care, Liverpool Community Health NHS Trust, Liverpool, UK

Abstract:

Falls can have a devastating effect on older people. Physical injury and fear of further falls may restrict social and physical activities, leading to a lack of confidence and social isolation. Nurses need to assess patients who have fallen to identify injury as well as to instigate appropriate interventions to reduce the risk of further falls. This article provides an overview of the assessment tools and management strategies that can be used in daily practice, particularly in the community setting.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Rediscovering the Art of Healing Connection by Creating the Tree of Life Poster; A Pilot Program for Hospitalized Older Adults

Rediscovering the Art of Healing Connection by Creating the Tree of Life Poster; A Pilot Program for Hospitalized Older Adults, Journal of Gerontological Nursing, Jun 2010, Vol. 36, Iss. 6; pg. 47, 9 pgs

Abstract:

The goal of this project was to provide a way for hospital staff to form meaningful therapeutic relationships with patients in the fast-paced hospital environment. Watson’s Theory of Human Caring was the framework guiding the project. The Lifestory intervention was a Tree of Life poster depicting sources of encouragement and enjoyment, special memories, life lessons, family, and roots. Preintervention and postintervention measures included quality of life (QOL) and spirituality scales with established psychometrics. A one-sample t test was used to analyze data. Mean age of participants ( n = 15) was 73.8. Ten (67%) patients reported the intervention positively affected their QOL. Improvements were noted in overall QOL ( p = 0.05), as well as emotional ( p = 0.005), physical ( p = 0.02,) and spiritual well-being, as measured by the Expanded Version of the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale ( p = 0.02). This simple Lifestory intervention was feasible and associated with improvement in several QOL dimensions in hospitalized older adults.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Driving and Dementia: What Nurses Need to Know

Driving and Dementia: What Nurses Need to Know,  Journal of Gerontological Nursing.  Aug 2011. Vol. 37, Iss. 8; p. 10 (4 pages)

Nina M. Flanagan.

Abstract:

Driving is considered an instrumental activity of daily living and, for many older adults, is also associated with the ability to maintain independence. The diagnosis of dementia, distressing on its own, paired with the threat to driving independence, makes this a difficult issue for patients, families, and clinicians. The purpose of this article is to provide a brief overview of the current research regarding driving safety and dementia, guidelines that can be used to assess driving risk, and counseling tips for patients and families regarding driving safety.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Older people, particularly those who are frail, are vulnerable to dehydration – Use of Hypodermoclysis to manage dehydration

Use of Hypodermoclysis to manage dehydration, Nursing Older People, 2011 Jun; 23(5): 16-22

Katie Scales

Nurse consultant, critical care, Imperial College Healthcare NHS Trust, London

Abstract:

Older people, particularly those who are frail, are vulnerable to dehydration. Management of dehydration in older people can be more complex than in younger adults because of the physical effects of ageing. As the population ages, nurses will increasingly care for older patients in every setting. This article provides an overview of the physiological changes that affect the ability of older people to maintain a normal fluid balance. Risk factors for dehydration are reviewed and strategies for the prevention, detection and management of dehydration are discussed. The article focuses on subcutaneous fluid replacement for the management of dehydration in older adults.

Lancashire Care staff can reques the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Water for Healthy Ageing – Hydration best practice toolkit

Water for Healthy Ageing – Hydration best practice toolkit , 2005, Water, UK

Click on the title above to access the full-text of this toolkit

Abstract:

Guidance and factsheets to assist care managers, care caterers and other service providers to bring the benefits of improved water consumption to those in care.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Keeping the elderly hydrated – Hydration Toolkit for Hospitals and Healthcare

Water for Health- Hydration Toolkit for Hospitals and Healthcare, 2007, Part of the Royal College of Nursing Nutrition Now campaign

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Abstract:

Developed to help protect the well-being and safety of patients by encouraging hydration best practice in the hospital environment.

 

This toolkit was created as a resource within the Royal College of Nursing campaign Nutrition Now. It aims to assist nurses, healthcare workers, caterers and other service providers to introduce good hydration and to implement the health benefits of drinking enough water.

 

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students’ Attitudes towards Taking Care of Older People

A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students’ Attitudes towards Taking Care of Older People, Nursing Research and Practice, 2011,

Ann R. Lamet, Rosanne Sonshine, Sandra M. Walsh, David Molnar, and Sharon Rafalko

Abstract:

 

Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students’ attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students’ willingness to take care of them. Using a self-transcendence conceptual framework, control (n=56) and experimental (n=14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P=.008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P=.08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Nature & Therapeutic Environment – The therapeutic benefits to residents and staff

How nature can be used to create a therapeutic outdoor environment, Nursing Older People, 2011 Apr; 23(3): 16-9

Carol Davis

Leicestershire, UK

Abstract:

This article reports on a Royal Society for the Protection of Birds scheme introduced into a group of care homes to encourage more wildlife into their grounds. The therapeutic benefits to residents and staff are discussed, along with the work that went into getting the Homes for Wildlife project up and running. The scheme is now being rolled out to 300 homes across the UK.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Falls & Innovation – Technology Innovation Enabling Falls Risk Assessment in a Community Setting

Technology Innovation Enabling Falls Risk Assessment in a Community Setting, Ageing International, 2011, Volume 36, Number 2, 217-231

Abstract:

Approximately one in three people over the age of 65 will fall each year, resulting in significant financial, physical, and emotional cost on the individual, their family, and society. Currently, falls are managed using on-body sensors and alarm pendants to notify others when a falls event occurs. However these technologies do not prevent a fall from occurring. There is now a growing focus on falls risk assessment and preventative interventions. Falls risk is currently assessed in a clinical setting by expert physiotherapists, geriatricians, or occupational therapists following the occurrence of an injurious fall. As the population ages, this reactive model of care will become increasingly unsatisfactory, and a proactive community-based prevention strategy will be required. Recent advances in technology can support this new model of care by enabling community-based practitioners to perform tests that previously required expensive technology or expert interpretation. Gait and balance impairment is one of the most common risk factors for falls. This paper reviews the current technical and non-technical gait and balance assessments, discusses how low-cost technology can be applied to objectively administer and interpret these tests in the community, and reports on recent research where body-worn sensors have been utilized. It also discusses the barriers to adoption in the community and proposes ethnographic research as a method to investigate solutions to these barriers.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Alcohol – Hidden harm? – Alcohol Concern recommends professionals working with older people need to be aware of alcohol misuse

Hidden harm? Alcohol and older people in Wales , 2011, Alcohol Concern

Click on the title above to gain full-text access to the briefing

Abstract:

To make sure older people in Wales receive the support they need to enjoy alcohol healthily, Alcohol Concern is recommending that professionals working with older people need to be aware of alcohol misuse; better joint working is needed between local older people’s services and alcohol treatment services; and research is needed into whether current unit guidance and screening methods for alcohol misuse are relevant to older people.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Falls – The Fallsafe Project Using a care bundle to reduce falls in hospital

The Fallsafe Project Using a care bundle to reduce falls in hospital ,2011, British Geriatric Society

Click on the title above to access the resources and information to download

Abstract:

The FallSafe Project: a quality improvement programme that uses specially trained nurses to introduce an evidence based care bundle to reduce inpatient falls.

It is run by the Royal College of Physicians Clinical Effectiveness and Evaluation Unit in partnership with the Royal College of Nursing, the National Patient Safety Association, the Association for Victims of Medical Accidents and South Central Regional Health Authority.

It is funded by The Health Foundation, an independent charity funded by the insurance industry, which specialises in Quality Improvement projects.

Download:

Fallsafe Care Bundle (pdf)
Fallsafe Guidance Notes (pdf)
Falls Drug Guide (pdf)
NPSA Rapid Response Report

The FallSafe project was designed to overcome this stalemate, taking the elements of care found in successful Random Control Trials (RCT) of inpatient falls reduction from the review by Oliver et al1, and putting them together in a care bundle. The care bundle is evidence based in that individual elements have been used in successful studies of multifactorial interventions to reduce inpatient falls (but not in the sense that the whole bundle has been subjected to an RCT).

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Innovation – Nurse-led study shows a tool kit may be useful in reducing falls in hospitals

Nurse-led study shows a tool kit may be useful in reducing falls in hospitals, American Journal of Nursing 2011, 111(3) p. 14

Abstract:

The tool kit, tailored fall-prevention interventions to the patient, integrating health information technology with routine assessments of a patient’s risk of falling. The three compo­nents of the tool kit were patient-and family-friendly educational handouts, a plan of care for healthcare professionals, and an over-the-bed poster containing icons and brief descriptors of the patient’s fall risk and “action­able interventions” to mitigate that risk. The researchers calculated that the use of the tool kit could prevent one fall every four days, 7.5 falls per month, and about 90 falls yearly on the units in­volved in the study.

Lancashire Care staff can request the full-text of this article, email: susan.jennings@lancashirecare.nhs.uk

Falls Prevention – Best Articles from Age & Aging

Falls Collection, Age & Aging , 2011

click on the title above to access the collection free

The following articles have been selected by the Editor of Age and Ageing for inclusion in this special collection of the Journal’s best articles on falls, and are free to read online:

A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT)
March 2009; 38: 194-199
Jacques C. L. Neyens, Béatrice P. J. Dijcks, Jos Twisk, Jos M. G. A. Schols, Jolanda C. M. van Haastregt, Wim J. A. van den Heuvel and Luc P. de Witte

The Winchester falls project: a randomised controlled trial of secondary prevention of falls in older people
January 2009; 38: 33-40
Claire L. Spice, Wendy Morotti, Steve George, Thomas H. S. Dent, Jim Rose, Scott Harris, and Christopher J. Gordon
A systematic review and meta-analysis of studies using the STRATIFY tool for prediction of falls in hospital patients: how well does it work?
November 2008; 37: 621-627
David Oliver, Alexandra Papaioannou, Lora Giangregorio, Lehana Thabane, Katerina Reizgys, and Gary Foster
Positional vertigo in a falls service
September 2008; 37: 585-588
Joanna Lawson, Doris-Eva Bamiou, Helen S. Cohen, and Julia Newton
The effect of bedrails on falls and injury: a systematic review of clinical studies
July 2008; 37: 368-378
Frances Healey, David Oliver, Alisoun Milne and James B. Connelly
Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention
May 2008; 37: 306-310
Anne Bouwen, Jan De Lepeleire and Frank Buntinx
Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward
May 2008; 37: 277-281
Michael Vassallo, Lynn Poynter, Jagdish C. Sharma, Joseph Kwan and Stephen C. Allen
Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons
January 2008; 37 19-24
Alice C. Scheffer, Marieke J. Schuurmans, Nynke van Dijk, Truus van der Hooft, and Sophia E. de Rooij
Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions
November 2007; 36: 656-662
A. John Campbell and M. Clare Robertson
A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people
May 2007; 36: 262-268
Jean Woo, Athena Hong, Edith Lau, and Henry Lynn

Lancashire care staff can either click on the links or email: susan.jennings@lancashirecare.nhs.uk

Innovation – Leading for Outcomes – Dementia

Leading for Outcomes – Dementia , 2011, IRISS

Click on the title to access the full-text of this resource

Abstract:

can be used in conjunction with Leading for outcomes: a guide. This guide seeks to explore how staff can be supported to effectively practice an outcomes-focused approach within the context of dementia. It provides information about dementia including key policies and legislation as well as signposts to other relevant resources. The guide contains a number of exercises, each with supporting training materials for leaders to use and adapt as appropriate.

This guide is part of the IRISS Leading for Outcomes series designed to support team leaders, managers and trainers to lead social services teams in the adoption and implementation of an outcomes-focused approach. Contact Ellen Daly for more information.

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

Dementia diagnosis and management: a narrative review of changing practice

Dementia diagnosis and management: a narrative review of changing practice , British Journal of General Practice, Volume 61, Number 589, August 2011 , pp. e513-e525

Koch, Tamar; Iliffe, Steve

Department of Primary Care and Population Health, University College London, Royal Free and University College Medical School, London

Abstract:

Background

Early detection and management of dementia in primary care are difficult problems for practitioners. England’s National Dementia Strategy 2009 seeks to improve these areas but there is limited evidence on how to achieve this most effectively.

Aim

This review aims to identify and appraise empirical studies of interventions designed to improve the performance of primary care practitioners in these areas.

Design

A narrative review of primary-care based studies.

Method

Publications up to February 2010 were identified by searching the electronic databases MEDLINE, Embase, and PsycINFO, and bibliographies. The criterion for inclusion was that studies had to be of interventions aimed at improving detection or management of dementia in primary care. Exclusion criteria included studies in non-English publications, pharmacological interventions, and screening instrument studies. Quality was assessed using the PEDro (Physiotherapy Evidence Database) scale.

Results

Fifteen studies were identified, of which 11 were randomised controlled trials. Eight reported educational interventions, and seven trialled service redesign, either by changing the service pathway or by introducing case management. Educationally, only facilitated sessions and decision-support software improved GPs’ diagnosis of dementia, as did trials of service-pathway modification. Some of the case-management trials showed improved stakeholder satisfaction, decreased symptoms, and care that was more concordant with guidelines.

Conclusion

The quality of the studies varied considerably. Educational interventions are effective when learners are able to set their own educational agenda. Although modifying the service pathway and using case management can assist in several aspects of dementia care, these would require the provision of extra resources, and their value is yet to be tested in different health systems.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

OT – Maximising participation for older people: scoping the occupational therapy role in residential care settings

Maximising participation for older people: scoping the occupational therapy role in residential care settings, New Zealand Journal of Occupational Therapy, 2010 Sep; 57 (2): 49-55

Dorrestein M; Hocking C;

Abstract:

Based on the first author’s experience, options for occupational therapy practice within the New Zealand aged residential care sector are explored in light of current legislation, stretched health care funding, organisational challenges, and the increased dependence of residents. Literature from a variety of disciplines and perspectives is used to inform and support the investigation. A framework with six discrete focuses is presented to assist occupational therapists to conceptualise and prioritise their actions. Information about the needs, skills, and knowledge of residents, caregivers, and managers is outlined, along with approaches to the delivery of occupational therapy services that maximise opportunities for residents’ occupational engagement and participation in life.

 

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Fall prevention in the community: what older people say they need

Fall prevention in the community: what older people say they need, British Journal of Community Nursing, 2011 Apr; 16 (4): 174-80

Dickinson, Angela; Machen, Ina; Horton, Khim; Jain, Deepak; Maddex, Ted; Cove, Jenny

Senior Research Fellow, Centre for Research in Primary and Community Care (CRIPACC) University of Hertfordshire
Research Fellow, CRIPACC, University of Hertfordshire
Senior Lecturer (Clinical), Centre for Research in Nursing and Midwifery Education (CRNME), University of Surrey
Consultant Physician, Queen Elizabeth II Hospital, Hertfordshire
Senior Commissioning Manager, Hertfordshire County Council
Research Assistant, CRIPACC, University of Hertfordshire

Abstract:

Uptake of and adherence to fall prevention interventions is often poor and we know little about how older people’s perceptions of and beliefs about fall prevention interventions affect uptake. This study aimed to explore older people’s perceptions of the facilitators and barriers to participation in fall prevention interventions. We undertook a qualitative study with older people who had taken part in, declined to participate or adhere to fall prevention interventions using semi-structured interviews (n=65), and 17 focus groups (n=122) with older people (including 32 South Asian and 30 Chinese older people) in primary and community care settings in the South of England. A number of factors acted as either barriers or facilitators to uptake of interventions. Older people also made recommendations for improving access to interventions. Community nurses are ideally placed to screen older people, identify those at risk of falling and refer them to appropriate interventions as well as providing health promotion and education.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Managing risk, minimising restraint: Challenges, dilemmas and positive approaches for working with older people in care homes

Managing risk, minimising restraint: Challenges, dilemmas and positive approaches for working with older people in care homes , SCIE, June 2011

  1. Exploring Restraint              Trainer’s Guide  Paticipants Workbook
  2. Decision making process    Trainer’s Guide   Participants Workbook
  3. Creating a positive culture Trainer’s Guide   Participants Workbook

Abstract:

 

These e-Learning resources are freely available to all.  They provide audio, video and interactive technology to assist in exploring the nature of managing risk and minimising restraint when working with older people in care homes.

Who are they suitable for:

These resources are suitable for staff working in care homes for older people. ‘Exploring restraint’ and ‘Decision making process’ are suitable for all; ‘Creating a positive culture’ is particularly suitable for managers and senior staff.

They may also be of interest to anyone involved in the support of older people in care homes, including health professionals, inspectors, and relatives.

Training Materials

 

This topic can also be helpfully explored through group sessions. These materials will support managers and trainers to plan and lead 3 in-house sessions. The content of each session relates to an e-learning module – ‘Exploring restraint’ and ‘Decision making process’ are suitable for all staff, and ‘Creating a positive culture’ is suitable for managers and senior staff.

 

 

Lancashire Care staff can click on the link above to access the resources or email: susan.jennings@lancashirecare.nhs.uk

Best Practice & Falls Prevention

A practical guide to best practices for falls reduction, June 2011, American Nurse Today

Click on the title above to access the full-text of this guide from American Nurse today

Abstract:

Whole issue of supplement is dedicated to falls reduction. Includes artices on focusing on staff awareness and accountability in reducing falls, creating a culture of safety, building a sustainable falls-reduction program,  current and emerging innovations to keep patients safe, using technology to reduce falls and how to build a successful business case for a falls-reduction program.

Lancashire Care staff can either click on the full-text link above or email: susan.jennings@lancashirecare.nhs.uk

Patient Education to Prevent Falls Among Older Hospital Inpatients

Patient education to prevent falls among older hospital inpatients: a randomized controlled trial, Archives of Internal Medicine 2011 Mar 28;171(6):516-24

Haines, T P

Abstract:

 

BACKGROUND:

 

Falls are a common adverse event during hospitalization of older adults, and few interventions have been shown to prevent them.

 

METHODS:

 

This study was a 3-group randomized trial to evaluate the efficacy of 2 forms of multimedia patient education compared with usual care for the prevention of in-hospital falls. Older hospital patients (n = 1206) admitted to a mixture of acute (orthopedic, respiratory, and medical) and subacute (geriatric and neurorehabilitation) hospital wards at 2 Australian hospitals were recruited between January 2008 and April 2009. The interventions were a multimedia patient education program based on the health-belief model combined with trained health professional follow-up (complete program), multi-media patient education materials alone (materials only), and usual care (control). Falls data were collected by blinded research assistants by reviewing hospital incident reports, hand searching medical records, and conducting weekly patient interviews.

 

RESULTS:

 

Rates of falls per 1000 patient-days did not differ significantly between groups (control, 9.27; materials only, 8.61; and complete program, 7.63). However, there was a significant interaction between the intervention and presence of cognitive impairment. Falls were less frequent among cognitively intact patients in the complete program group (4.01 per 1000 patient-days) than among cognitively intact patients in the materials-only group (8.18 per 1000 patient-days) (adjusted hazard ratio, 0.51; 95% confidence interval, 0.28-0.93]) and control group (8.72 per 1000 patient-days) (adjusted hazard ratio, 0.43; 95% confidence interval, 0.24-0.78).

 

CONCLUSION:

 

Multimedia patient education with trained health professional follow-up reduced falls among patients with intact cognitive function admitted to a range of hospital wards.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Common core principles for supporting people with dementia: a guide to training the social care and health workforce

Common core principles for supporting people with dementia: a guide to training the social care and health workforce, June 2011, Department of Health

click on the link above to access this document

Abstract:

The ‘Common core principles for supporting people with dementia’ have been produced jointly by Skills for Care and Skills for Health. They can be used to support workforce development for any member of staff, in any health or social care setting, working with people at any stage of dementia. They can also be used to inform the content of curricula and training courses

Please note: the attached  document has not been fully tagged for accessibility. If you require an accessible version of the document please email mb-web-feedback@dh.gsi.gov.uk

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk

End-of-life treatment and care: GMC good practice guidance

End-of-life treatment and care: General Medical Council good practice guidance,  The Psychiatrist 2011 v. 35, (6) p. 228-229

Michael Tapley and David Jolley

Michael Tapley is palliative medicine doctor, Willow Wood Hospice, Ashton under Lyne, Manchester, UK

David Jolley is honorary reader, Manchester University, Manchester

Abstract:

 

The General Medical Council’s guidelines on treatmentand care towards the end of life, published in May 2010, containimportant guidance for all doctors, including psychiatrists,who care for patients and their families towards the end oflife. The document is written in the light of the Mental CapacityAct 2005 and complements existing Good Medical Practice andconfidentiality guidelines, also from the General Medical Council.Psychiatrists need to be aware of the communication, legaland ethical issues around end-of-life care, including advancedirectives and clinically assisted nutrition and hydration.This new guidance is compulsory reading for all psychiatrists.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

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