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Background/Objectives Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. Design A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. Setting Two cardiac care units of the University Hospitals Leuven. Participants One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes. Onderzoeksraad, KU Leuven, Grant/Award Number: REF22/15/028 Deschodt, M (corresponding author), UZ, Dept Gerontol & Geriatr, AGSF, Herestr 49 Box 7003 35, B-3000 Leuven, Belgium. mieke.deschodt@kuleuven.be

Background and purpose Regaining functional independence and independent living is challenging in hospitalized geriatric patients. Different from community dwelling and institutionalized older people, geriatric patients on rehabilitation wards generally receive more frequent and structured physiotherapy with the primary aim to discharge them to their home or place of residence. There is a paucity of evidence concerning the structure and components of physiotherapy programs to improve functional performance in this particular group. In this paper, we describe how we developed the Geriatric Activation Program Pellenberg (GAPP) based on patients' needs and available literature. Methods We searched the literature on physiotherapy interventions focusing on the core components for improvement of functional performance: strength, balance, function, (gait)speed, coordination, and endurance training. Based on physiotherapist staffing and physiotherapy time allocated to each patient, we organized the practical, daily delivery of the program. Results GAPP is a 5-day program, repeated weekly, delivered by physiotherapists and physiotherapy students. Each day, one or a combination of two to three different core components of functional performance is trained intensively in 45-min sessions. A set of standard exercises is constantly adjusted to each patients' capacity. On day 5, there is a mix of these core elements in a group session (e.g., chair-dance, table tennis, karate) and the Berg Balance Scale is completed to evaluate progress. Conclusion GAPP is a multicomponent physiotherapy program for hospitalized patients on a geriatric rehabilitation ward, aimed at improving functional performance.

OBJECTIVES: To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department Screener for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged ≥70 years) community-dwelling adults admitted to the ED. DESIGN: Single-center, prospective, observation study. SETTING: ED with embedded observation unit in University Hospitals Leuven (Belgium). PARTICIPANTS: A total of 794 patients (median age = 80 years; 55% female) were included. MEASUREMENTS: Study nurses collected data using semistructured interviews and patient record review during ED admission. Outcome data were collected with patient record review. RESULTS: Hospitalization (following index ED stay) and unplanned ED readmission at 30 and 90 days occurred in 67% (527/787) of patients and in 12.2% (93/761) and 22.1% (168/761) of patients, respectively. For all outcomes at cutoff 2, the three screening tools had moderate to high sensitivity (range = 0.71-0.90) combined with (very) low specificity (range = 0.14-0.32) and low accuracy (range = 0.21-0.67). At all cutoffs, likelihood ratios and interval likelihood ratios had no or small impact (range = 0.46-3.95; zero was not included) on the posttest probability of the outcomes. For all outcomes, area under the receiver operating characteristics curve varied in the range of 0.49 to 0.62. CONCLUSION: Diagnostic characteristics of all screening tools were comparable. None of the tools accurately predicted the outcomes as a stand-alone index. Future studies should explore the clinical effectiveness and implementation aspects of ED-specific minimum geriatric assessment and intervention strategies. J Am Geriatr Soc 68:1454-1461, 2020. ispartof: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY vol:68 issue:7 pages:1454-1461 ispartof: location:United States status: published

ispartof: JOURNAL OF NURSING SCHOLARSHIP vol:52 issue:1 pages:3-5 ispartof: location:United States status: published

ispartof: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY vol:68 issue:10 pages:2414-2415 ispartof: location:United States status: published

Aim To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients. Methods A secondary data analysis comprising data from a prospective non-randomized trial including 86 patients with a hip fracture aged 65 years and older was carried out. State anxiety was measured preoperatively using the State-Trait Anxiety Inventory. Delirium and its severity was measured pre- and postoperatively (day 1, 3, 5, 8) by trained research nurses using the Confusion Assessment Method and Delirium Index. Results A total of 24 patients (27.9%) developed delirium postoperatively. Preoperative state anxiety (State-Trait Anxiety Inventory) was not associated with postoperative delirium (rb = 0.135, P = 0.353), duration of postoperative delirium (rho = 0.038, P = 0.861) or severity of postoperative delirium (rho = 0.153, P = 0.160). Independent predictors of postoperative delirium were lower MMSE scores (OR 0.75, 95% CI 0.60–0.95, P = 0.015), osteosynthesis surgery (OR 3.66, 95% CI 1.02–13.15, P = 0,047) and lowest intraoperative diastolic blood pressure (OR 0.92, 95% CI 0.85–0.99, P = 0.031). Conclusion No relationship between state anxiety and postoperative delirium was found, but significant methodological hurdles were observed and discussed providing important groundwork for further research in this area. Further research should focus on reliable measurement of state anxiety in cognitively impaired older populations. Geriatr Gerontol Int ●●; ●●: ●●–●●.

As the number of care-dependent older people is projected to grow drastically, the number of individuals depending on long-term care services will increase significantly over the next 50 years, while the number of informal caregivers and healthcare professionals is decreasing (European Commission, Economic Policy Committee, 2012). One of the key challenges for healthcare systems therefore is to develop and implement effective long-term care programs that provide person-centered, efficient, safe, and sustainable care and living environments, as well as a corresponding work environment for healthcare workers. Although the majority of care-dependent older people are cared for in their own homes, about one fifth receive care in residential care facilities (Colombo, Llena-Nozal, Mercier, & Tjadens, 2011). Future long-term residential care needs to be able to adapt to older people's needs rather than coerce older people to adapt to the system. Moreover, long-term residential care cannot do without combining both health and social care, putting the evidence into practice to support older persons' best possible quality of life.While many initiatives and innovations have been launched and tested to optimize long-term care in recent years (Leichsenring, Billings, & Nies, 2013), four major challenges remain to ensure that healthcare workers are able to provide the best possible care at all times in safe and positive work environments. In tackling each of these challenges, residents' well-being should be kept on the forefront, focusing on residents' capacities, personal preferences, interpersonal relationships, involvement, and social needs.First, despite the great number of initiatives taken to improve long-term care, the actual implementation of evidence-based long-term care models has been scarce. The INTERLINKS research initiative listing European long-term care projects illustrated which elements have to be in place to construct an integrated long-term care system. However, from the 59 identified projects, only 8 had undergone a systematic mixed-method evaluation of processes and outcomes. Half of the project had no, minimal, or uncompleted evaluations and therefore failed to truly impact clinical practice and health policy, because the interventions aspects having the most or no impact could not be identified (Leichsenring et al., 2013). Successful implementation of effective and sustainable interventions in long-term care requires a systematic approach. Implementation research, which is intended to aid our understanding of what, why, and how interventions work in the real world setting, is therefore what is truly and urgently needed (Peters, Adam, Alonge, Ageypong, & Tran, 2013).Second, person-centered outcomes, such as improving quality of life or strengthening partnerships between resident and healthcare providers on the one hand, and system outcomes, such as reducing avoidable hospitalizations or costs on the other hand, should be equally important in evaluating the effectiveness of new models of long-term care. This is in line with the Institute for Healthcare Improvement triple aim of improving patient's experience of care and health while reducing costs (Berwick, Nolan, & Whittington, 2008). Ideally, the long-term care environment strives to create a living environment mirroring home as much as possible, while strengthening the residents and their relatives as active and empowered service users and not as passive recipients of care (Wagner, Austin, Davis, Hindmarsh, Schaefer, & Bonomi, 2001). Moreover, the development of new models should also address the building of supportive work environments for healthcare professionals that provide the basis to achieve excellence in care.Third, optimal coordination of care and well-founded care transitions between long-term care settings and healthcare providers are pivotal. Although multiple healthcare professions are involved in the care of older people, nurses are in a key position to ensure continuity of care. …

Objectives To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission. Design Controlled trial based on assignment by convenience. Setting Trauma ward in a university hospital. Participants One hundred seventy-one people with hip fracture aged 65 and older. Intervention Participants were assigned to a multidisciplinary geriatric intervention (n=94) or usual care (n=77) during hospitalization after hip fracture. Measurements End points were functional status, length of stay, mortality, new nursing home admission, and hospital readmission 6 weeks, 4 months, and 12 months after surgery. Results Mean length of stay was 11.1 ± 5.1 days in the intervention group and 12.4 ± 8.5 days in the control groups (P=.24). Complete adherence to IGCT recommendations was 56.8%. A significant benefit of intervention on functional status in univariate analyses (P=.02) 8 days after surgery disappeared in a linear mixed model. Participants with dementia had better functional status in a linear mixed model than those without (P=.03), but this effect was no longer significant after Bonferroni correction for multiple testing. After 6 weeks, 4 months, and 12 months, no between-group differences could be documented for mortality, new nursing home admission, or readmission rate. Conclusion This trial could not document functional benefits of an IGCT intervention in people with hip fracture. More research is needed to investigate whether a more-intensive approach with more-direct control over patient management, more-specific recommendations, and more-intense education would be effective.

deschodt m., dierckx de casterle b. & milisen k. (2010) Gerontological care in nursing education programmes. Journal of Advanced Nursing66(1), 139–148. Abstract Title. Gerontological care in nursing education programmes. Aim. This paper is a report of a study conducted to identify the coverage of gerontological care in baccalaureate nursing education programmes. Background. Although in recent years the average age of patients has increased, nurses do not always have the knowledge, competencies, and attitudes necessary to care for older people. Its complexity is not recognized. Method. A descriptive cross-sectional mail survey of 17 baccalaureate nursing education programmes in Flanders, Belgium, was performed in 2007. Findings. While there was great variability among nursing education programmes in terms of gerontology courses, clinical placements, and number of experts, it was encouraging that most programmes had integrated gerontology content into non-gerontology courses, all programmes offered gerontology clinical placements, and many nursing educators were considered to be experts in gerontology. Lack of interest in care for older people in general, lack of gerontology-related competencies within curricula, and a negative image of gerontological care were reported as the most frequently-encountered barriers to incorporating gerontological care aspects into curricula. Conclusion. Because a minority of nursing students choose the gerontology specialist option, gerontology content in basic nursing curricula should be increased. A minimum standard curriculum and specific competencies for care of older people should be formulated for all baccalaureate nursing education programmes. Strengthening educators’ expertise and investing in role models remain important priorities for the nursing profession.