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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., (© 2021 The American Geriatrics Society.)

Background: Education of healthcare workers is a core element of multicomponent delirium strategies to improve delirium care and, consequently, patient outcomes. However, traditional educational strategies are notoriously difficult to implement. E-learning is hypothesised to be easier and more cost effective, but research evaluating effectiveness of delirium education through e-learning is scarce at present. Aim is to determine the effect of a nursing e-learning tool for delirium on: (1) in-hospital prevalence, duration and severity of delirium or mortality in hospitalized geriatric patients, and (2) geriatric nurses' knowledge and recognition regarding delirium., Methods: A before-after study in a sample of patients enrolled pre-intervention (non-intervention cohort (NIC); n = 81) and post-intervention (intervention cohort (IC); n = 79), and nurses (n = 17) of a geriatric ward (university hospital). The intervention included an information session about using the e-learning tool, which consisted of 11 e-modules incorporating development of knowledge and skills in the prevention, detection and management of delirium, and the completion of a delirium e-learning tool during a three-month period. Key patient outcomes included in-hospital prevalence and duration of delirium (Confusion Assessment Method), delirium severity (Delirium Index) and mortality (in-hospital; 12 months post-admission); key nurse outcomes included delirium knowledge (Delirium Knowledge Questionnaire) and recognition (Case vignettes). Logistic regression and linear mixed models were used to analyse patient data; Wilcoxon Signed Rank tests, McNemar's or paired t-tests for nursing data., Results: No significant difference was found between the IC and NIC for in-hospital prevalence (21.5% versus 25.9%; p = 0.51) and duration of delirium (mean 4.2 ± SD 4.8 days versus 4.9 ± SD 4.8 days; p = 0.38). A trend towards a statistically significant lower delirium severity (IC versus NIC: difference estimate - 1.59; p = 0.08) was noted for delirious IC patients in a linear mixed model. No effect on patient mortality and on nurses' delirium knowledge (p = 0.43) and recognition (p = 1.0) was found., Conclusion: Our study, the first in its area to investigate effects of delirium e-learning on patient outcomes, demonstrated no benefits on both geriatric patients and nurses. Further research is needed to determine whether delirium e-learning nested within a larger educational approach inclusive of enabling and reinforcing strategies, would be effective., Trial Registration: ISRCTN ( 82,293,702 , 27/06/2017).

Background: Since more people are reaching older and older ages, healthcare systems are becoming in need of more and more knowledgeable nurses to meet the specific health care needs of older persons. Several instruments exist to measure and evaluate students' knowledge of older persons, ageing, and gerontological care; however, unequivocal evidence on their use and psychometric properties is scarce. The aim of the study was to validate a revised version of Palmore's Facts on Aging Quiz (FAQ)., Methods: A cross-sectional, exploratory study was conducted. Palmore's FAQ version 1 and Facts on Aging Mental Health Quiz were used as bases for the development of a revised FAQ instrument. Three researchers translated these instruments into Dutch. A panel of nine experts in geriatric research and gerontological care evaluated the translation and the face and content validity of the instrument. We used a cross-sectional, exploratory design to assess its internal consistency and construct validity. Cronbach's alpha coefficients, exploratory factor analysis, and the known-groups technique were used for these analyses., Results: Based on the experts' consensus, a revised version of the FAQ, consisting of 36 items, was produced. Exploratory factor analysis did not reveal underlying constructs suggesting that the revised version encloses a more general concept of knowledge (e.g. about older persons, aging, gerontological care). Using the known-groups technique, we validated the instrument, showing that it discriminates between the knowledge of first- and third-year nursing students. The overall Cronbach's coefficient of 0.723 was acceptable and changed minimally (from 0.708 to 0.724) when items were removed., Conclusion: We conclude that the revised version of the FAQ can be used to properly evaluate nursing students' knowledge about older persons and gerontological care, as reasonable reliability and validity were established for this revised version of the FAQ.

There is an unclear relation between staffing levels and the use of physical restraints in nursing homes (NHs). A survey design was used in 570 older adults (median age = 86; 77.2% women), living on 23 wards within seven NHs. Restraint use was high (50% of residents, of which 80% were restrained on a daily basis). Multivariate analysis was conducted at the level of the individual wards. Neither staff intensity nor staff mix was a determinant of restraint use. Bathing dependency, transfer difficulties, risk for falls, frequent restlessness/agitation, and depression were independent predictors of restraint use. Patient characteristics have significant greater impact on physical restraint use than staffing levels. Therefore, improving knowledge and skills of NH staff to better deal with restlessness/agitation, mobility problems, and risk for falls is encouraged to decrease the use of physical restraints in NH residents., (Copyright 2014, SLACK Incorporated.)

Background: Inpatient geriatric consultation teams are multidisciplinary teams that advice and sensitize health care professionals in the hospital for the care of older patients. Despite the lack of clear evidence that these teams are effective, they were rated highly relevant and introduced in Belgian hospitals in 2007., Objectives: To evaluate the implementation and performance of geriatric consultation teams and geriatric resource nurses (GRNs) in Belgium., Design: A cross-sectional survey was performed in March and April 2010., Setting: Acute hospitals., Participants: Sixty-six hospitals completed the questionnaire (response rate of 68.8%); 63 geriatric consultation teams were included., Methods: A newly developed questionnaire was sent to all hospitals. The head of the geriatric department completed the general parts of the questionnaire. The other parts, covering the organization of the consultation teams and geriatric resource nurses, respectively, were completed by the geriatrician or the head nurse of the geriatric consultation team. All data were analysed in a descriptive manner., Results: The mean number of full time equivalents (FTE) per consultation team was 4.3 (SD±1.3; range 1.9-10.1). The nurse, represented by a mean of 1.7 FTE (SD±0.8), was a core member in almost all teams (n=60; 98.4%). The occupational therapist, geriatrician, dietician, psychologist and speech therapist were core members in more than 59% of the teams. Twenty-seven teams (42.9%) estimated that more than 75% of the patients (≥75 years) were screened for having a geriatric profile. This screening was mostly performed using the Triage Risk Screening Tool (n=23) or the Identification of Seniors At Risk (n=20). A positive screening automatically resulted in a request for a geriatric consultation team intervention in 45 teams (71.4%). Thirty-five teams (55.5%) had an advisory role only, while the other 28 teams (44.5%) had both advisory and executive roles. The median number of patients for whom recommendations were formulated per year, was 423 (Q1=230; Q3=633). Most participants rated the function of GRNs as 'poor' or 'bad'., Conclusion: To increase their impact, inpatient geriatric consultation teams focus on frail older persons using screening tools for detection of high-risk patients. More intense collaboration with GRNs is essential, and the function of GRNs needs further improvement., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

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.

Objectives: To examine the care tasks performed for residents of Belgian care institutions for older people and the association between the performance of care tasks by persons of different staffing categories (registered nurses (RN) and care assistants (CA)) and the characteristics (the dependency level and the diagnosis of dementia) of the residents., Study Design and Setting: Survey on the care for residents, aged 65 or over, living in 26 care institutions for aged people., Main Outcome Measures: Separate bivariate comparisons of care time spent on residents with and without dementia and bivariate comparisons of care time spent on six task categories on residents of different dependency levels were performed. The median number of minutes over seven days (mosd) and the inter quartile range (IQR) are presented as summary measures. The proportion of the time spent by RNs and CAs per resident and per task category was calculated., Results: Time spent was highest on primary care tasks (34,554 mosd; 48.7%), followed by in order of time spent, supportive tasks (10,845 mosd; 15.3%), logistic tasks (10,697 mosd; 15.1%), practical nursing procedures (8,689 mosd; 12.2%), administrative tasks (3,357 mosd; 4.7%) and communication tasks (2,814 mosd; 4.0%). Overall there was no significant difference between the total time spent by RNs (median=190 mosd; IQR 105-334) and the total time spent by CAs (median=196 mosd; IQR 91-331; p=0.89). RNs were spending significantly more time than CAs in practical nursing procedures, communication tasks and administrative tasks., Conclusions: There was a sharp task demarcation between RNs and CAs in the three less frequent task categories. There was no indication that RNs were delegating tasks to CAs.

Objective: To evaluate whether implementation of discharge management by trained social workers or nurses reduces hospital readmissions and institutionalizations of geriatric patients in a real-world setting., Design: Quasi-experimental design., Setting: Six general hospitals in Belgium., Participants: A representative sample of 824 patients, 355 of whom were assigned to the experimental group receiving comprehensive discharge management and 469 to the control group receiving usual care. Inclusion criteria were patients admitted to a geriatric, rehabilitation, or internal medicine ward, not residing in a nursing home, and showing risk of readmission or institutionalization on admission in the hospital., Intervention: In-hospital discharge planning according to a case management protocol allowing for adjustment to participating hospitals' case mix and patients' and families' specific needs., Main Outcome Measures: Hospital readmission within 15 and 90 days post discharge; institutionalization at discharge and within 15 and 90 days post discharge., Results: Discharge management resulted in fewer institutionalizations (n = 53; 14.9%) compared with usual care (n = 130; 23.7%) (adjusted odds ratio = 0.47; CI 95% = 0.31-0.70). Readmission rates between the intervention and usual care group were not significantly different., Conclusions: This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.

This pilot study investigated the feasibility of a nurse-led fall prevention strategy in community-dwelling older persons. The sample included 126 subjects (mean age = 76 years) who could rise from a chair and transfer independently. During a home visit, a research nurse identified individuals at risk: a history of >or= 2 falls in the previous year or difficulties in gait and/or balance. Patients not at risk received an educational leaflet. Older persons at risk received an evaluation of risk factors for falling. Whenever problems were identified, the nurses gave specific advice and subjects were referred to their general practitioner (GP). After one month, adherence to these recommendations was evaluated. Twenty-seven individuals showed an increased risk of falling (21.4%). The mean number of risk factors per person was 3.4 (SD=1.2). Noncompliance with one or more of the fall prevention recommendations was 58.3%. Differentiated by type of recommendations, a high degree of compliance was observed for recommendations related to gait and balance, use of medication, orthostatic hypotension, urge-incontinence, environment and behavior (81.8%-100%). While most individuals followed the recommendation to consult their GP (66.7%-80%), most of the GP's failed to propose any further measures to prevent falls. Screening, evaluation of risk factors, giving advice and follow-up required on average 3.1 (SD=0.8), 29.4 (SD=15.1), 15.8 (SD=11.0) and 13.1 (SD=3.9) minutes, respectively. Of those subjects who were not at risk, 76.1% had read the leaflet and 74.6% of those considered it useful. This study provides preliminary evidence for the feasibility in terms of time investment to integrate a nurse-led multifactorial fall intervention in current care for older persons living at home. However, further investigation to increase compliance with recommendations and more insight in the GP's role relating to the management of patients at risk for falls is needed.

In order to support the urgent need for proactive and targeted investments in care for older persons a group of geriatric nurse specialists from different European countries convened in Leuven (Belgium) in November 2002 to launch the European Nursing Academy for Care of Older persons (ENACO). The mission of ENACO is to enhance outcomes of older persons and their caregivers through strengthening gerontological clinical nursing care, education, research and health policy within an interdisciplinary context. Specific objectives of ENACO are: 1) providing up-to-date education and training by "teaching the teachers". More specifically, the target groups are master's prepared nurses specialized in gerontology who can contribute and guide the development of gerontological/geriatric nursing care in their own country; 2) developing a core curriculum for basic gerontological nursing education in Europe and; 3) developing an European network of gerontological nursing expertise. More specifically, a web page providing opportunities for interactive communication as well as a mentoring program will be developed for nurses interested in the deepening and fine-tuning of their professional experience in care for older persons. The fact that care for older persons is high on the European agenda, the collaboration with the European Academy for Medicine of Ageing (EAMA), and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.

Objectives: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients., Design: Longitudinal prospective before/after design (sequential design)., Setting: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium., Participants: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12)., Intervention: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol., Measurements: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini-Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively., Results: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P =.82), duration of delirium was shorter (P =.03) and severity of delirium was less (P =.0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive., Conclusions: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip-fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.

Delirium is a serious health problem with significant negative consequences which is experienced by many hospitalized elderly patients. Because of its clinical impact and potential reversibility, prompt treatment of delirium is essential. Therefore an understanding of delirium, its manifestations, methods of detection, prevention, and treatment in hospitalized elderly patients is needed. This article provides an overview of the diagnostic and therapeutic dilemmas of delirium.

A theoretical model of clinical case management for psychogeriatric patients and their families is described. Psychogeriatric patients often have complex health care needs, requiring specific nursing interventions. The increasing frailty of these patients over time, together with the risk for institutionalization, make professional nursing contribution to their care even more desirable. Nursing case management is described by means of a conceptual-operational continuum. On the conceptual site, the continuum includes a geriatric definition and core principles of case management. On the operational site, case management is described as a clinical system, a process, a technology, and a role. The process of case management is a deliberate, intellectual activity whereby the practice of nursing is approached in an orderly, systematic manner. It includes components of assessment, diagnosis, planning, implementation, and evaluation. The case management approach requires nurses to assume an active role in designing care maps and to work collaboratively with members of a multidisciplinary team.