Sarah McGrory is a PhD Student at the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh. Reblogged from the British Geriatrics Society blog.
Are some activities harder than others for people with dementia? In our research, recently reported in Age and Ageing, we looked at how people with dementia differed in their day to day activities. 202 people with mostly mild to moderate dementia in Scotland were asked about their activities
Activities (using the telephone, shopping, food preparation, housekeeping, laundry, travelling, taking medications, handling finances) can be measured using a questionnaire called the Lawton Instrumental Activities of Daily Living (IADL) scale. Usually scores on the individual tasks are added together to give a total score ranging from 0 to 8. This number can hide a lot of information about a patient’s functional ability. It assumes every functional activity is equally difficult, which is rarely the case. For example, being able to manage your finances is likely to be harder for most people than being able to eat.
Our research used a statistical technique called item response theory (IRT) to get more information from a questionnaire about function. IRT allows the different activities to be ranked according to their difficulty. This can be especially useful for assessing progression of cognitive impairment. Knowing the expected order of decline can help to monitor progression, so any changes from the usual course, or changes in rates of decline, can be identified and studied. IRT can help to identify key tasks in a scale, and can also show in what order tasks might become more difficult as dementia progresses. To do this, though, clinicians and researchers have to record answers to every task on a scale, not just to the total number.
We found that the tasks included in the scale could be ordered by increasing difficulty from being able to use the telephone (easiest) to the ability to shop (most difficult). This means a person may be having problems shopping independently may showing the first sign of functional difficulties related to cognitive impairment. Problems with this task should alert doctors as a possible early symptom of cognitive decline. Recognising these early stages is very important and can help people live independently for as long as possible with the help of medications, family education and counselling. Looking at the individual tasks within a scale instead of relying on the total score can help us to understand more about dementia progression and help us to identify care requirements for patients.
Dr Rowan Harwood is a consultant physician, professor of geriatric medicine at Nottingham University Hospital NHS Trust. Reblogged from the BGS Blog
Click here to go to video
There is a lot of criticism of how we manage cognitively impaired patients in acute hospitals. And advice on how to do it better. The hope has been that more expert and co-ordinated services would improve outcomes and save resources. But there has been little in the way of rigorous evaluation.
We developed a specialist medical and mental health unit with the ambitious objective of demonstrating best practice. We enhanced the ward environment, ward staffing and skill mix, including mental health specialist nurses, therapists and psychiatry, trained all staff to a high level in the person centred philosophy of care, and endeavoured to engage family carers more fully.
After 18 months of operation we ran a randomised controlled trial, published in the BMJ.This video abstract describes the intervention and trial results.To illustrate the challenges and capture the essence of compassionate person-centred care, we made a 23 minute documentary, called Today is Monday. Footage from this is used to illustrate the abstract.
The full 23-minute film is available for training purposes; interested readers are welcome to discuss this with me Rowan.Harwood@nuh.nhs.uk.
Matteo Cesari, MD, PhD is Chargé de Mission at the Gérontopôle of the Centre Hospitalier Universitaire de Toulouse, researcher at the INSERM UMR1027, and Professor at the Université de Toulouse III Paul Sabatier (Toulouse, France). He is Editor-in-Chief of the Journal of Frailty & Aging. Reblogged from the British Geriatrics Society Blog
Our societies are ageing. The number of older people is steadily growing, threatening the sustainability of public services including healthcare. Age-related chronic and disabling conditions not only adversely influence older people’s quality of life, but also represent a burden for public health expenditures. It is a fact that something has to be done in order to prevent the (often irreversible) loss of physical function that occurs with advancing age. If we are to accomplish such an ambitious task, a major revision is needed in our approach to older people and, consequently, in the concept of geriatric medicine. Continue reading
R Lisk, K Yeong, A Nasim, B Mandal, R Nari, Z Dhakam presented their research at the Autumn conference of the British Geriatrics Society. Reblogged from the British Geriatrics Society blog
Residents of Care Homes with Nursing tend to be frail, have multiple diagnoses and high levels of dependency. This results in complex care needs. Many experience multiple admissions to hospital, often with long lengths of stay.
This initiative was aimed at reducing the number of emergency admissions to our Trust from local Care Homes with Nursing, by working in partnership with staff in the homes and local GPs. The aim was to help provide more bespoke care for this vulnerable patient group, keeping them out of hospital whenever it was possible and appropriate to do so. The project was also part of a Trust-wide response to the new emergency admission cap introduced through the National Operating Framework 2010/11. Continue reading
Professor Tom Downes is consultant geriatrician and has expertise in the design of acute interface geriatric care. He is the Clinical Lead for Quality Improvement at Sheffield Teaching Hospitals. Saira Ghafur is a Quality Improvement and Leadership Fellow and Respiratory Registrar at Sheffield Teaching Hospitals NHS Foundation Trust. Reblogged from the British Geriatrics Society blog.
‘Something as mundane as a checklist can be a powerful tool for simplifying the complexity of the world and, in the context of medical procedures, save lives’ Atul Gawande 2010
International studies have indicated that approximately 10% of all patients who are admitted to hospital suffer some form of adverse event (AE)- defined as an unintended harm to a patient resulting in injury, death or a prolonged admission. Older people are more likely to suffer AEs and the consequences of these are often more severe in frail, older patients. Continue reading