Outlier admissions of medical patients: Prognostic implications of outlying patients. The experience of the Hospital of Mestre

ABSTRACT The admission of a patient in wards other than the appropriate ones, known as the patient outlying phenomenon, involves both Medicine and Geriatric Units of many Hospitals. The aims were to learn more about the prognosis of the outlying patients, we investigated 3828 consecutive patients hospitalized in Medicine and Geriatrics of our hub Hospital during the year 2012. We compared patients\u2019 mean hospital length of stay, survival, and early readmission according to their outlying status. The mean hospital length of stay did not significantly differ between the two groups, either for Medicine (9.8 days for outliers and 10.0 for in-ward) or Geriatrics (13.0 days for both). However, after adjustment for age and sex, the risk of death was about twice as high for outlier patients admitted into surgical compared to medical areas (hazard ratio 1.8, 1.2-2.5 95% confidence interval). Readmission within 90 days from the first discharge was more frequent for patients admitted as outliers (26.1% vs 14.2%, P<0.0001). We highlight some critical aspects of an overcrowded hospital, as the shortage of beds in Medicine and Geriatrics and the potential increased clinical risk denoted by deaths or early readmission for medical outlier patients when assigned to inappropriate wards. There is the need to reorganize beds allocation involving community services, improve in-hospital bed management, an extent diagnostic procedures for outlier patients admitted in nonmedical wards

Meeting Aging-Related Needs in 2016

Our Virginia Center on Aging has four program focuses. These programs are: dementia, elder abuse and domestic violence in later life, geriatrics education, and lifelong learning. Each achieved substantially in calendar 2016

“Listen Carefully:” A Study of Ageist Stereotypes and Undergraduates’ Desire to Work with Elders

“Listen Carefully:” A Study of Ageist Stereotypes and Undergraduates’ Desire to Work with Elders identifies and assesses how prior experience with elders and ageist stereotypes informs the degree to which undergraduates are inclined (or disinclined) to consider geriatrics as a potential career. Current literature indicates a lack of interest among social workers and other allied-health professionals in working with this demographic. Here, the “generation gap” not only pertains to the differences between younger people and their elders, but to the gap between the aging population’s increasing demand of need and how many individuals plan to serve the elderly. For this study, participants were required to prioritize a set of 27 statements in order from least to most significant in influencing their desire to work with elders (Q methodology). A factor analysis of the data generated two groups of participants. Group 1 was significantly (p \u3c.01) more willing to work with elders, which was associated with their rejection of negative stereotypes and their indication of having prior experience working with elders. Group 2 was significantly less willing to work with the elders (p \u3c .01), put significantly (p \u3c .05) more emphasis on deficits of old age, and reported not having as much experience working with the elderly. The data suggest that exposure to actual work with elders and debunking false, negative stereotypes about the elderly are key in attracting professionals to work in geriatrics. Funding for incentive and awareness programs should be provided to encourage more people to work in geriatrics

Assessment and management of dysphagia in acute stroke: an initial service review of international practice

The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management tended to be similar within, but not between, countries. Relationships were found between the use of instrumental assessment and the compensatory management techniques that were employed. The variation in practice that was found, may reflect the lack of an available robust evidence base to develop care pathways and identify the best practice. Further investigation and identification of the impact on dysphagia outcome is needed

VirginiaNavigator/GWEP Community Outreach Training for Older Adults, Caregivers, and Service Programs

Educational Objectives 1. Demonstrate how VirginiaNavigator (VN) can support self-care and connecting with community resources. 2. Discuss how VN can assist service providers who work with older adults and their families. 3. Explain how VN relates to six focus areas of the Geriatrics Workforce Enhancement Program (GWEP) to improve the well-being of older adults

Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

Preparing for an Aging Nation: The Need for Academic Geriatricians

According to the author of this issue brief, a strong commitment by the government to a regular stream of financial support for geriatrics would encourage medical centers to establish or expand programs, enhance their ability to attract funds from private sources, and ultimately produce a sufficient number of academic geriatricians. Given the impending retirement of the baby boom generation, this process should begin as soon as possible. This issue brief highlights the critical need for academic geriatricians and presents a realistic proposal to help address the problem

Educational Games in Geriatric Medicine Education: A Systematic Review

OBJECTIVE: To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. METHODS: We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) and excluded single arm studies. Population of interests included members (practitioners or students) of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. RESULTS: We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. CONCLUSION: The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly.Society of General Internal Medicin

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