Older People, Telematics and Care

About the book: What are the implications of current economic, social and political trends in Britain for older people? Social and demographic changes have led to traditional areas of welfare being transformed. The contributors to this book take a critical look at the current situation and assess the implications for future practice. They debate the assumptions and values underlying established welfare programmes and consider the case for change as growing demands put health and social services under increasing pressure. The second part of the book discusses specific areas in detail, ranging from the organisation of effective domiciliary social care to the impact of new technologies on older people's lives. This book provides a comprehensive and practical overview of the provision of services for older people and will be a valuable and thought-provoking resource for anyone involved in caring for and supporting them

Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.State of Alaska, Division of Behavioral Health Grant #SP020783Executive Summary / Introduction / Methodology / Results / Discussion / Reference

The Impact of Compassion Fatigue and Burnout Among Residential Care Workers on Client Care: Implications for Social Work Practice

The purpose of this study was to explore what factors contribute to burnout and compassion fatigue in a residential treatment setting, what factors may help to minimize risk for the development of compassion fatigue in a residential treatment setting, and how these two issues affect client care. This study utilized a mixed-methods design by sending out an online survey to two residential treatment centers serving youth with emotional and behavioral difficulties (n = 88). Descriptive statistics were used to identify participants compassion fatigue and burnout levels as well as better understand what symptoms of these two phenomena were most affecting participants as well as what factors they most contribute to the development of burnout and compassion fatigue. An open coding process was used on qualitative questions to better understand how burnout and compassion fatigue effect client care standards and what participants felt was needed to help mitigate burnout and compassion fatigue in their agencies. Five major themes emerged: quality of work; organizational needs; worker-client relationship; self-care; and, organizational support and incentives. These findings aligned with previous research, however they were able to add new information and depth to the already limited research out there on burnout and compassion fatigue in a residential treatment setting

The Impact of Compassion Fatigue and Burnout Among Residential Care Workers on Client Care: Implications for Social Work Practice

The purpose of this study was to explore what factors contribute to burnout and compassion fatigue in a residential treatment setting, what factors may help to minimize risk for the development of compassion fatigue in a residential treatment setting, and how these two issues affect client care. This study utilized a mixed-methods design by sending out an online survey to two residential treatment centers serving youth with emotional and behavioral difficulties (n = 88). Descriptive statistics were used to identify participants compassion fatigue and burnout levels as well as better understand what symptoms of these two phenomena were most affecting participants as well as what factors they most contribute to the development of burnout and compassion fatigue. An open coding process was used on qualitative questions to better understand how burnout and compassion fatigue effect client care standards and what participants felt was needed to help mitigate burnout and compassion fatigue in their agencies. Five major themes emerged: quality of work; organizational needs; worker-client relationship; self-care; and, organizational support and incentives. These findings aligned with previous research, however they were able to add new information and depth to the already limited research out there on burnout and compassion fatigue in a residential treatment setting

Be Fruitful and Multiply: Fertility and Tradeoffs in Latter-Day Saints

In humans, there are evolutionary trade-offs between energy allocated to reproduction and embodied capital (investing in extended development). We see selection toward early and frequent reproduction over embodied capital in the predominantly Latter-Day Saints (LDS) culture of Utah. We hypothesize that encouragement toward reproduction in LDS individuals has tradeoffs with embodied capital compared to non-LDS individuals. We collected data through an anonymous online survey (Qualtrics) distributed to a stratified random sample of LDS and non-LDS college students and recent graduates of Utah State University in Logan, UT (n=45) and Texas A&M in College Station, Texas (n=17) . We include questions on marital status, religion, sexual behavior, reproductive goals, and college grades. Current results suggest that LDS students are much less likely to be sexually active when unmarried compared to non-LDS students (14% compared to 44%). Non-LDS students in both samples are 65% more likely to have used birth control methods compared to sexually active LDS students. The percentage of participants that wanted children in the future differed according to affiliation with the LDS church X 2 (12, N=58)=31.95, p These results suggest differences in embodied capital priorities between LDS and non-LDS students. This study applies evolutionary theory to cultural behaviors specific to the LDS faith, including previously untested ideas that are relevant to biological anthropology. Here we show connections between religion, reproduction, and evolutionary fitness in a subset of American culture

The Gendered Division of Housework and Couples’ Sexual Relationships: A Re-Examination

Contemporary men and women increasingly express preferences for egalitarian unions. One recent high profile study (Kornrich, Brines, & Leupp, 2013) found that married couples with more equal divisions of labor had sex less frequently than couples with conventional divisions of domestic labor. Others (Gager & Yabiku, 2010) found that performing more domestic labor was associated with greater sexual frequency, regardless of gender. Both studies drew from the same data source, which was over two decades old. We utilize data from the 2006 Marital and Relationship Survey (MARS) to update this work. We find no significant differences in sexual frequency and satisfaction among conventional or egalitarian couples. Couples where the male partner does the majority of the housework, however, have less frequent and lower quality sexual relationships than their counterparts. Couples are content to modify conventional housework arrangements, but reversing them entirely has consequences for other aspects of their unions

Evaluating Treatments and Interventions: What Constitutes “Evidence-based” Treatment?

This chapter provides an overview of the evidence-based treatment (EBT) paradigm, beginning with definitional issues, followed by a discussion on use of the iterative process and the importance of strong academic–practice partnerships to inform the development, selection, and implementation of EBTs. The discussion then turns to the importance of attaining, measuring, and sustaining fidelity to the treatment models; and identifying common barriers to sustained EBT use. Drawing from our expertise related to interventions for children and adolescents, a few dissemination/implementation models are highlighted as examples of current efforts to achieve sustained use of EBTs among practitioners, within agencies, and across communities. This involves keeping up to date with the research and integrating the available evidence base with clinical expertise and patient characteristics, including cultural considerations and client preferences for treatment. The chapter concludes with directions for the future, including considerations for practitioners, referring agents, and agency senior leaders to promote, support, and sustain EBTs

Opioid Consumption After Scheduled Cesarean Delivery Following Implementation of Enhanced Recovery After Surgery

Background With 47,600 opioid overdose related deaths in the U.S. in 2017, the opioid crisis is of national concern.1 Cesarean delivery is the most common surgery worldwide, with over 1.2 million in the U.S. in 2018 alone.2,3 As cesarean delivery is a highly prevalent surgery it has a large capacity to influence the opioid epidemic. Literature is showing that Enhanced Recovery after Surgery (ERAS) and multimodal analgesia are effective means of managing postoperative pain while minimizing opioid use.4,5,6,7,8 This project aims to help discover if introduction of ERAS, and more specifically it’s multimodal analgesia aspect, has helped decrease oral morphine milligram equivalent (MME) consumption of opioids following cesarean delivery. Methods • Design: Retrospective Observational Cohort Study • Human Subjects Protection: Data fully de-identified and stored only in a secure REDCap database; patient care was not altered • Inclusion Criteria: Adult women undergoing scheduled cesarean delivery at Providence Sacred Heart Medical Center, Spokane, WA • Exclusion Criteria: Urgent/emergent cesarean delivery, use of an intravenous opioid patient-controlled analgesia (PCA) device • Measured Outcome: Cumulative 72-hr oral MME consumption following cesarean delivery • Baseline Comparability Demographics: Age, ASA, BMI, gravida/parity, weeks gestation, prior cesarean delivery, multiple birth, estimated blood loss, etc. (table 1) • Statistical Analysis: • A Priori Power Analysis: n=670 (n=335 per group) participants for adequate power (α=0.5, β=0.2) • Bivariate Analysis: Independent Samples T-Test (symmetrical data) and Mann Whitney U Test (skewed data) • Multivariate Analysis: An interrupted time series was conducted for comparison of oral median MME over time • Split File Analysis conduced to confirm accuracy of findings Discussion The implementation of ERAS and use of multimodal analgesia led to a sustained MME decrease among women utilizing opioids post scheduled cesarean delivery. The pre-implementation group (n=464) utilized a median of 90 [IQR 37.5-165] oral MME while the post-implementation group (n=514) used 71.3 [IQR 30-127.5] median oral MME (p\u3c0.01). This was a difference of 18.7 oral MME, or a 21% reduction. The use of multimodal analgesia following scheduled cesarean delivery is an effective means of managing postoperative pain while also reducing the need for opioids.https://digitalcommons.psjhealth.org/other_pubs/1109/thumbnail.jp

Postoperative Length of Stay Following Enhanced Recovery After Surgery Protocol Implementation for Scheduled Cesarean Deliveries

Background Cesarean delivery is the most common major surgery worldwide. 1 In 2018, 1.2 million cesarean deliveries occurred in the United States, accounting for nearly 32% of all deliveries.2 Research has shown ERAS benefits include decreased length of stay, improved pain control, and improved patient satisfaction.2,3 Despite its use in numerous surgical specialties, ERAS implementation within obstetrics has been slow.2 The ERAS Society released a three-part guideline specific to cesarean deliveries in 2018 and 2019,4,5,6 yet few studies have assessed the impact of ERAS on cesarean postoperative outcomes.2 An improved perioperative course would be particularly beneficial for mothers undergoing cesarean delivery as they require a quick recovery in order to care for their newborn. The purpose of this retrospective, observational study was to determine how the recovery process following cesarean delivery may be improved by standardizing the perioperative care pathway, with the primary outcome of interest being postoperative length of stay. Methods • Design: Retrospective, observational cohort study at Providence Sacred Heart Medical Center (PSHMC) • This project was approved by the PSHMC Clinical Innovation and Research Council and deemed exempt from human subjects research by Providence Health Care Institutional Review Board. • Human subjects protection: Patient demographic and surgical data from electronic medical records were extracted, deidentified, and encrypted using a REDCap data collection tool • Inclusion Criteria: parturients 18 years of age or older who underwent scheduled cesarean delivery between June 1, 2017 to May 31, 2018 for pre-intervention group and June 1, 2019 to February 29, 2019 for postintervention group. • Exclusion Criteria: urgent or emergent cesarean deliveries, cesarean deliveries occurring in the run-in time period of June 1, 2018 through May 31, 2019, and mothers under the age of 18 years. • Outcome measurement: postoperative length of stay, defined as time of end of surgery to time of discharge • Exposure measurement: defined as post-ERAS protocol implementation following April 1, 2019. • Other variables considered included: age, weeks gestation, BMI, ASA, primary vs repeat cesarean, weeks gestation, and multiparty births. • Statistical analysis: a-prior power analysis, univariate analysis, bivariate analysis, and multivariate analysis Discussion In this retrospective observational study, this facility’s postoperative LOS following cesarean delivery was found to be low, with a median of 52.4 hours. Following ERAS implementation, the median postoperative LOS decreased to 51.2 hours but was not found to be statistically significant in an adjusted model. Cesarean deliveries comprised nearly 29% of all births at this facility, 58.5% of which were scheduled or elective cesarean deliveries. Characteristics of parturients were very similar among the pre- and post-ERAS patient groups; most patients were classified as ASA 2 and a mean age of 31 years. Repeated multivariate analysis using run-in periods of varying lengths and controlling for time consistently showed no significant difference in postoperative LOS between the pre-ERAS and post-ERAS groups. With the postoperative LOS at PSHMC being low prior to protocol implementation, it is likely that other facilities with longer postoperative LOS may see a greater benefit of ERAS implementation. Additional work is still required to further the understanding of ERAS for cesarean deliveries and its impact on postoperative recovery. Future studies of interest includes determining 30-day readmission rates and emergency room visits following discharge. In order to determine the true effect ERAS may have on postoperative length of stay and the recovery process following cesarean delivery, large prospective control trials are needed.https://digitalcommons.psjhealth.org/other_pubs/1110/thumbnail.jp

Rate of Unscheduled Administration of an Epidural Bolus Among Pregnant Women Receiving Labor Epidurals

Background The labor and delivery process is a painful experience that pregnant women undergo and while various medical options are available for managing labor pain, labor epidurals are the most common.1,3 Breakthrough pain, or inadequate analgesia, is a significant complication of labor epidurals that is typically managed with the administration of an unscheduled epidural bolus. The purpose of this evidence-based practice (EBP) project is to describe the rate of unscheduled epidural bolus administration in pregnant women receiving continuous labor epidurals (CLE) at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH). Methods • Design: Retrospective, observational, EBP project • Human subjects protection: De-identified data was extracted into a HIPPA compliant REDCap database after facility approval and IRB exemption • Inclusion Criteria: Parturient women age ≥18 with labor epidurals at PSHMC and PHFH from January 2015 to December 2019 (Table 1) • Outcome Measurement: Unscheduled provider administered epidural bolus after epidural initialization (Figure 1) • Bivariate: T-tests (symmetrical continuous data), Mann Whitney U (skewed continuous data), Chi-Test (categorical data) • Multivariate: Kaplan Meier analysis performed on epidural bolus timing (Figure 2) • Multivariate multivariable: Proportional hazards model was used to identify independent risk factors associated with time to first unscheduled provider administered epidural bolus (Table 2) Discussion We found that approximately 36.7% of parturient women with a CLE required at least one unscheduled provider administered epidural bolus. Gravida 1, elective case type, increased BMI and CLE duration were identified as independent risk factors associated with receiving a provider bolus. Of the identified risk factors, gravida 1 was the most significant with women having a 1.22 increase in risk of requiring an unscheduled provider administered epidural bolus (hazard risk 1.22; 95% CI 1.14 – 1.31; p \u3c0.001). The rate of 36.7% is higher compared to literature reported rates of 30.7% and 14.4% from RCTs and observational studies that had comparable epidural regimens and techniques to our facilities. 2,4,5 Further in-depth investigation is warranted in describing with more detail the patient characteristics and anesthesia provider practices as they relate to unscheduled epidural bolus administration.https://digitalcommons.psjhealth.org/other_pubs/1104/thumbnail.jp