Hoe denken ouderen over automatische contactloze monitoring? Een systematische literatuurstudie

Inleiding Om te voorzien in kwaliteitsvolle en kosteneffectieve ouderenzorg wordt er in toenemende mate gebruik gemaakt van technologieën voor contactloze monitoring. Het doel van dit systematisch literatuuronderzoek is het exploreren van de attitudes en percepties van ouderen ten aanzien van contactloze monitoringsystemen. Methodologie Relevante studies zijn geïdentificeerd via een uitgebreide zoekstrategie in de gecomputeriseerde bestanden van Medline, Embase en Cinahl voor studies gepubliceerd tussen januari 1990 en 19 augustus 2012; via een referentielijst aangeboden door een groep van experts in dit onderzoeksdomein en via de referentielijsten van alle relevante studies. Resultaten Negen studies met een kwalitatief onderzoeksdesign en één studie met een gecombineerd onderzoeksdesign werden geïncludeerd. Diverse facetten van de attitudes, percepties en behoeften van ouderen als potentiële of actuele gebruikers van contactloze monitoring worden in vijf thematische clusters besproken. Hierbij gaat het om de percepties van ouderen over het potentiële nut van contactloze monitoring, over de communicatie van informatie die via monitoring verkregen wordt, diverse bezorgdheden bij het gebruik van contactloze monitoring en participatie en inspraak van de gemonitorde persoon. Al deze facetten kunnen de bereidheid van ouderen tot acceptatie van deze monitoringsystemen beïnvloeden. Conclusies Dit onderzoek kan technologieontwikkelaars en zorgaanbieders belangrijke informatie bieden om te zorgen dat monitoringsystemen tegemoetkomen aan de behoeften, bezorgdheden en wensen van hun gebruikers en aldus succesvol geïntegreerd kunnen worden in de dagelijkse praktijk. Verdere exploratie van de attitudes en percepties van ouderen ten aanzien van contactloze monitoringsystemen via kwalitatief en kwantitatief onderzoek met een goede methodologische kwaliteit is vereist

The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

BACKGROUND: The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. METHODS: In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. RESULTS: The primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat. CONCLUSION: The BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation

Unplanned readmission prevention by a geriatric emergency network for transitional care (URGENT): a prospective before-after study

URGENT is a comprehensive geriatric assessment (CGA) based nurse-led care model in the emergency department (ED) with geriatric follow-up after ED discharge aiming to prevent unplanned ED readmissions. Methods A quasi-experimental study (sequential design with two cohorts) was conducted in the ED of University Hospitals Leuven (Belgium). Dutch-speaking, community-dwelling ED patients aged 70 years or older were eligible for enrolment. Patients in the control cohort received usual care. Patient in the intervention cohort received the URGENT care model. A geriatric emergency nurse conducted CGA and interdisciplinary care planning among older patients identified as at risk for adverse events (e.g. unplanned ED readmission, functional decline) with the interRAI ED Screener (c) and clinical judgement of ED staff. Case manager follow-up was offered to at risk patients without hospitalization after index ED visit. For inpatients, geriatric follow-up was guaranteed on an acute geriatric ward or by the inpatient geriatric consultation team on a non-geriatric ward if considered necessary. Primary outcome was unplanned 90-day ED readmission. Secondary outcomes were ED length of stay (LOS), hospitalization rate, in-hospital LOS, 90-day higher level of care, 90-day functional decline and 90-day post-hospitalization mortality. Results Almost half of intervention patients (404/886 = 45.6%) were categorized at risk. These received on average seven advices. Adherence rate to advices on the ED, during hospitalization and in community care was 86.1, 74.6 and 34.1%, respectively. One out of four at risk patients without hospitalization after index ED visit accepted case manager follow-up. Unplanned ED readmission occurred in 170 of 768 (22.1%) control patients and in 205 of 857 (23.9%) intervention patients (p = .11). The intervention group had shorter ED LOS (12.7 h versus 19.1 h in the control group; p < .001), but higher rate of hospitalization (70.0% versus 67.0% in the control group; p = .003)

Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study

Up to one in three of older patients who are hospitalised develop functional decline, which is associated with sustained disability, institutionalisation and death. This study developed and validated a clinical prediction model that identifies patients who are at risk for functional decline during hospitalisation. The predictive value of the model was compared against three models that were developed for patients admitted to a general medical ward.; A prospective cohort study was performed on two cardiac care units between September 2016 and June 2017. Patients aged 75 years or older were recruited on admission if they were admitted for non-surgical treatment of an acute cardiovascular disease. Hospitalisation-associated functional decline was defined as any decrease on the Katz Index of Activities of Daily Living between hospital admission and discharge. Predictors were selected based on a review of the literature and a prediction score chart was developed based on a multivariate logistic regression model.; A total of 189 patients were recruited and 33% developed functional decline during hospitalisation. A score chart was developed with five predictors that were measured on hospital admission: mobility impairment = 9 points, cognitive impairment = 7 points, loss of appetite = 6 points, depressive symptoms = 5 points, use of physical restraints or having an indwelling urinary catheter = 5 points. The score chart of the developed model demonstrated good calibration and discriminated adequately (C-index = 0.75, 95% CI (0.68-0.83) and better between patients with and without functional decline (chi; 2; = 12.8, p = 0.005) than the three previously developed models (range of C-index = 0.65-0.68).; Functional decline is a prevalent complication and can be adequately predicted on hospital admission. A score chart can be used in clinical practice to identify patients who could benefit from preventive interventions. Independent external validation is needed

[The attitudes and perceptions of older persons towards the automatic monitoring of the activities of daily living using contactless sensors: a systematic literature review.]

status: publishe

[The development and validation of a standardised transfer sheet for care transitions between residential and acute care settings in Leuven, Belgium]

When elderly patients are transferred from a residential to an acute care setting, important information regarding their health care can be lost. Over the past years, the concept of advance care planning has also been given a more prominent place in the care for the elderly. However it remains a challenge to communicate the results achieved by this process when patients are referred to another health care setting. Developing a sound method for transferring information is a key element in the transitional care for the elderly patient.status: publishe

Attitudes and perceptions of adults of 60 years and older towards in-home monitoring of the activities of daily living with contactless sensors: an explorative study

Background and objectives Contactless monitoring is increasingly used to enhance qualitative and cost-effective care for older persons. Succesful integration of this technology in older peoples’ daily lives, depends on their acceptance of these systems. The primary purpose was to explore attitudes and perceptions of adults of 60 years and older towards contactless monitoring of the activities of daily living. Design, participants and methods A questionnaire was developed, validated and used in a cross-sectional survey with a convenience sample (n = 245). The results were presented using descriptive statistics and bivariate analyses to explore variables associated with willingness to install the technology. Results Descriptive statistics indicate that adults of 60 years and older find contactless monitoring useful for various purposes (e.g. to remain living at home longer, safely and independently; for timely detection of emergency situations and gradually emerging health problems). They agree to share collected information with professional caregivers and own access to the data is valued. Respondents like to take part in diverse decisions about the monitoring (e.g. about the rooms in which it is installed, the type of sensors used and access of third parties to collected information). However, several concerns were expressed related to the functioning and financing of contactless monitoring. Bivariate analyses show that both socio-demographic factors (e.g. age, receiving professional home care) and attitudes and perceptions towards contactless monitoring (e.g. on its potential usefulness, on the availability of collected information, on the functional requirements and financial costs of the system and on the use of video cameras) can promote or impede acceptance of the technology. Conclusions This explorative study indicates that older adults are willing to incorporate contactless monitoring in later life or when their health declines. They agree to share collected information with professional caregivers and clearly demand for participation in decisions about the technology. Various concerns and requirements provide implications for clinical practice and future research. Thereby, technology developpers, policy makers and professional caregivers can promote the implementation of contactless monitoring in the care for older adults.publisher: Elsevier articletitle: Attitudes and perceptions of adults of 60 years and older towards in-home monitoring of the activities of daily living with contactless sensors: An explorative study journaltitle: International Journal of Nursing Studies articlelink: http://dx.doi.org/10.1016/j.ijnurstu.2014.05.010 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.status: publishe

Does the get up and go test improve predictive accuracy of the Triage Risk Screening Tool or Rowland questionnaire in older patients admitted to the emergency department?

Objectives: To assess the diagnostic characteristics of the get up and go test (GUGT) as a stand-alone test and in combination with the Flemish Triage Risk Screening Tool (fTRST) and Rowland questionnaire. One aim was to determine whether the diagnostic accuracy of these instruments could be improved for predicting unplanned emergency department (ED) readmission following ED discharge. Methods: We carried out a prospective cohort study at the ED of the University Hospitals Leuven, Belgium. All patients aged at least 75 years (n=380) completed fTRST, Rowland, and GUGT testing at the index ED admission. Diagnostic characteristics for unplanned ED readmission were determined for hospitalized and discharged patients 1 and 3 months after the index ED visit. Results: In both hospitalized and discharged patients, fTRST and Rowland (cut-off >=2) had good to excellent sensitivity and negative predictive value (NPV) but low to moderate specificity and accuracy; GUGT had low sensitivity and good to excellent NPV and specificity. The combined fTRST/GUGT or Rowland/GUGT had moderate to excellent NPV (56.3-94.3%). The combined fTRST (cut-off >=2)/GUGT had low sensitivity and moderate to excellent specificity. Sensitivity of the combined Rowland (cut-off >=4)/GUGT was good at the 1-month follow-up and moderate at the 3-month follow-up for hospitalized patients; it was low for discharged patients. Specificity was low for hospitalized patients and good for discharged patients. Conclusion: Neither the objective measure of mobility (GUGT) nor the combined fTRST/GUGT or Rowland/GUGT improved the results. Our analysis shows that the predictive accuracy of the stand-alone, self-reported screening instruments fTRST and Rowland (cut-off=2) is still good. This study also confirmed their previously known limitations.status: publishe