Indentifying published studies of care home research: an international survey of researchers

Collating the published research around institutional, long term care is confounded by the differing terminologies used to describe this health-care setting. We aimed to collate the descriptors used by researchers to inform the future development of a ‘search filter’ (a collection of search terms to help identify relevant records from electronic literature databases). We surveyed international researchers via the Nursing Home Research International Working Group, European Geriatric Medicine Society and published reviewers, achieving at 38% response rate across 21 countries. Our findings identified variation in terminology used by researchers to describe long-term care settings in their country of practice. Nursing home was the most accepted term (96%). ‘Homes for the Aged’ was selected by 48% of respondents. A range of terms are likely to be necessary to identify all relevant research and these may not be intuitive. We will use these data to help inform development of a search filter

Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011

The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably hig

Living at home after emergency hospital admission:prospective cohort study in older adults with and without cognitive spectrum disorder

Background: Cognitive spectrum disorders (CSDs) are common in hospitalised older adults and associated with adverse outcomes. Their association with the maintenance of independent living has not been established. The aim was to establish the role of CSDs on the likelihood of living at home 30 days after discharge or being newly admitted to a care home. Methods: A prospective cohort study with routine data linkage was conducted based on admissions data from the acute medical unit of a district general hospital in Scotland. 5570 people aged ≥ 65 years admitted from a private residence who survived to discharge and received the Older Persons Routine Acute Assessment (OPRAA) during an incident emergency medical admission were included. The outcome measures were living at home, defined as a private residential address, 30 days after discharge and new care home admission at hospital discharge. Outcomes were ascertained through linkage to routine data sources. Results: Of the 5570 individuals admitted from a private residence who survived to discharge, those without a CSD were more likely to be living at home at 30 days than those with a CSD (93.4% versus 81.7%; difference 11.7%, 95%CI 9.7–13.8%). New discharge to a care home affected 236 (4.2%) of the cohort, 181 (76.7%) of whom had a CSD. Logistic regression modelling identified that all four CSD categories were associated with a reduced likelihood of living at home and an increased likelihood of discharge to a care home. Those with delirium superimposed on dementia were the least likely to be living at home (OR 0.25), followed by those with dementia (OR 0.43), then unspecified cognitive impairment (OR 0.55) and finally delirium (OR 0.57). Conclusions: Individuals with a CSD are at significantly increased risk of not returning home after hospitalisation, and those with CSDs account for the majority of new admissions to care homes on discharge. Individuals with delirium superimposed on dementia are the most affected. We need to understand how to configure and deliver healthcare services to enable older people to remain as independent as possible for as long as possible and to ensure transitions of care are managed supportively

Identifying care-home residents in routine healthcare datasets:a diagnostic test accuracy study of five methods

Background: there is no established method to identify care-home residents in routine healthcare datasets. Methods matching patient’s addresses to known care-home addresses have been proposed in the UK, but few have been formally evaluated. Study design: prospective diagnostic test accuracy study. Methods: four independent samples of 5,000 addresses from Community Health Index (CHI) population registers were sampled for two NHS Scotland Health Boards on 1 April 2017, with one sample of adults aged ≥65 years and one of all residents. To derive the reference standard, all 20,000 addresses were manually adjudicated as ‘care-home address’ or not. The performance of five methods (NHS Scotland assigned CHI Institution Flag, exact address matching, postcode matching, Phonics and Markov) was evaluated compared to the reference standard. Results: the CHI Institution Flag had a high PPV 97–99% in all four test sets, but poorer sensitivity 55–89%. Exact address matching failed in every case. Postcode matching had higher sensitivity than the CHI flag 78–90%, but worse PPV 77–85%. Area under the receiver operating curve values for Phonics and Markov scores were 0.86–0.95 and 0.93–0.98, respectively. Phonics score with cut-off ≥13 had PPV 92–97% with sensitivity 72–87%. Markov PPVs were 90–95% with sensitivity 69–90% with cut-off ≥29.6. Conclusions: more complex address matching methods greatly improve identification compared to the existing NHS Scotland flag or postcode matching, although no method achieved both sensitivity and positive predictive value > 95%. Choice of method and cut-offs will be determined by the specific needs of researchers and practitioners

Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions

Background  Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.  Methods  Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.  Results  A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (allP < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.  Conclusions  CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone

Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis

Background: moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods: we registered and conducted a systematic review (PROSPERO: CRD42015023497). We searched MEDLINE; EMBASE and CINAHL Plus in September 2015. We included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results: from 9,176 records, we included 23 studies (n = 354,985 participants). Studies were heterogeneous, with the proportions discharged to a care home 3–77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age (pooled odds ratio (OR) 1.02, 95% confidence intervals (CI): 1.00–1.04), female sex (pooled OR 1.41, 95% CI: 1.03–1.92), dementia (pooled OR 2.14, 95% CI: 1.24–3.70) and functional dependency (pooled OR 2.06, 95% CI: 1.58–2.69). Conclusions: discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk

Music Therapy for Neuropsychiatric Symptoms in the General Hospital: A Systematic Literature Review

Dementia and delirium are common in medical and surgical inpatients. Neuropsychiatric symptoms can be challenging to manage. Non-pharmacological interventions such as music therapy have been used to manage symptoms in psychiatric hospitals and nursing homes but are not routine in general hospitals. We performed a systematic literature review to establish whether music therapy improves neuropsychiatric symptoms in adults with dementia and/or delirium in the general hospital. We searched CINAHL, Medline and PsycINFO in November 2015. Search terms included music therapy, dementia, delirium. We screened 5054 titles, and read 142 full text articles. None of these met inclusion criteria for our review. To inform future research in music in general hospitals for people with dementia and/or delirium, we qualitatively reviewed 8 articles involving 239 patients. Music delivery was feasible and had a positive effect on some aspects of neuropsychiatric symptoms in various settings, but the studies were generally small, at high risk of bias, and did not use recognized frameworks for evaluating complex interventions. We found no robust published evidence for the use of music therapy in the treatment of neuropsychiatric symptoms in patients with dementia and/or delirium in the general hospital. Well-designed studies of this promising intervention are needed. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Experience and opinions on post-graduate dementia training in the UK: A survey of selected consultant geriatricians

Introduction: People with dementia are more likely to come into contact with a geriatrician than any other hospital specialty. Whilst it is known that there are some geriatricians with a special interest in dementia, it is unclear how this group of clinicians gained experience, and what their opinions are on current training.  Methods: We obtained a list of geriatricians known to have an interest in dementia care (known as dementia champions) from the British Geriatric Society Dementia and Similar Disorders Special Interest Group. We contacted 100 'dementia champions' with an invitation to respond to a questionnaire relating to their role, experience and opinions on current training in dementia within geriatric medicine.  Results: Fifty-five geriatricians responded. Ninety-one per cent were consultant physicians, and 71% were not involved in outpatient diagnostic services. Fifty-six per cent reported that their experience was via clinical attachments with old age psychiatry, and 47% regarded themselves as 'self-taught'. The majority felt that current training was inadequate with a need for more structure and time spent on attachments, less geographical variation, more training at undergraduate level and throughout other specialties and better collaboration with psychiatry.  Discussion: This is the first survey of the views of geriatricians leading on dementia care in acute hospitals within the UK. It gives a useful insight into how they have gained their own experience, and their opinions on how training may be improved. Equipped with the right training and expertise in diagnosis and management of dementia perhaps geriatricians may feel more confident in taking a lead in dementia care.&nbsp

New antipsychotic prescribing and antipsychotic stopping in people aged ≥65 years with dementia.

<p>New antipsychotic prescribing and antipsychotic stopping in people aged ≥65 years with dementia.</p