The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Tarazona-Santabalbina, Francisco José; Doménech-Pascual, Juan Ramón; A, Ángel Belenguer-Varea; Daudi, Eduardo Rovira

doi:10.1017/s0959259814000100

Cited by 3 publications

(8 citation statements)

References 62 publications

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“…Older patients with hip fractures often have associated comorbiditiesincluding thinking, moving and mood disordersthat may go unrecognised and increase mortality risk during and after hospitalisation for the fracture. 105,112,113 The need for holistic assessments to discover and manage falls risk factors emerged as an important theme from the literature. Moreover, identifying patients with dementia in itself can be challenging, with the result that cognitive impairment and delirium may go undiagnosed.…”

Section: Context-mechanism-outcome Configuration 2: Ensuring a Suppormentioning

confidence: 99%

“…105 Including routine assessment of cognitive function in holistic assessment is, therefore, essential. 112 A structured assessment, such as CGA, was shown to improve outcomes for older people who have fallen; 103,113,114 however, an advisory CGA model was not effective. 41 Where no holistic assessments were used, authors reflected that they may have aided patient and carer understanding of the causes of falls and helped to address other health issues that otherwise affected therapy.…”

Section: Context-mechanism-outcome Configuration 2: Ensuring a Suppormentioning

confidence: 99%

“…Collaboration between professionals emerged as an important factor in whether or not patients received effective treatment. 112 Three studies described delegation of work previously undertaken by physicians to nurse practitioners and other health-care providers; these new processes of care were successfully integrated for two interventions, 137,138 but another attained low referral rates relating to poor documentation by physicians and poor uptake by patients. 136 Few data were available concerning the processes through which decisions were made about referrals.…”

Section: Context-mechanism-outcome Configuration 8: Upskilling the Womentioning

confidence: 99%

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An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

Allan

Wheatley

Smith

et al. 2019

Health Technol Assess

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Background Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. Objectives To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. Design This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. Setting This study was set in the community. Participants The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. Interventions This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. Main outcome measures (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). Results A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. Conclusions The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. Trial registration Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.

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Section: Context-mechanism-outcome Configuration 2: Ensuring a Suppormentioning

confidence: 99%

Section: Context-mechanism-outcome Configuration 2: Ensuring a Suppormentioning

confidence: 99%

Section: Context-mechanism-outcome Configuration 8: Upskilling the Womentioning

confidence: 99%

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An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

Allan

Wheatley

Smith

et al. 2019

Health Technol Assess

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“…Holistic assessments to discover and manage falls risk factors emerged as an important theme. Comorbidities that increase mortality risk during and after hospitalisation for hip fracture in older people may go unrecognised and undiagnosed [45,52,53]. Psychosocial factors, such as depression [53,54] and social isolation [54], may also be important for the wellbeing and recovery of people with dementia following a fall.…”

Section: Cmoc3: Adopting a Holistic Approachmentioning

confidence: 99%

“…Collaboration between professionals is an important factor in whether patients receive effective treatment [52,80,81]. A range of social and contextual factors influences decisions to refer to services, including lack of confidence in the service provided, reluctance to share responsibility for patient care, or a perception that the patient would not benefit from the service [57,79].…”

Section: Cmoc9: Improving Pathways and Referralmentioning

confidence: 99%

Developing an Intervention for Fall-Related Injuries in Dementia (DIFRID): an integrated, mixed-methods approach

et al. 2019

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Background: Falls in people with dementia can result in a number of physical and psychosocial consequences. However, there is limited evidence to inform how best to deliver services to people with dementia following a fall. The aim of the DIFRID study was to determine the feasibility of developing and implementing a new intervention to improve outcomes for people with dementia with fall-related injuries; this encompasses both short-term recovery and reducing the likelihood of future falls. This paper details the development of the DIFRID intervention. Methods: The intervention was designed using an integrated, mixed-methods approach. This involved a realist synthesis of the literature and qualitative data gathered through interviews and focus groups with health and social care professionals (n = 81). An effectiveness review and further interviews and observation were also conducted and are reported elsewhere. A modified Delphi panel approach with 24 experts was then used to establish a consensus on how the findings should translate into a new intervention. After feedback from key stakeholders (n = 15) on the proposed model, the intervention was manualised and training developed. Results: We identified key components of a new intervention covering three broad areas: • Ensuring that the circumstances of rehabilitation are optimised for people with dementia • Compensating for the reduced ability of people with dementia to self-manage • Equipping the workforce with the necessary skills and information to care for this patient group Consensus was achieved on 54 of 69 statements over two rounds of the Delphi surveys. The statements were used to model the intervention and finalise the accompanying manual and protocol for a feasibility study. Stakeholder feedback was generally positive and the majority of suggested intervention components were approved. The proposed outcome was a 12-week complex multidisciplinary intervention primarily based at the patient's home. Conclusions: A new intervention has been developed to improve outcomes for people with dementia following a fall requiring healthcare attention. The feasibility of this intervention is currently being tested. Trial registration: ISRCTN41760734 (16/11/2015).

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A Risk Factor Analysis of Cognitive Impairment in Elderly Patients with Chronic Diseases in a Chinese Population

Fang

Zhao

et al. 2017

Med Sci Monit

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BackgroundThis study analyzed the risk factors of cognitive impairment (CI) in elderly patients with chronic diseases.Material/MethodsIn total of 385 elderly patients with chronic diseases were selected and assigned into CI and normal groups. The activities of daily living (ADL), global deterioration scale (GDS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), patient-generated subjective global assessment (PG-SGA), and mini nutritional assessment (MNA) were performed to analyze the differences between the 2 groups. Logistic regression analysis was conducted for risk factors of CI in elderly patients with chronic diseases.ResultsThere were differences in age, education level, type 2 diabetes mellitus, multifocal cerebral infarction, hearing, and eyesight between CI and normal groups. Patients in the CI group showed more CD4+ cells, more admission times, and higher GDS scores than the normal group. Also, MMSE and MoCA scores revealed differences in total score, directive force, attention and calculating ability, language, delayed memory, reading comprehension, writing, and visual-spatial ability between the 2 groups. The number of B and CD8+ cells, ADL, and MNA scores were protective factors, while cerebral infarction history, number of CD4+ cells, admission times, GDS score, and age were risk factors of CI in elderly patients with chronic diseases.ConclusionsOur study provides evidence that cerebral infarction history, number of CD4+ cells, admission times, GDS score, and age are risk factors of CI in elderly patients with chronic diseases.

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The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Cited by 3 publications

References 62 publications

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study

Developing an Intervention for Fall-Related Injuries in Dementia (DIFRID): an integrated, mixed-methods approach

A Risk Factor Analysis of Cognitive Impairment in Elderly Patients with Chronic Diseases in a Chinese Population

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