Search results for: geriatric hospital care

Authors: Ndukwe, Chinedu O.

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Background: There are only a few epidemiological studies published on skin disorders in the elderly within the Nigerian context and none from the Southeast Region of the country. In addition, none of these studies has considered the pattern and frequency of histopathologically diagnosed geriatric skin lesions. Hence, we attempted to determine the frequency as well as the age and gender distributions of histologically diagnosed dermatological diseases in the geriatric population from skin biopsies submitted to the histopathology department of a tertiary care hospital in Southeast Nigeria. Material and methods: This is a cross-sectional retrospective hospital-based study involving all skin biopsies of patients 60 years and above, received at the Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 2004 to December 2019. Results: During the study period, 751 skin biopsies were received in the histopathology department. Of these, 142 were from patients who were older than 60 years. Thus, the overall share of geriatric patients was 18.9%. The mean age at presentation was 71.1 ± 8.6 years. The M: F was 1:1 and most of the patients belonged to the age group of 60–69 years (69 cases, 48.6%). The mean age of the male patients was 72.1±9.5 years. In the female patients, it was 70.1±7.5 years. The commonest disease category was neoplasms (91, 64.1%). Most neoplasms were malignant. There were 67/142 (47.2%) malignant lesions. Commonest was Squamous cell carcinoma (SCC) (30 cases) which is 21.1% of all geriatric skin biopsies and 44.8% of malignant skin biopsies. This is closely followed by melanoma (29 cases). Conclusion: Malignant neoplasms, benign neoplasms and papulosquamous disorders are the three commonest histologically diagnosed skin lesions in our geriatric population. The commonest skin malignancies in this group of patients are squamous cell carcinoma and malignant melanoma.

Keywords: geriatric, skin, Nigeria, histopathology

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Authors: Tulika Bhattacharyya, Suhita C. Chatterjee

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West Bengal, one of the most rapidly ageing states in India, has inadequate structure for elder care. Therefore, there is an urgent need to improve elder care which involves focusing on different care settings where the elderly exists, like - Homes, Hospitals and Long-Term Care facilities (e.g. - Old Age Homes, Hospices). The study explores various elder care settings, with the intention to develop an understanding about them, and thereby generate comprehensive information about the entire spectrum of elder care in Kolkata. Empirical data are collected from the elderly and their caregivers in different settings. The tools for data collection are narratives, in-depth interviews and focus group discussions, along with field observations. Mixed method design is adopted to analyze the complexities of elder care in different set ups. The major challenges of elder care in private Homes are: architecturally inadequate housing conditions, paucity of financial support and scarcity of skilled caregivers. While the key factors preventing the Hospital and Long-Term Care Facilities from providing elder care services are inadequate policies and set governmental standards for elder care for the hospitalized elderly in various departments of the Hospital and the elderly residing in different kinds of Long Term Care Facilities. The limitations in each care setting results in considerable neglect and abuse of the elderly. The major challenges in elder care in West Bengal are lack of continuum between different care settings/ peripheral location of private Homes within public health framework and inadequate state Palliative policy- including narcotic regulations. The study suggests remedial measures to improve the capacity to deliver elder care in different settings.

Keywords: elder care settings, family caregiver, home care, geriatric hospital care, long term care facility

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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Authors: Jin Hun Choi, So Hyun Ahn, Seong Keun Wang, Ik-Seung Chee, Jung Lan Kim, Sun Woo Lee

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Objectives: The purpose of the study is to investigate the effects of day hospital care in hospitalized schizophrenic patients in terms of treatment adherence and treatment outcomes. Methods: Among schizophrenic patients hospitalized between 2011 and 2012, 23 day hospital care patient and 40 control subjects were included in the study. All candidates underwent Beck Cognitive Insight Scale, Drug Attitude Inventory, World Health Organization Quality of Life Assessment and Psychological Well-Being Scale when their symptoms were stabilized during hospitalization, and after being discharged, 23 patients received day hospital care for two months and then changed to out-patient care while 40 patients received out-patient care immediately after discharge. At the point of two months of out-patient care, the treatment adherence of the two groups was evaluated; tracking observation was performed until February, 2013, and survival rates were compared between the two groups. Results: Treatment adherence was higher in the day hospital care group than in the control group. Kaplan-Meier survival analysis showed a higher survival rate for the day hospital care group compared to the control group. Levels of cognitive insight and quality of life were higher after day hospital care than before day hospital care in the day hospital care group. Conclusions: Through the study, it was confirmed that when hospitalized schizophrenic patients received continuous day hospital care after being discharged, they received further out-patient care more faithfully. The study is considered to aid in the understanding regarding schizophrenic patients’ treatment adherence issues and improvement of treatment outcomes.

Keywords: schizophrenia, day hospital care, adherence, outcomes

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Authors: Chick Loveline Ayoh Epse Ndi

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Our cultural stance has deep implications for the psychological and physical well-being of the old. Cameroon is still rooted on the traditional belief that stipulates that; the aged are best catered for in the family setting where the children and grandchildren are supposed to give in return for services invested on them by the former. This is why up till date, there are no “Rest Homes” or “Convalescent hospitals” despite the rising challenges faced by the aged in this context. Beside the special measure set aside to cater for the aged, such as “Rest Homes” for the healthy, “Convalescent hospitals” are created set to cater for the health of the aged in the Western context with other facilities such as geriatric units. The health care practitioners are aware of aging diseases and have trained human resources like Gerontologists to cater for the aged and aging diseases. Meanwhile, in Africa and Cameroon in particular, such infrastructural and human resources are still to be considered in the health care system. It can be assumed that the aged and aging diseases are still to be considered in the health care system in this context. This is why we talk of therapeutic nihilism, where the aged are mixed up with other categories of patients with no special attention given to them. This qualitative study carried out in the Yaounde, the capital city of Cameroon, with their best referent hospitals, reveal that; the aged and aging diseases are still a myth in this context. Data collected in both private and public health institutions show that there is only one public institution in Cameroon that has a geriatric unit with no specialists. Patients who aretreated in this unit are considered as aged with terminal diseases that need palliative care and not intensive care. Cameroon is still lacking in terms of health care to the aged and ageing diseases. Like other patients, the aged are treated with a lot of laxity and no value. There is an emergency to create special health care units for geriatrics and and train gerontologist. Mentally or physically ill aged faced medical rational with psychodynamic treatment considered as waste of time. The aged are less likely to be regarded salvageable when they enter a hospital in serious conditions due to the lack of specialists and geriatric units for them. The implication of this study is to sensitization the stake holders for an urgent need to extend special care units for the aged and aging diseases in this context.

Keywords: challeng, therapy, agtng, diseases cameroon

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Authors: Merve Aydin, Mağfiret Kara Kaşikçi

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Aim: To determine the perceptions of inpatients about care at Farabi Hospital in KTU. Material and Method: This research was conducted by using the universe known examples of formulas and probability selected by sampling method with 277 chosen patients in the hospital at least 14 days in other internal and surgical clinics except for pediatric, psychiatry, and intensive care unit services between January-March 2014 in KTU Farabi Hospital. The data was collected through the forms of nursing care perception scale of patients and defining characteristics of patients. In the evaluation of data, percentage, mean, Mann Whitney U, Student t and Kurskall Wallis tests were applied. Results: The average point the patients got in nursing care perception scale is 62.64±10.08’dir. 48.7 % of patients regard nursing care well and 36.8 % of them regard it very well. 19 % of the patients regard nursing care badly. When the age, sex, occupation, marital status, educational background, residential place, income level, hospitalization period, hospitalization clinic and having a hospital attendant were compared with nursing care perception average point, the difference among point averages was not found meaningful statistically (p > 0.05). The average point of nursing care perception was found greater in those having chronic disease (p < 0.05). Conclusion: The perception point of patients about nursing care is above the average according to the average of the lowest and highest points. The great majority of patients regard nursing care well or very well.

Keywords: hospital, patient, perception of nursing care, nursing care

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Authors: Roongtiwa Chobchuen, Siriporn Mongkholthawornchai, Boonsong Hatawaikarn, Uriwan Chaichangreet, Kobkaew Thongtid, Pusda Pukdeekumjorn, Panita Limpawattana

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Background: Age-friendly nursing service system in Srinagarind Hospital has been developed continuously based on the value and cultural background of Thailand which corporates with the modified WHO’s Age friendly Primary Care Service System. It consists of 3 issues; 1) development of staff training, 2) age-friendly service and 3) appropriate physical environment. Objective: To evaluate the efficacy of Age-friendly Nursing Service System: KKU (AFNS:KKU) model and to evaluate factors associated with nursing perception with AFN:KKU. Study design: Descriptive study Setting: 31 wards that served older patients in Srinagarind Hospital Populations: Nursing staff from 11 departments (31 wards) Instrument: Age-friendly nursing care scale as perceived by hospitalized older person Procedure and statistical analysis: All participants were asked questions using age-friendly nursing care scale as perceived by hospitalized older person questionnaires. Descriptive statistics and multiple logistic regression analyses were used to analyse the outcomes. Results: There were 337 participants recruited in this study. The majority of them were women (92%) with the mean ages of 29 years and 77.45% were nurse practitioners. They had average nursing experiences of 5 years. The average scores of age-friendly nursing care scale were high and highest in the area of attitude and communication. Age, sex, educational level, duration of work among, and having experience in aging training were not associated with nursing perception where type of department was an independent factor. Nurses from department of Surgery and Orthopedic, Eye and ENT, special ward and Obstetrics and Gynecological had significant greater perception than nurses from Internal Medicine Department (p < 0.05). Conclusion: Nurses had high scores in all dimensions of age-friendly concept. The result indicates that nurses have good attitude to aging care which can lead to improve quality of care. Organization should support other domains of ageing care to achieve greater effectiveness in geriatric care.

Keywords: age-friendly, nursing service system, excellence model, geriatric care

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Authors: Sehrish Ather

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Introduction: To improve organizational achievements through the production of new knowledge, health policy and system research is the basic requirement. An aging population is always the source of the increased burden of chronic diseases, disabilities, mental illnesses, and other co-morbidities; therefore the provision of quality health care services to every group of the population should be achieved by making strong policy and system research for the betterment of health care system. Unfortunately, the whole world is lacking policies and system research for providing health care to their elderly population. Materials and Methods: A literature review of published studies on aging diseases was done, ranging from the year 2011-2018. Geriatric, population, health policy, system, and research were the key terms used for the search. Databases searched were Google Scholar, PubMed, Science Direct, Ovid, and Research Gate. Grey literature was searched from various websites, including IHME, Library of the University of Lahore, World Health Organization (Ageing and Life Course), and Personal communication with Neuro-physicians. After careful reviewing published and un-published information, it was decided to carry on with commentary. Results and discussion: Most of the published studies have highlighted the need to advocate the funders of health policy and stakeholders of healthcare system research, and it was detected as a major issue, research on policy and healthcare system to provide health care to 'geriatric population' was found as highly neglected area. Conclusion: It is concluded that physicians are more involved with the policy and system research regarding any type of diseases, but scientists and researchers of basic and social science are less likely to be involved in methods used for health policy and system research due to lack of funding and resources. Therefore ageing diseases should be considered as a priority, and comprehensive policy and system research should be initiated for diseases of the geriatric population.

Keywords: geriatric population, health care system, health policy, system research

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Authors: Chiharu Miyata, Hidenori Arai

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Background: The quality of care in geriatric intermediate facilities (GIFs) in Japan is not in a satisfied level. To improve it, it is crucial to reconsider nurses’ professionalism. Our goal is to create an organizational system that allows nurses to succeed professionally. To do this, we must first discuss the relationship between nurses’ characteristics and the organization. Objectives: The aim of the present study was to determine the extent to which demographic and work-related factors are related to organizational commitment among nurses in GIFs. Method: A quantitative, cross-sectional method was adopted, using a self-completion questionnaire survey. The questionnaires consisted of 49 items for job satisfaction, the three-dimensional commitment model of organizational commitment and the background information of respondents. Results: A total of 1,189 nurses participated. Of those, 91% (n=1084) were women, and mean age was 48.2 years. Most participants were staff nurses (n=791; 66%). Significant differences in 'affective commitment' (AC) scores were found for age (p < .001), overall work experience (p < .001), and work status (p < .001). For work experience in the current facility, significant differences were found in all organizational commitment scores (p < .001). The group with high job satisfaction scored significantly higher in all types of organizational commitment (p < 0.001). Conclusions: These results led to a conclusion that understanding the expectations of nurses at the workplace to adapt with the organization, and creating a work environment that clarifies contents of tasks, especially allowing for nurses to feel significance and achievement with tasks, would increase AC.

Keywords: geriatric intermediate care facilities, geriatric nursing, job satisfaction, organizational commitment

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Authors: Marlene Rosa, Susana Lopes

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Board games have been used for different purposes in geriatric care, demonstrating good results for health in general. However, there is not a conceptual framework that can help professionals and researchers in this area to design intervention programs or to think about future studies in this area. The aim of this study was to provide a pilot collection of board games’ serious purposes in geriatric care, using a WHO framework for health and disability. Study cases were developed in seven geriatric residential institutions from the center region in Portugal that are included in AGILAB program. The AGILAB program is a serious game-based method to train and spread out the implementation of board games in geriatric care. Each institution provides 2-hours/week of experiences using TATI Hand Game for serious purposes and then fulfill questions about a study-case (player characteristics; explain changes in players health according to this game experience). Two independent researchers read the information and classified it according to the International Classification for Functioning and Disability (ICF) categories. Any discrepancy was solved in a consensus meeting. Results indicate an important variability in body functions and structures: specific mental functions (e.g., b140 Attention functions, b144 Memory functions), b156 Perceptual functions, b2 sensory functions and pain (e.g., b230 Hearing functions; b265 Touch function; b280 Sensation of pain), b7 neuromusculoskeletal and movement-related functions (e.g., b730 Muscle power functions; b760 Control of voluntary movement functions; b710 Mobility of joint functions). Less variability was found in activities and participation domains, such as purposeful sensory experiences (d110-d129) (e.g., d115 Listening), communication (d3), d710 basic interpersonal interactions, d920 recreation and leisure (d9200 Play; d9205 Socializing). Concluding, this framework designed from a brief gamed-based experience includes mental, perceptual, sensory, neuromusculoskeletal, and movement-related functions and participation in sensory, communication, and leisure domains. More studies, including different experiences and a high number of users, should be developed to provide a more comprehensive ICF framework for game-based experiences in geriatric care.

Keywords: board game, aging, framework, experience

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Authors: Peter Park, Alfonso Ayala, Douglas Saeks, Jordan Miller, Carmen Flores, Karen Nelson

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Introduction Hip fractures account for more than 300,000 hospital admissions every year. Many present as fragility fractures in geriatric patients with multiple medical comorbidities. Standardized protocols for the multidisciplinary management of this patient population have been shown to improve patient outcomes. A hip fracture protocol was implemented at a Level I Trauma center with a focus on pre-operative medical optimization and early surgical care. This study evaluates the efficacy of that protocol, including the early transition period. Methods A retrospective review was performed of all patients ages 60 and older with isolated hip fractures who were managed surgically between 2020 and 2022. This included patients 1 year prior and 1 year following the implementation of a hip fracture protocol at a Level I Trauma center. Results 530 patients were identified: 249 patients were treated before, and 281 patients were treated after the protocol was instituted. There was no difference in mean age (p=0.35), gender (p=0.3), or Charlson Comorbidity Index (p=0.38) between the cohorts. Following the implementation of the protocol, there were observed increases in time to surgery (27.5h vs. 33.8h, p=0.01), hospital length of stay (6.3d vs. 9.7d, p<0.001), and ED LOS (5.1h vs. 6.2h, p<0.001). There were no differences in in-hospital mortality (2.01% pre vs. 3.20% post, p=0.39) and complication rates (25% pre vs 26% post, p=0.76). A trend towards improved outcomes was seen after the early transition period but failed to yield statistical significance. Conclusion Early medical management and surgical intervention are key determining factors affecting outcomes following fragility hip fractures. The implementation of a hip fracture protocol at this institution has not yet significantly affected these parameters. This could in part be due to the restrictions placed at this institution during the COVID-19 pandemic. Despite this, the time to OR pre-and post-implementation was quicker than figures reported elsewhere in literature. Further longitudinal data will be collected to determine the final influence of this protocol. Significance/Clinical Relevance Given the increasing number of elderly people and the high morbidity and mortality associated with hip fractures in this population finding cost effective ways to improve outcomes in the management of these injuries has the potential to have enormous positive impact for both patients and hospital systems.

Keywords: hip fracture, geriatric, treatment algorithm, preoperative optimization

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Authors: Mohd Said Nurumal, Sarah Sheikh Abdul Karim

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Information regarding out of hospital cardiac arrest incidence include outcome in Malaysia is limited and fragmented. This study aims to identify incidence and adherence to protocol of out of hospital cardiac arrest and also to explore the issues faced by the pre-hospital personnel in regards managing cardiac arrest victim in Kuala Lumpur, Malaysia. A mixed method approach combining the qualitative and quantitative study design was used. The 285 pre-hospital care data sheet of out of hospital cardiac arrest during the year of 2011 were examined by using checklists for identify the incidence and adherence to protocol. Nine semi-structured interviews and two focus group discussions were performed. For the incidence based on the overall out of hospital cardiac arrest cases that occurred in 2011 (n=285), the survival rates were 16.8%. For adherence to protocol, only 89 (41.8%) of the cases adhered to the given protocol and 124 did not adhere to such protocol. The qualitative information provided insight about the issues related to out of hospital cardiac arrest in every aspect. All the relevant qualitative data were merged into few categories relating issues that could affect the management of out of hospital cardiac arrest performed by pre-hospital care team. One of the essential elements in the out of hospital cardiac arrest handling by pre-hospital care is to ensure increase of survival rates and excellent outcomes by adhering to given protocols based on international standard benchmarks. Measures are needed to strengthen the quick activation of the pre-hospital care service, prompt bystander cardiopulmonary resuscitation, early defibrillation and timely advanced cardiac life support and also to tackle all the issues highlighted in qualitative results.

Keywords: pre-hospital care, out of hospital cardiac arrest, incidence, protocol, mixed method research

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Authors: Hala Kama Ahmed Rashwan

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Ensuring the patient safety especially at intensive care units and those exposed to hospital tools and equipment is one of the most important challenges facing healthcare today. Outbreak of food poisoning as a result of food-borne pathogens has been reported in many hospitals and care homes all over the world due to hospital meals. Patient safety of eating hospital meals is a fundamental principle of healthcare; it is new healthcare disciplines that assure the food raw materials, food storage, meals processing, and control of kitchen errors that often lead to adverse healthcare events. The aim of this article is to promote any hospital in attaining the hygienic practices and better quality system during processing of the ready-to- eat meals for intensive care units patients according to the WHO safety guidelines.

Keywords: hospitals, meals, safety, intensive care

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Authors: Mekroud Amel

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Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

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Authors: R. Litt, A. Kana, K. House

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The primary aim of this patient-related experience questionnaire was to gain a better understanding of our patients' experience as inpatients when they undergo orthognathic surgery. The secondary aim of this study was to identify ways in which we can improve the orthognathic inpatient experience and to share this with other units. All patients who received orthognathic surgery at an NHS hospital - Bristol Royal Infirmary, England, over the course of 6 months were asked to complete a questionnaire regarding their care. This data was then analysed and compared to the same questionnaire given to patients treated in a private hospital where orthognathic surgery was completed. All treatment was completed by the same surgeon. The design of the questions took into account NICE (National Institute for Health and Care Excellence) guidance on improving the experience of patient care. Particularly taking into account patients' essential requirements of care, for example, assessing and managing pain, ensuring adequate and appropriate nutrition, and ensuring the patients' personal needs are regularly reviewed and addressed. Overall the patient-related experience after orthognathic surgery was comparable in both the NHS and private hospitals. However, the questionnaire highlighted aspects of inpatient care after orthognathic surgery that can easily be improved in order to provide our patients with the best possible care.

Keywords: orthognathic surgery, patient feedback, jaw surgery, inpatient experience

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Authors: Muhammed Ordu, Eren Demir, Chris Tofallis

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Over the past decade, the non-elective admissions in the UK have increased significantly. Taking into account limited resources (i.e. beds), the related service managers are obliged to manage their resources effectively due to the non-elective admissions which are mostly admitted to inpatient specialities via A&E departments. Geriatric medicine is one of specialities that have long length of stay for the non-elective admissions. This study aims to develop a discrete event simulation model to understand how possible increases on non-elective demand over the next 12 months affect the bed occupancy rate and to determine required number of beds in a geriatric medicine speciality in a UK hospital. In our validated simulation model, we take into account observed frequency distributions which are derived from a big data covering the period April, 2009 to January, 2013, for the non-elective admission and the length of stay. An experimental analysis, which consists of 16 experiments, is carried out to better understand possible effects of case studies and scenarios related to increase on demand and number of bed. As a result, the speciality does not achieve the target level in the base model although the bed occupancy rate decreases from 125.94% to 96.41% by increasing the number of beds by 30%. In addition, the number of required beds is more than the number of beds considered in the scenario analysis in order to meet the bed requirement. This paper sheds light on bed management for service managers in geriatric medicine specialities.

Keywords: bed management, bed occupancy rate, discrete event simulation, geriatric medicine, non-elective admission

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Authors: Bei Shan Lin, Chun Mei Lu, Ya Ping Chen, Li Chen Lu

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This study explores the ethical issues concerning the use of physical restraint in geriatric care. Physical restraint use in a medical care setting is seen as a controversial form of treatment that has occurred over decades. There is no doubt that people nowadays are living longer than previous generations. The ageing process is inevitable. Common disease such as impaired comprehension, memory loss, and trouble expressing one’s self contribute to the difficulty that these older patients have in adapting to medical institution. For these reasons, physical restraint is often used in reducing the risk of falling, managing wandering behaviour, preventing agitation, and promoting patient compliance in geriatric care. It can mean that physical restraints are considered as a common practice that is used in the care of older patients. It is most commonly used for three specific purposes, including procedural restraint, restraint to prevent falls, and behavioural restraints. Although there have been well documented instances of morbidity and mortality recognised as being potential risks associated with physical restraint use, it continues to be permitted and used in healthcare, often in the name of safety. However, there is insufficient evidence supporting the effectiveness of physical restraint use reducing injuries from falls and controlling challenging behaviour in geriatric care settings. There is barely any empirical evidence of either a scientific basis or clinical trials have evaluated the improvement in patient safety following physical restraint. In difficult clinical situations, guidelines and practical suggestions for Healthcare professionals to comply requirements can help those making appropriate decisions and to facilitate better judgement regarding physical restraint use. The following recommendations are given for physical restraint use in long-term care settings: an interdisciplinary team approach to assess, evaluate, and treat underlying diseases to determine if treatment can ease issues precipitating physical restraint use; a clearly stated purpose of treatment plan should be made after weighing up the risk of physical restraint use against the risk of without physical restraint use; a care plan for physical restraint has to include individualised treatment planning, informed consent, identification and remedial action to avoid negative consequences, regular assessment and modification, reduction and removal of risks; patients and their families must have the opportunity to consider and give voluntary informed consent prior to physical restraint utilisation; patients, family members, and Healthcare professionals should be educated on use and adverse consequences of physical restraints in order to make raise awareness of potential risks and to take appropriate steps to prevent unnecessary harm; after physical restraint removal, Healthcare professionals should discuss with patients and family members about their experience, feelings, and any anxieties regarding the treatment. Physical restraint should always be considered a last resort as deprive patient’s freedom, control, and individuality. Healthcare professionals should emphasise on providing individualized care, interdisciplinary decision-making process, and creative and collaborative alternatives to promote older patient’s rights, dignity and overall well-being as much as possible.

Keywords: ethics healthcare, geriatric care, healthcare, physical restraint

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Authors: Mubita Namuyamba

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Despite an increase in the number of cancer programs and partnerships in cancer care provision, the burden of cancer in Zambia is increasingly having a significant impact on morbidity and mortality rates. The increase in cancer morbidity and mortality rates has given rise to psychological and psycho social implications (PPsI) in cancer care. Cancer patients, care givers and health care providers are faced with a multitude of PPsIs in cancer care that mainly impact negatively on the management of cancer patients. The study adopted a case study design and was purposively conducted at the Cancer Diseases Hospital in Lusaka (Zambia) after obtaining ethical clearance from the Ethics committee. The sample for this study included 70 cancer patients, 20 care givers and 5 hospital staff (4 nurses and 1 doctor). Data was collected using interviews guides, focus group discussion guides and questionnaires respectively. The qualitative data was analysed thematically. The various psychological and psychosocial challenges that conspire to deter the provision of effective cancer care nursing and improved methods of minimizing the psychological and psychosocial implications in cancer care are the products of this study.

Keywords: case study, enquiry, psychological and psycho social aspects, Zambia

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Authors: Vinay Kumar, M. Kishor, Sathyanarayana Rao Ts

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Background: Growth of elderly people in the general population in recent years is termed as ‘greying of the world’ where there is a shift from high mortality & fertility to low mortality and fertility, resulting in an increased proportion of older people as seen in India. Improved health care promises longevity but socio-economic factors like poverty, joint families and poor services pose a psychological threat. Epidemiological data regarding the prevalence of mental disorders in geriatric population with physical illness is required for proper health planning. Methods: Sixty consecutive elderly patients aged 60 years or above of both sexes, reporting with physical illness to general outpatient registration counter of JSS Medical College and Hospital, Mysore, India, were considered for the Study. With informed consent, they were screened with General Health Questionnaire (GHQ-12) and were further evaluated for diagnosing mental disorders according to WHO International Classification of Diseases (ICD-10) criteria. Results: Mental disorders were detected in 48.3%, predominantly depressive disorders, nicotine dependence, generalized anxiety disorder, alcohol dependence and least was dementia. Most common physical illness was cardiovascular disease followed by metabolic, respiratory and other diseases. Depressive disorders, substance dependence and dementia were more associated with cardiovascular disease compared to metabolic disease and respiratory diseases were more associated with nicotine dependence. Conclusions: Depression and Substance use disorders among elderly population is of concern, which needs to be further studied with larger population. Psychiatric morbidity will adversely have an impact on physical illness which needs proper assessment and management. This will enhance our understanding and prioritize our planning for future.

Keywords: Geriatric, mental disorders, physical illness, psychiatry

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Authors: A. Dali-Ali, F. Agag, H. Beldjilali, A. Oukebdane, K. Meddeber, R. Dali-Yahia, N. Midoun

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The ability of Acinetobacter baumannii to develop multiple resistances towards to the majority of antibiotics explains the therapeutic difficulties encountered in severe infections. Furthermore, its persistence in the humid or dry environment promotes cross-contamination in intensive care units. The aim of our study was to describe the epidemiological and bacterial resistance profiles of hospital-acquired infections caused by Acinetobacter baumannii in the intensive care unit of our teaching hospital. During the study period (June 3, 2012 to December 31, 2013), 305 patients having duration of hospitalization equal or more than 48 hours were included in the study. Among these, 36 had developed, at least, one health-care associated infection caused by Acinetobacter baumannii. The rate of infected patients was equal to 11.8% (36/305). The rate of cumulative incidence of hospital-acquired pneumonia was the highest (9.2%) followed by central venous catheter infection (1.3%). Analysis of the various antibiotic resistance profile shows that 93.8% of the strains were resistant to imipenem. The nosocomial infection control committee set up a special program not only to reduce the high rates of incidence of these infections but also to descrease the rate of imipenem resistance.

Keywords: Acinetobacer baumannii, epidemiological profile, hospital acquired infections, intensive care unit

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Authors: G. R. Constantine, M.C.K. Thilakasiri, V.S. Mohottala, T.V. Soundaram, D.S. Rathnayake, E.G.H.E. De Silva, A.L.S. Mohamed, V.R. Weerasekara

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Orthostatic hypotension is prevalent in the elderly population, and it is an important risk factor contributing to falls in the elderly. This study aims to evaluate the prevalence of orthostatic hypotension in hospitalized elderly patients, changes in blood pressure during the hospital stay, morbidities associated with it and its association with falls in the elderly. A cross-sectional descriptive study was conducted in the National Hospital of Sri Lanka (NHSL) in a sample of 120 patients of age 65 years or above who were admitted to the medical wards. The demographic, clinical data was obtained by an interviewer-administered questionnaire. Two validated questionnaires were used to assess symptoms and effects of orthostatic hypotension and risk factors associated with falls. Orthostatic hypotension on admission and after 3 days of hospital stay was measured by bed-side mercury sphygmomanometer. Prevalence of orthostatic hypotension among the study population was 63.3%(76 patients). But no significant change in the orthostatic hypotension noted after 3 days of hospital admission (SND 0.61, SE= 5.59, p=0.27). There was no significant association found between orthostatic hypotension and its symptoms (dizziness and vertigo, vision problems, malaise, fatigue, poor concentration, neck stiffness), impact on standing or walking and non-communicable diseases. Falls were experienced by 27.5 % (33 patients) of the study population and prevalence of patients with orthostatic hypotension who had experienced falls was 25.9% (28 patients). In conclusions, orthostatic hypotension is more prevalent among elderly patients, but It wasn’t associated with symptoms, and non-communicable diseases, or as a risk factor for falls in elderly.

Keywords: orthostatic hypotension, elderly falls, emergency geriatric, Sri Lanka

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Authors: Moses Balina, Archbald Bahizi

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Introduction: Early onset neonatal sepsis is a systemic infection in a newborn baby during the first week after birth and contributes to 50% of neonatal deaths each year. Risk factors for early onset neonatal sepsis, which can be maternal, health care provider, or health care facility associated, can be prevented with access to quality antenatal care. Objective: The objective of the study was to assess early onset neonatal sepsis and antenatal factors associated with Fort Portal Regional Referral Hospital. Methodology: A cross sectional study design was used. The study involved 60 respondents who were mothers of breastfeeding neonates being treated for early onset neonatal sepsis at Fort Portal Regional Referral Hospital neonatal intensive care unit. Simple random sampling was used to select study participants. Data were collected using questionnaires, entered in Stata 16, and analysed using logistic regression. Results: The prevalence of early onset neonatal sepsis at Fort Portal Regional Referral Hospital was 25%. Multivariate analysis revealed that institutional factors were the only antenatal factors found to be significantly associated with early onset neonatal sepsis at Fort Portal Regional Referral Hospital (p < 0.01). Bivariate analysis revealed that attending antenatal care at a health centre III or IV instead of a hospital (p = 0.011) and attending antenatal care in health care facilities with no laboratory investigations (p = 0.048) were risk factors for early onset neonatal sepsis in the newborn at Fort Portal Regional Referral Hospital. Conclusion: Antenatal factors were associated with early onset neonatal sepsis, and health care facility factors like lower level health centre and unavailability of quality laboratory investigations to pregnant women contributed to early onset neonatal sepsis in the newborn. Mentorships, equipping/stocking laboratories, and improving staffing levels were necessary to reduce early onset neonatal sepsis.

Keywords: antenatal factors, early onset neonatal sepsis, neonates 0-7 days, fort portal regional referral hospital

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Authors: Eddy K. Mukadi

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The aim of this study was to provide contributing elements to improve the management of the asthma crisis in the intensive care unit of the General Reference Hospital of Kinshasa. This was a descriptive study of all patients in the intensive care unit presenting with the asthma attack during the period from February 5, 2013 to February 5, 2014. The main data were obtained from consultation registry and medical records. A total of 35 patients, 21 of whom were male (majority) compared to 14 female. Average age of patients was 46.48 plus or minus 16.98 with extremes ranging from 21-75 years. The clinic was dominated by dyspnea in 100% of cases, followed by rales with 91.4% of cases. In spite of the control of the crisis obtained after the treatment with B2 mimetic by inhalation was introduced A 91.5%; 88% corticosteroids; 80% oxygen, the therapeutic principle recommended for the management of asthma attacks was not respected in the majority of cases. This is why we suggest that improving the quality of care to be administered to patients will yield more adequate results.

Keywords: asthma crisis, intensive care, general hospital, Kinshasa

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Authors: A. Sherif, A. El Zafarany, R. Arafa

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Hospitals, everywhere, are considered heavy energy consumers. Hospital Intensive Care Unit spaces pose a special challenge, where design guidelines requires the provision of external windows for day-lighting and external view. Window protection strategies could be employed to reduce energy loads without detriment effect on comfort or health care. This paper addresses the effectiveness of using various window strategies on the annual cooling, heating and lighting energy use of a typical Hospital Intensive Unit space. Series of experiments were performed using the EnergyPlus simulation software for a typical Intensive Care Unit (ICU) space in Cairo, located in the Egyptian desert. This study concluded that the use of shading systems is more effective in conserving energy in comparison with glazing of different types, in the Cairo ICUs. The highest energy savings in the West and South orientations were accomplished by external perforated solar screens, followed by overhangs positioned at a protection angle of 45°.

Keywords: energy, hospital, intensive care units, shading

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Authors: Fares Mahdi

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Background: Infection control is an important concern for all health care professionals, especially nurses. Nurses have a higher risk for both self-acquiring and transmitting infections to other patients. Aim of this study: to assess nurses' knowledge regarding infection control for wound care. Methodology: a descriptive research design was used in the study. The total number studied sample was 200 nurses, were conducting in Amran Public Hospitals in Amran City- Yemen. The study covered sample nurses in the hospital according to the study population; a standard closed-ended questionnaire was used to collect the data. Results: The results showed less than half (37.5 %) of nurses were from 22 May Hospital, also followed by (62.5%) of them were from Maternal and Child Hospital. Also according to the department name. Most (22.5%) of nurses worked in an intensive care unit, followed by (20%) of them were working in the pediatric world, also about (19%) of them were working in the surgical department. While in finally, only about (8.5%) of them worked from another department. According to course training, The results showed about (21%) of nurses had course training in wound care management. At the same time, others (79%) of them have not had course training in wound care management. According to the total nurse's knowledge of infection control for wound care, that find more than two-thirds (68%) of nurses had fair knowledge according to total all of nurse's knowledge of infection control wound care. Conclusion:The results showed that more than two-thirds (68%) of nurses had fair knowledge according to total all of the nurse's knowledge of infection control for wound care. Recommendations: There should be providing training program about infection control masseurs and it's important for new employees of nurses. Providing continuing refreshment training courses about infection control programs and about evidence-based practice in infection control for all health care teams.

Keywords: assessment, knowledge, infection control, wound care, nurses, amran hospitals

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Authors: Corbel Camille, Le Cerf Flora, Capriz Françoise, Vaillant-Ciszewicz Anne-Julie, Breaud Jean, Guerin Olivier, Corveleyn Xavier

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Background: The medical environment can generate stressful and anxiety-provoking situations for patients, particularly during painful care procedures for the older population. These stressful environments have deleterious effects on the quality of care and can even put the patient at risk and set the care team up for failure. The search for a solution is, therefore, imperative. The development of new technologies, such as virtual reality (VR), seems to be an answer to this problem. Objectives: The objective of this study is to compare the effects of virtual reality on pain and anxiety when caring for older hospitalized people with the effects of usual care. More precisely, different individual factors (age, cognitive level, individual preferences, etc.) and different virtual reality universes (personalized or non-personalized) are studied to understand the role of these factors in reducing pain and anxiety during care procedures. The aim of this study is to improve the quality of life of patients and caregivers in their work environment. Method: This mono-centered, randomized, controlled study was conducted from September 2023 to September 2024 on 120 participants recruited from the geriatric departments of the Cimiez Hospital, Nice, France. Participants are randomized into three groups: a control group, a personalized VR group and a non-personalized VR group. Each participant is followed during a painful care session. Data are collected before, during and after the care, using measures of pain (Algoplus and numerical scale) and anxiety (Hospital anxiety scale and numerical scale). Physiological assessments with an oximeter are also performed to collect both heart and respiratory rate measurements. The implementation of the care will be assessed among healthcare providers to evaluate its effects on the difficulty and fatigue associated with the care. Additionally, a questionnaire (System Usability Scale) will be administered at the conclusion of the study to determine the willingness of healthcare providers to integrate VR into their daily care practices. Result: The preliminary results indicate significant effects on anxiety (p=.001) and pain (p=<.001) following the VR intervention during care, as compared to the control group. Conclusion: The preliminary results suggest that VRI appears to be a suitable and effective method for reducing anxiety and pain among older hospitalized individuals compared with standard care. Finally, the experiences of healthcare professionals involved will also be considered to assess the impact of these interventions on working conditions and patient support.

Keywords: anxiety, care, pain, older adults, virtual reality

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Authors: Wladislaw Mill, Hariet Kirschner, Anna Zimmermann, Sashi Singh, Simon Forstmeier, Uwe Berger, Bernhard Strauss, Benedikt Werner

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Introduction: A promising method to improve mental health of elderly people are structured life-reviews. We report the evaluation of our newly developed manual for structured life-reviews. The manual was created with the emphasis on straightforward application so that it can be used by professionals and lay people alike. Method: A within-subjects pre-post design is used to evaluate the manual using a geriatric depression scale and a self-integrity measure. Participants are elderly people living by themselves and in nursing homes. Findings: It is shown that elderly people perceive the structured life-review as a very positive experience. More importantly, it is shown that a negative trend of self-integrity and geriatric depression is significantly reduced by the intervention. Conclusion: The data suggest that the manual contributes positively to self- perception and mental health. We conclude that this newly developed device is very valuable to augment elderly care.

Keywords: structured life-review, self-integrity, geriatric depression, preventation research

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Authors: Adriane Amend, Leidiene Ferreira Santos, Daniella Pires Nunes

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The experience of assuming or caring for older persons dependents by relatives is a complex task that encompasses or affective involvement, the demand for technical activities and or psychological support. It would be necessary to understand the situations related to the caregiver, the person and the environment, which help the family difficulty, as a caregiver to lead this role. Objective: To identify the forces that drive and restrict the care process of family caregivers of the older adults. Method: Descriptive and exploratory research, with a qualitative approach, which has as a reference the Force Field Theory. Five family caregivers of older adult’s dependents residing in the city of Palmas, Tocantins, Brazil will participate. The data were collected from December 2021 to February 2022, through a semi-structured individual interview, and submitted to content analysis. Results: As forces that drive or process of caring for family caregivers were: the account of compassionate attitudes and patience of the caregiver (I); to the collaboration of the other person to the care and to the body structure of the same (Other); and the supports of other people not cared for and structural, such as adaptations in the room, read and bathroom, as in the presence of air conditioners (Environment). Among the restrictive forces of care we mention difficulties in delegating care to another person, or stress of care and other personal demands (I); imposition of the older person about care and e a transfer from bed to hip (Other); e lack of accessibility of the house and absence of air conditioning and hospital bed (Environment). Conclusion: The results show that there are driving forces with the caregiver's attitude and feelings, a bond as an idol and support for the caregiver and the environment. On the other hand, conflicting ties, absence of physical structure and daily and continuous care shifts, can significantly compromise well-being or the cycle of older adult, caregiver and care.

Keywords: caregivers, frail elderly, perception, geriatric nursing

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Authors: Chuang-Chun Chiou

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Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Similar to hospital and other health care service, care home service do need to provide quality and cost-effective service to satisfy the dwellers. The main purpose of this paper is to show how lean thinking and service innovation can be applied to care home operation. The issues and key factors of implementing lean practice are discussed.

Keywords: lean, service improvement, SERVQUAL, care home service

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Authors: Samira Mehrabi

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Geriatric depression is a common late-life mental health disorder that increases morbidity and mortality. It has been shown that exercise is effective in alleviating symptoms of geriatric depression. However, inconsistencies across studies and lack of optimal dose-response of exercise for improving geriatric depression have made it challenging to draw solid conclusions on the effectiveness of exercise in late-life depression. Purpose: To further investigate the moderators of the effectiveness of exercise on geriatric depression across the current body of evidence. Methods: Based on the Arksey and O’Malley framework, an extensive search strategy was performed by exploring PubMed, Scopus, Sport Discus, PsycInfo, ERIC, and IBSS without limitations in the time frame. Eight systematic reviews with empirical results that evaluated the effect of exercise on depression among people aged ≥ 60 years were identified and their individual studies were screened for inclusion. One additional study was found through the hand searching of reference lists. After full-text screening and applying inclusion and exclusion criteria, 21 studies were retained for inclusion. Results: The review revealed high variability in characteristics of the exercise interventions and outcome measures. Sample characteristics, nature of comparators, main outcome assessment, and baseline severity of depression also varied notably. Mind-body and aerobic exercises were found to significantly reduce geriatric depression. However, results on the relationship between resistance training and improvements in geriatric depression were inconsistent, and results of the intensity-related antidepressant effects of exercise interventions were mixed. Extensive use of self-reported questionnaires for the main outcome assessment and lack of evidence on the relationship between depression severity and observed effects were of the other important highlights of the review. Conclusion: Several literature gaps were found regarding the potential effect modifiers of exercise and geriatric depression. While acknowledging the complexity of establishing recommendations on the exercise variables and geriatric depression, future studies are required to understand the interplay and threshold effect of exercise for treating geriatric depression.

Keywords: exercise, geriatric depression, healthy aging, older adults, physical activity intervention, scoping review

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