Frailty is a recognised state of increased vulnerability to adverse outcomes resulting from an interaction of physical, psychological, socio-economic and co-morbidity factors. As a diagnosis it is independently associated with falls, decreased quality of life, hospital admissions, premature entry into long-term care and death.
A combination of two historic papers and one new paper has provided evidence on deconditioning in older people during hospitalisation.
UK policy and guidance state that people should have their preferences and priorities for end of life care recorded in the form of an advance care plan.
Compiled by Vicki Leah, nurse consultant for older people, University College London Hospitals NHS Foundation Trust, London
Three research articles of interest to nurses of older people
Summaries of three studies into issues of concern for older people's nurses
Despite the potential benefits of ACP for nursing home residents with dementia, the authors of this study highlight that hardly any research has focused on the involvement of residents/families in ACP and that ACP is rarely realised for these people. Their research aimed to evaluate the ACP policy for people with dementia in nursing homes and to gain insight into the involvement of residents with dementia and their families in ACP.
This comprehensive synthesis of published literature from a team in Northern Ireland focused on the perspectives of healthcare professionals in relation to ACP for people with dementia living in long-term care settings. From the 14 papers discussed, the authors identified that people with dementia are often not recognised as having a terminal illness. Four key themes were identified: ■ Early integration and planning for palliative care in dementia is important. ■ Healthcare professionals’ perspectives on ACP are influenced by ethical and moral concerns including presumptions regarding capacity of the person with dementia towards ACP and the impact of the increased role of the family in the decision-making processes. ■ Challenges in communicating with people who have dementia and their families. ■ A need for improvement in healthcare professionals’ knowledge of the disease trajectory of dementia with emphasis on end of life care, and a greater understanding of the process of ACP itself. This would assist them in engaging in ACP discussions.
Through a three-stage project in a specialist memory clinic in Australia, researchers introduced ACP to clients with mild cognitive impairment or recently diagnosed dementia and their families. Clients and carers were initially posted a survey assessing completed documentation for future care, understanding of the principles of ACP and willingness to receive further information. Those wanting more information were invited to a seminar introducing the ACP programme and service. Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians.
Despite being 15 years old, this study remains relevant. To investigate carer involvement in care planning in the psychiatric unit of an older person’s hospital, the researchers observed multidisciplinary ward rounds and family meetings, and reviewed documentation about admissions, discharges and care plans. They also conducted interviews with 20 carers and with members of the 29-strong multidisciplinary team to explore their experiences of carer involvement.
Danish researchers investigated how collaboration between relatives and nurses affects carers’ experiences during admissions. The researchers also examined the relationship between carer satisfaction, carers’ characteristics and specific aspects of collaboration.
There is a lack of definitions, evidence and guidance about carer engagement in hospitals. In this study, researchers carried out an integrative literature review to assess the components of carer engagement for older people’s hospital care.