Herman Cools

Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence.

A prospective study was done to investigate functional outcome, quality of life, and type of residence after hip fracture in patients 65 years of age and older. One hundred two patients admitted consecutively to a university and a general hospital were followed up as long as 4 months after admission. The mean age of the participants was 83 years; 58% of patients came from their own home, and 42% of patients came from institutions. Nearly 70% of patients had two or more diagnoses other than the hip fracture. Cumulative mortality was 20% at 4 months after fracture. Of surviving patients, 57% were back in their original situation for accommodation, 43% reached the same level of walking ability, and 17% achieved the same level of activities of daily living as before fracture. Patients experienced on average three complications, 26% of which were severe. Quality of life improved in the followup period of 4 months; however, the quality of life at 4 months was worse than the quality of life reported in a reference population. Average costs amounted to ε (Euro) 15.338 (which at the time was nearly equivalent to the US dollar) per patient, with nearly 50% of the costs attributable to hospital costs and 30% attributable to nursing home costs. The results of this study show a poor outcome after hip fracture in elderly patients.

Quality of life after hip fracture: a comparison of four health status measures in 208 patients.

Objectives: We compared four health status measures for the evaluation of quality of life after hip fracture. Methods: Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated. Results: At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning. Conclusions: To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.

Early discharge of hip fracture patients from hospital: transfer of costs from hospital to nursing home.

Hip fracture patients occupy more and more hospital beds. One of the strategies for coping with this problem is early discharge from the hospital to institutions with rehabilitation facilities. We studied whether early discharge affects outcome and costs. 208 elderly patients with a hip fracture were followed up to 4 months after the fracture. First, a group of 102 patients stayed in our hospital for the usual period (median 18 days). Then, 106 patients were assigned to a group for early discharge (median 11 days). We measured disabilities, health-related quality of life and cognition at 1 week, 1, and 4 months after hospitalization. To calculate total societal costs, inpatient days, the efforts of professionals in- and outside institutions, and interventions/examinations were recorded during this 4-month period. At 4 months, we found no differences in mortality, ADL level, complications, quality of life, and type of residence. More patients in the early discharge group were discharged to nursing homes with rehabilitation facilities (76% versus 53%), but the median total stay in hospital and nursing home was the same (26 days). Early discharge from hospital did not substantially reduce the total costs (conventional management ] 15,338 per patient and early discharge ] 14,281 per patient), but merely shifted them from the hospital to the nursing home.

Absence of Influenza A(H1N1) During Seasonal and Pandemic Seasons in a Sentinel Nursing Home Surveillance Network in the Netherlands

To describe the epidemiological, virological, and institutional characteristics of influenza‐like illness (ILI) in nursing homes (NHs).

Effectiveness of post-exposition prophylaxis with oseltamivir in nursing homes: a randomised controlled trial over four seasons

BackgroundOseltamivir has been registered for use as post-exposition prophylaxis (PEP) following exposure to influenza, based on studies among healthy adults. Effectiveness among frail elderly nursing home populations still needs to be properly assessed.MethodsWe conducted a randomised double-blind placebo-controlled trial of PEP with either oseltamivir (75 mg once daily) or placebo among nursing home units where influenza virus was detected; analysis was unblinded. The primary outcome was laboratory-confirmed influenza among residents in units on PEP; the secondary outcome was clinical diagnosis of influenza-like illness (ILI).Results42 nursing homes were recruited, in which 17 outbreaks occurred from 2009 through 2013, two caused by influenza virus B, the others caused by influenza virus A(H3N2). Randomisation was successful in 15 outbreaks, with a few chance differences in baseline indicators. Six outbreaks were assigned to oseltamivir and nine to placebo. Influenza virus positive secondary ILI cases were detected in 2/6 and 2/9 units respectively (ns); secondary ILI cases occurred in 2/6 units on oseltamivir, and 5/9 units on placebo (ns). Logistical challenges in ensuring timely administration were considerable.ConclusionWe did not find statistical evidence that PEP with oseltamivir given to nursing home residents in routine operational settings exposed to influenza reduced the risk of new influenza infections within a unit nor that of developing ILI. Power however was limited due to far fewer outbreaks in nursing homes than expected since the 2009 pandemic. (RCT nr NL92738)

How much time should long-term care and geriatric rehabilitation facilities (nursing homes) spend on infection control?

BACKGROUNDnFor hospitals, standards for the required number of infection control personnel are outdated and disputed. Such standards are not even available for long-term care and geriatric rehabilitation facilities (ie, nursing homes). This study addressed the question of how much time nursing homes should spend on infection control.nnnMETHODSnThrough group discussions and individual sessions, experienced infection control practitioners, medical microbiologists, and nursing home doctors evaluated the time needed to perform infection control activities in a model nursing home.nnnRESULTSnThe number of hours needed was estimated as 513 per 100 beds, or 154 per 10,000 care-days per year.nnnCONCLUSIONnGiven that significant differences can be expected among the various facilities identified as nursing homes, long-term care facilities, or geriatric rehabilitation centers, as well as among countries, the standard that we propose for The Netherlands will not be generally applicable. However, the method we have used to determine this standard can be easily applied in other countries and settings.

Complexe InfectiePreventie &; Controle (IPC) in zorginstellingen: 7 aandachtspunten

SamenvattingDe afgelopen decennia is de aandacht voor IPC in zorginstellingen verschoven van ziekenhuis gerelateerde (‘nosocomial’) infecties naar infecties die samenhangen met de gezondheids-zorg-in-het-algemeen (‘health-care-associated’).1 Deze ‘zorginfec-ties’ doen zich voor in het gehele extra-, semi- en intramurale zorgnetwerk ondanks de verschillen in doelgroepenbeleid tussen zorginstellingen en de heterogene populaties per instelling omdat de IPC overal in dit netwerk faalt.2 Als gevolg daarvan neemt het aantal langdurig asymptomatische dragers van micro-organismen met een lage virulentie toe en verhoogt de kans op transmissie van resistente micro-organismen en de kans op voorbijgaand dragerschap onder vooral zorgverleners (zie Figuur 1).

‘Update 2006’ van de NVVA-richtlijn ‘Influenzapreventie in verpleeghuizen en verzorgingshuizen’

SamenvattingIn april 2004 verscheen de NVVA-richtlijn ‘Influenzapreventie in verpleeghuizen en verzorgingshuizen’ (verder te noemen: De Richtlijn).

Wat is verantwoorde behandeling van ouderen in een zorginstelling

Abstract Summary How to define sound medical treatment for the elderly in nursing homesBased on further concepts of nursing home medicine / general geriatric medicine and major changes in healthcare assurance in the Netherlands, new priorities have to be formulated for research.Under the terms of de Dutch Law of Quality in Health Care Facilities, nursing home medical practitioners have to give a professional interpretation of sound medical treatment. Undertreatment has to be changed into patientoriented, effective and efficient medical treatment.SamenvattingOp basis van de vernieuwde Taaken Functie Verpleeghuisarts/Sociaal Geriater is het noodzakelijk opnieuw prioriteiten vast te stellen ter onderbouwing van de gewijzigde inhoud van het beroep. Dit geldt temeer nu de Minister van VWS een nieuwe Zorgverzekeringswet en Wet Maatschappelijke Ondersteuning en (mogelijk) een aangepaste AWBZ voorbereidt.Dit artikel gaat in op enkele prioriteiten in de verpleeghuisgeneeskundige cq medische behandeling van ouderen als onderdeel van ‘verantwoorde zorg’ zoals bedoeld in de Kwaliteitswet Zorginstellingen. Beoogd wordt de geneeskundige onderbehandeling van vele chronische aandoeningen zo spoedig mogelijk te wijzigen in doelmatige, effectieve en patiëntgerichte geneeskundige behandeling. Sleutelwoorden: verantwoorde zorg, onderbehandeling, chronische aandoeningen.