Irene Schofield

Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test.

To determine the utility of the 4-item Abbreviated Mental Test (AMT4) for detecting cognitive impairment in accident and emergency patients aged 65 years or older. Cognitive function was assessed using the Mini Mental State Examination (MMSE), 4 and 10-point AMT and subjective judgment. Cognitive impairment was defined as an MMSE score 23/30 or less. Of 601 patients, 226 (37.6%) scored 23 or less on MMSE. Cutoffs of 3 or less for AMT4 and 7 or less for AMT had sensitivities of 80% [95% confidence interval (CI): 0.75–0.85] and 76% (95% CI: 0.69–0.81), and specificities of 88% (95% CI: 0.84–0.91) and 93% (95% CI: 0.90–0.96), respectively, for detection of cognitive impairment; subjective judgement of admitting nurse had 50.5% (95% CI: 44–57%) sensitivity and 98.6% (95% CI: 0 96–1.00%) specificity. In conclusion, the AMT4 performs as well as the 10-point AMT in screening for cognitive impairment, and will assist in the early detection of cognitive problems.

Football reminiscence for men with dementia: lessons from a realistic evaluation

Football reminiscence for men with dementia: lessons from a realistic evaluation A major challenge of studies of non pharmacological dementia interventions is the likely modest intervention effect size and difficulties collecting data from individuals with behavioural, psychological and communicative symptoms. The reported Realist Evaluation is built around sets of contextually comparable case studies of Football Focussed Reminiscence for men with dementia. The study aim was to evaluate benefits of football related reminiscence for individuals and family carers. Four case studies were constructed; two community groups, one nursing home groups and individual sessions within their family home. Data was collected as field notes from non-participation observation of reminiscence sessions, notes of conversations with people with dementia, audio recorded interviews with family members, facilitators and dementia link workers. The analysis was framed around identification and extraction of data pertaining to Context-Mechanism-Outcome configurations within each data set, and patterns and threads were compared across the cases. An important finding was that anticipation of pleasure in tandem with a sense of continuity appeared to be important mechanisms triggering optimal benefit. The paper explores design considerations, project delivery experiences and the contribution that innovative theory driven research adds to the study of complex interventions including those with behavioural and communicative symptoms of dementia.

Delirium: challenges for clinical governance

BACKGROUND Delirium is caused by pathophysiology but yet it presents as a disorder of cognition. It can be a transient phenomenon, and full recovery is common once the underlying cause has been diagnosed and treated. EVALUATION Through key studies on prevalence, prevention and management of delirium, together with emerging results from doctoral study. KEY ISSUES Delirium is an independent predictor of poor clinical outcomes as follows: a slower rate of recovery and poor functional recovery; prolonged time spent in hospital; increased likelihood of admission to a care home and re-admission to hospital and increased risk of mortality. In addition, aspects of daily care raise important clinical governance issues. CONCLUSIONS Delirium is an indicator of the quality of hospital care for older people. It impacts on key clinical outcomes and care process such as person-centred care, respect and dignity, and patient and staff safety. IMPLICATIONS FOR NURSING MANAGEMENT Delirium has been neglected and trivialized. Nurse managers are the key to initiating and giving continued support to evidence-based facility-wide strategies to prevent or decrease the impact of delirium.

The Potential of Communities of Practice to Promote Evidence-Informed Practice Within Nursing Homes

Debbie Tolson, PhD, MSc, BSc (Hons), RGN, Andrew Lowndes, MSc, BA, RNT, RCNT, RN,Joanne Booth, PhD, BSc (Hons), BA, RN, RNT, Irene Schofield, PhD, MSc (Gerontology), RNT, RGN,and Ann Wales, PhD, BSc (Hons), DipLib, MBEHealth care providers are increasingly seeking new tech-nologiestoimprovequalityandcosteffectiveness.