Jita G. Hoogerduijn

Geriatric Conditions in Acutely Hospitalized Older Patients: Prevalence and One-Year Survival and Functional Decline

Background To study the prevalence of eighteen geriatric conditions in older patients at admission, their reporting rate in discharge summaries and the impact of these conditions on mortality and functional decline one year after admission. Method A prospective multicenter cohort study conducted between 2006 and 2008 in two tertiary university teaching hospitals and one regional teaching hospital in the Netherlands. Patients of 65 years and older, acutely admitted and hospitalized for at least 48 hours, were invited to participate. Eighteen geriatric conditions were assessed at hospital admission, and outcomes (mortality, functional decline) were assessed one year after admission. Results 639 patients were included, with a mean age of 78 years. IADL impairment (83%), polypharmacy (61%), mobility difficulty (59%), high levels of primary caregiver burden (53%), and malnutrition (52%) were most prevalent. Except for polypharmacy and cognitive impairment, the reporting rate of the geriatric conditions in discharge summaries was less than 50%. One year after admission, 35% had died and 33% suffered from functional decline. A high Charlson comorbidity index score, presence of malnutrition, high fall risk, presence of delirium and premorbid IADL impairment were associated with mortality and overall poor outcome (mortality or functional decline). Obesity lowered the risk for mortality. Conclusion Geriatric conditions were highly prevalent and associated with poor health outcomes after admission. Early recognition of these conditions in acutely hospitalized older patients and improving the handover to the general practitioner could lead to better health outcomes and reduce the burden of hospital admission for older patients.

Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study.

Background The aim of this research was to study the clinical characteristics and mortality and disability outcomes of patients who present distinct risk profiles for functional decline at admission. Methods Multicenter, prospective cohort study conducted between 2006 and 2009 in three hospitals in the Netherlands in consecutive patients of ≥65 years, acutely admitted and hospitalized for at least 48 hours. Nineteen geriatric conditions were assessed at hospital admission, and mortality and functional decline were assessed until twelve months after admission. Patients were divided into risk categories for functional decline (low, intermediate or high risk) according to the Identification of Seniors at Risk-Hospitalized Patients. Results A total of 639 patients were included, with a mean age of 78 years. Overall, 27%, 33% and 40% of the patients were at low, intermediate or high risk, respectively, for functional decline. Low-risk patients had fewer geriatric conditions (mean 2.2 [standard deviation [SD] 1.3]) compared with those at intermediate (mean 3.8 [SD 2.1]) or high risk (mean 5.1 [SD 1.8]) (p<0.001). Twelve months after admission, 39% of the low-risk group had an adverse outcome, compared with 50% in the intermediate risk group and 69% in the high risk group (p<0.001). Conclusion By using a simple risk assessment instrument at hospital admission, patients at low, intermediate or high risk for functional decline could be identified, with distinct clinical characteristics and outcomes. This approach should be tested in clinical practice and research and might help appropriately tailor patient care.

Prevention of functional decline in older hospitalized patients: nurses should play a key role in safe and adequate care.

This paper presents a discussion of knowledge and awareness regarding prevention of functional decline in older hospitalized patients. Functional decline is experienced by 30-60% of the older hospitalized patients, resulting in decreased independence and other adverse health outcomes. One literature study and four cohort studies (total n = 1628) were conducted to develop and validate an instrument to identify older hospitalized patients at risk for functional decline. An evidence-based best practice was developed to improve the quality of care for older patients. This paper shows the relevance and the complexity of this problem and shows that patients at risk can be recognized by four simple questions. Due to their ability to observe and guide patients and their 24-h patient supervision, nurses should play a key role in strategies to prevent functional decline. Nurses should assess the geriatric needs in patients at risk and based on these initiate and coordinate multi-professional interventions. Given the growing number of older people in western society and the growing need for care, action to prevent functional decline cannot be withheld. Knowledge of the ageing process, implementation of an evidence-based programme and a multidisciplinary approach is a basic ingredient to prevent functional decline.

Predicting functional decline in older patients undergoing cardiac surgery

BACKGROUND a growing number of older patients undergo cardiac surgery. Some of these patients are at increased risk of post-operative functional decline, potentially leading to reduced quality of life and autonomy, and other negative health outcomes. First step in prevention is to identify patients at risk of functional decline. There are no current published tools available to predict functional decline following cardiac surgery. OBJECTIVE to validate the identification of seniors at risk-hospitalised patients (ISAR-HP), in older patients undergoing cardiac surgery. DESIGN AND METHODS a multicenter cohort study in cardiac surgery wards of two university hospitals with follow-up 3 months after hospital admission. INCLUSION CRITERIA consecutive cardiac surgery patients, aged ≥65. Functional decline was defined as a decline of at least one point on the Katz ADL Index at follow-up compared with preadmission status. RESULTS 475 patients were included, 16% of all patients and 20% of patients ≥70+ suffered functional decline. The amended prediction model predicted functional decline using four criteria: preadmission need for daily assistance in instrumental activities of daily living, use of a walking device, need for assistance in travelling and no education after age 14. Area under the receiver operating curve for patients ≥70 it was 0.73. For the amended ISAR-HP sensitivity, specificity, positive and negative predictive values were 85, 48, 29 and 93%, respectively. CONCLUSIONS the amended ISAR-HP used in older cardiac surgery patients showed good discriminative values at score ≥1, supporting the generalisability of this prediction model for this patient group.

Comparisons of Knowledge of Dutch Nursing Students and Hospital Nurses on Aging

BACKGROUND Although there is a growing population of older adults admitted to hospitals, the literature demonstrates knowledge deficits of nurses regarding older patients. This study investigated knowledge levels of both nursing students and RNs about older hospitalized patients in relation to their educational level and work experience. METHOD First- and final-year vocational and bachelor nursing students, and associate degree and bachelor degree nurses working in the hospital setting with 0 to 5 years, 6 to 15 years, and more than 15 years of experience, have completed the Knowledge about Older Patients-Quiz (KOP-Q). The KOP-Q has a clearly described theoretical base finding its origin in knowledge regarding nursing care for older patients and shows good content and construct validity. RESULTS A substantial proportion of participants in all groups demonstrated insufficient knowledge about older patients. A difference in knowledge exists among nurses with different educational qualifications, and a link between years of experience and higher knowledge levels of nurses is found. CONCLUSION Throughout the nursing career, basic care topics in relation to care for older patients should play a key role in basic nursing education programs, as well as for continuing education programs provided in hospitals for nurses. J Contin Educ Nurs. 2018;49(2):84-90.

Structural Validity and Reliability of the Dutch Older Patient in Acute Care Survey (OPACS), Measuring Nurses Attitude towards Older Patients

Background: In clinical practice, nurses’ attitudes regarding older patients are important in relation to quality of care. The Older People in Acute Care Survey (OPACS) is an instrument measuring hospital nurses attitudes regarding older patients and validated in Australia and the USA. The OPACS is translated in Dutch language and content validity of this translation is previously assessed, presenting questionable results. Measurement instruments, however, cannot be “validated” based on content validity evidence alone. Judgmental evidence and statistical analysis should be combined to fully evaluate content domain definition and representation and guide further development. Objective: Assess structural validity and reliability to fully evaluate the OPACS for use in the Netherlands, complementing previous conducted content validity results. Design: Cross-sectional. Setting: Three general hospitals in the Netherlands. Participants: 201 registered nurses. Methods: Confirmatory factor analysis was used to assess the structural validity. Reliability was assessed with Cronbach’s alpha. Results: OPACS Section A (measuring practice experiences) demonstrated to have acceptable structural validity- and good reliability outcomes after exclusion of two items (model fit: x² [df=537]=8475.40, p |z|)= 0.551 -0 .788). Conclusion: Even though structural validity for section A was acceptable, content validity scores of a majority of items in this subscale were low, resulting in questionable use of this subscale for the Dutch context. The findings of this study, in relation to the earlier findings regarding content validity, justify the conclusion that use of the Dutch OPACS in clinical practice and research is not recommended. Given these findings, future research should pursue the development or (cross-cultural) validation of other instruments measuring hospital nurses attitudes towards older patients for the Dutch cultural context. Furthermore, this study demonstrated the influence of cultural differences on measurement instruments and the need for rigorous research before using a measurement instrument in a new culture or context.

Measurement of nurses' attitudes and knowledge regarding acute care older patients: Psychometrics of the OPACS-US combined with the KOP-Q

ABSTRACT In clinical practice, identifying positive and negative attitudes toward older patients is very important to improve quality of care provided to them. The Older People in Acute Care Survey – United States (OPACS‐US) is an instrument measuring hospital nurses attitudes regarding older patients. However, psychometrics have never been assessed. Furthermore, knowledge being related to attitude and behavior should also be measured complementing the OPACS‐US. The purpose of this study was to assess structural validity and reliability of the OPACS‐US and assess whether the OPACS‐US can be complemented with the Knowledge about Older Patients‐Quiz (KOP‐Q). A multicenter cross sectional design was conducted. Registered nurses (n = 130, mean age 39,9 years; working experience 14,6 years) working in four general hospitals were included in the study. Nurses completed the OPACS‐US section A: practice experiences, B: general opinion and the KOP‐Q online. Findings demonstrated that the OPACS‐US is a valid and reliable survey instrument that measures practice experiences and general opinion. Furthermore, the OPACS‐US can be combined with the KOP‐Q adding a knowledge construct, and is ready for use within education and/or quality improvement programs in the USA.

Verpleegkundige, blijf leren!

SamenvattingVergrijzing, nieuw opnamebeleid: verpleegkundigen in de ziekenhuizen zien steeds vaker oudere patiënten met complexe zorgproblematiek. Het leren over de zorg aan deze patiënten houdt niet op bij de schoolbanken: verpleegkundigen moeten die kennis bijhouden en blijven ontwikkelen in de loop van hun carrière. Hoe is het gesteld met het kennisniveau van verpleegkundigen over de oudere patiënt? Een onderzoek onder mbo- en hbo-verpleegkundigen, van studenten en net-afgestudeerden tot verpleegkundigen met jarenlange ervaring in de ziekenhuispraktijk.

Inspirerend leren in de learning community: Waar onderwijs, onderzoek en beroepspraktijk elkaar ontmoeten

SamenvattingHet fenomeen leerafdeling, waarin vooral een kwantitatieve oplossing wordt geboden voor de zorgvraag is veelvuldig beschreven in de vakliteratuur. Een nieuwe tendens is de aandacht voor kwalitatieve vragen vanuit de instellingen,gericht op verbetering van de zorg. Deze vragen zijn aanleiding geweest binnen de Hogeschool Utrecht om het bestaande concept learning community nader uit te werken. Binnen dat concept wordt nadruk gelegd op de samenwerking tussen studenten van verschillende niveaus, onderzoekers, docenten en professionals van de zorginstelling. Gezamenlijk werken zij aan de verbetering van de zorg. In dit artikel wordt de ontwikkeling van de learning community beschreven en wordt een praktijkvoorbeeld gegeven.