Michele Board

A simple drawing test to identify patients who are unlikely to be able to learn to use an inhaler

Previous research has shown that patients are not able to learn to use self‐administered inhaler devices if they have impaired general cognition, executive (frontal lobe) dysfunction or dyspraxia. These impairments are most frequently encountered in frail elderly people. Some of the tests required to detect such impairments are time‐consuming and are therefore not easily adopted in routine clinical practice, particularly in an outpatient setting. We performed a study of 50 elderly inhaler‐naïve patients to explore the use of a simple quick drawing test (copying overlapping pentagons) to determine whether that test was able to identify patients who were unable to learn to use a Turbohaler. Patients who were not able to perform the pentagon copying test were found to be unable to learn to use a Turbohaler with a specificity of 93% and positive predictive value of 87%. This was at least as discriminating as the Abbreviated Mental Test and the Mini Mental State Examination. The overlapping pentagon drawing test is useful in clinical practice to identify patients who will probably not use a self‐administered inhaler correctly, and who will require an alternative approach to the treatment of their airways disease. This finding might have implications for other self‐administered treatment, such as insulin pens and complex drug regimens.

Dementia care in nursing

Introduction Setting the Scene Models of Nursing Care Attitudes, Culture and Spirituality The Person Assessment Diagnosis Care Legal and Ethical Issues

End-of-life care in UK care homes: a systematic review of the literature:

Background The number of people requiring end-of-life care provision in care homes has grown significantly. There is a need for a systematic examination of individual studies to provide more comprehensive information about contemporary care provision. Aim The aim of this study was to systematically review studies that describe end-of-life care in UK care homes. Method A systematic PRISMA review of the literature published between 2008 and April 2017 was carried out. A total of 14 studies were included in the review. Results A number of areas of concern were identified in the literature in relation to the phases of dying during end-of-life care: end-of-life pre-planning processes; understandings of end-of-life care; and interprofessional end-of-life care provision. Conclusions Given that the problems identified in the literature concerning end-of-life care of residents in care homes are similar to those encountered in other healthcare environments, there is logic in considering how generalised solutions that have been proposed could be applied to the specifics of care homes. Further research is necessary to explore how barriers to good end-of-life care can be mitigated, and facilitators strengthened.

Ask the experts: How might the recession affect acute and community services for older people?

Taking account of the mental health needs of older people should be an integral part of any strategy aimed at improving the overall performance of health and social care. A typical district general hospital with 500 beds will admit around 5,000 older people each year and 3,000 of these will have or develop a mental disorder.