Steve Strupeit

Mobility and Quality of Life after Discharge from a Clinical Geriatric Setting Focused on Gender and Age

Purpose: The purpose of this study was to assess the long‐term functional status and quality of life of older individuals with functional mobility impairment. Design: A prospective longitudinal study was conducted. Methods: The study sample consisted of elderly patients who had been admitted to a rehabilitation facility in Hamburg, Germany. Data were collected from February 2008 to August 2009 in the rehabilitation center and the living environment of the participants after discharge. Quality of life was assessed using the WHO Quality of Life‐BREF; activities of daily living were measured using the Barthel‐Index (BI). Findings: Functional status and overall quality of life increased from admission (BI = 73.33) to 6 months postadmission (BI = 89.29) but decreased at 12 months postadmission (BI = 85.71). Quality of life significantly increased in the psychological domain from admission (57.85) to 6 months follow‐up (67.85) (p = .010). Men showed a better functional status over time (p = .010) than women. Higher quality of life scores were associated with higher MMSE (p = .031) and self‐efficacy scores (p = .019) at admission. Conclusion: The findings of this study suggest a need for interventions to improve functional status and quality of life in this population, especially following 6 months after discharge. Clinical Relevance: Special interventions should address physical quality of life and physical functioning. Gender differences should be considered in planning and implementing programs.

Influence of living situation on vulnerable elderly: Focus on nutritional status

OBJECTIVES We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements). DESIGN For this secondary analysis, a cross-sectional study was performed. SETTING For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study. PARTICIPANTS The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs. MEASUREMENTS Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE). RESULTS Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting. CONCLUSION Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings.

Assessing Risk of Falling in Older Adults—A Comparison of Three Methods

BACKGROUND Various risk assessment methods have been developed to assess fall risk. Diagnostic accuracy of fall risk assessments is low and there is a scarcity of evidence regarding clinical effectiveness. AIMS The aim of this study was to evaluate the diagnostic accuracy and clinical effectiveness of a standardized fall risk assessment relative to clinical and self-report assessment. METHODS A single-site, prospective, longitudinal study was performed in a group of geriatric patients. Participants were patients being admitted to a geriatric rehabilitation hospital. The St. Thomass risk assessment tool (STRATIFY), clinical assessment, and a self-report assessment (fear of falling) were used to assess fall risk at two time points (at baseline and 3-week follow-up). The primary outcome was fall events. Contingency tables were used to calculate sensitivity, specificity, positive predictive values, and negative predictive values. Fishers exact test was used to test the association between assessments and fall events. RESULTS A total of 124 patients participated in the study. The self-report technique demonstrated the highest sensitivity and negative predictive validity. The STRATIFY tool showed the highest specificity but the lowest sensitivity. The self-report technique was associated with a lower number of fall events. DISCUSSION Given the lack of diagnostic accuracy of all three assessment techniques and the lack of evidence regarding clinical effectiveness, the usefulness of these fall risk assessments can be challenged. IMPLICATIONS FOR PRACTICE At least in settings in which fall prevention programs are a part of standard care, additional time consuming assessments may not be required. LINKING EVIDENCE TO ACTION It is questionable whether time-consuming assessments examined in this study are necessary. Further studies are needed to examine the diagnostic accuracy and clinical effectiveness of fall risk assessments.

Effectiveness of educational nursing home visits on quality of life, functional status and care dependency in older adults with mobility impairments: a randomized controlled trial

RATIONALE, AIMS AND OBJECTIVES Facilitating and maintaining functional status (FS) and quality of life (QoL) and avoiding care dependency (CD) are and will increasingly become major tasks of nursing. Educational nursing home visits may have positive effects on FS and QoL in older adults. The aim of this study was to determine the effectiveness of educational home visits on FS, QoL and CD in older adults with mobility impairments. METHOD We performed a randomized controlled trial. The study was conducted in the living environments of 123 participants with functional impairments living in Hamburg, Germany. The intervention group received an additional nursing education intervention on mobility and QoL; the control group received care as usual. Data were collected from August 2011 to December 2012 at baseline, 6 months and 12 months of follow-up. The main outcomes were FS (Barthel Index), QoL (WHOQOL-BREF) and CD (Care Dependency Scale). Data were analyzed using descriptive statistics and generalized linear models. RESULTS In total, 113 participants (57 in the intervention and 56 in the control group) were included in the study. The intervention had no statistical significant effect on FS, QoL and CD. CONCLUSIONS The intervention did not show the benefits that we assumed. Further studies on the effects of educational nursing interventions should be performed using different concepts and rigorous research methods.

Effectiveness of a Nursing Consultation Intervention for Older People with Functional Mobility Impairments: A Prospective, Longitudinal Study

Background: There is a need for prevention strategies in elderly individuals with mobility impairments. Purpose: The aim of this study was to determine the effects of nursing consultations on the functional abilities and quality of life of elderly individuals with mobility impairments after discharge from a rehabilitation facility. Methods: A single-site, prospective, longitudinal study with a nonequivalent control group pretest–posttest design was conducted in a geriatric rehabilitation facility and in the living environments of the patients after discharge. The intervention consisted of nurse-delivered consulting home visits and follow-up telephone calls. Patient quality of life and functional status were the primary outcomes, and self-efficacy was the secondary outcome. Data were collected at admission, at discharge, and at a 6-month follow-up visit. Results: A cohort of 124 patients participated in the study. The intervention group showed a nonsignificant improvement in functional status compared with the control group. The intervention did not affect quality of life, except for a trend toward significance in the social domain (p = .060). Conclusions: The findings of this study suggest that nursing consultations do not significantly improve functional status and have almost no effect on quality of life.

E-Health in der Pflege - Wirksamkeit von pflegegeleiteten Interventionen bei älteren Menschen

E-Health-Ansatze greifen in der Gesundheitsversorgung vermehrt um sich. Insbesondere die Pflege und Versorgung alterer vulnerabler Gruppen birgt Potential fur die Umsetzung E-Health-gestutzter Interventionen. Pflegende konnen in diesem Zusammenhang eine zentrale Rolle einnehmen. Neben den (potentiellen) Kosteneinsparungen bedarf es eines Nachweises fur eine ausreichende Evidenz zur Wirksamkeit umgesetzter Interventionen auf die gesundheitsbezogenen Outcomes bei den Patienten und deren Inanspruchnahme von Gesundheitsleistungen. Der folgende Beitrag fasst die Studienlage zu diesem Thema aus pflegerischer Sicht zusammen und zieht Schlussfolgerungen fur Wissenschaft und Praxis.

Effectiveness of nurse-delivered patient education interventions on quality of life in elders in the hospital: A systematic review

BACKGROUND Nurse-delivered education is a crucial part of nursing practice; however, evidence regarding its impact on quality of life is lacking. To our knowledge, no systematic review has addressed the effects of nurse-delivered education interventions on the quality of life in a general elderly inpatient population. OBJECTIVES To evaluate the effectiveness of nurse-delivered education interventions compared to usual care with regard to the quality of life in elders in the hospital. METHODS A systematic review was performed to identify randomized controlled trials examining the effects of nurse-delivered educational interventions on the quality of life in elders in the hospital. The search was performed in December 2012 in the MEDLINE (via PubMed), EMBASE (via Ovid), and CINAHL (via EBSCO) databases and was limited with regard to publication time and language. The studies were appraised according to methodological quality, and p-values were extracted to determine the effectiveness of the interventions. RESULTS Four studies were included in the review. One study testing multicomponent interventions showed positive effects on quality of life. Two studies showed no effect, and one study showed a negative effect of the intervention on quality of life. Methodological appraisal revealed single biases in most of the studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Because of the scarcity of positive findings, methodological issues, and heterogeneity between studies, this review could not provide evidence of the effectiveness of nurse-delivered education interventions in elders in the hospital for improving quality of life. Nurse-delivered education may be more effective as a part of multifactorial interventions. Further studies should examine interventions that focus on quality of life using validated measures.

Selbstpflegekompetenz entwickeln: Ulcus cruris: Die Krankheit verstehen

Menschen mit chronischen Wunden leiden nicht nur unter der Wunde. Vielmehr sind es die Einschränkungen im Alltag, mit denen die Betroffenen zu kämpfen haben. Professionelle Klientenedukation ermöglicht Klienten, die Ursachen ihrer Krankheit zu erkennen, die Therapie zu verstehen und möglichst selbstständig zu leben.