المؤلفون: Kelly Hislop Lennie, Catherine Murphy, Miranda Fader, Margaret Macaulay, Christine de Laine

المصدر: Age and Ageing. 50:944-954

مصطلحات موضوعية: Aging, Health Personnel, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Nursing, Health care, medicine, Humans, Dementia, 030212 general & internal medicine, Social isolation, business.industry, General Medicine, medicine.disease, Mental health, Urinary Incontinence, Caregivers, Toileting, Geriatrics and Gerontology, medicine.symptom, business, Psychosocial, 030217 neurology & neurosurgery, Independent living

الوصف: Background many people living at home with dementia (PLWD) also have poorly managed toilet-use or incontinence problems with damaging consequences for both people with dementia, unpaid carers and healthcare professionals (HCPs). Currently, there are no theoretically or empirically based interventions to help. The underlying causes and subsequent consequences of these problems need to be fully understood in order to support the development of interventions that have the potential to decrease the impact of these problems on people’s lives. Aim to establish the range of causes, consequences and potential solutions of toilet-use and incontinence problems for PLWD and their carers. Method a qualitative design was used. Semi-structured interviews were undertaken with PLWD, carers and HCPs (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were digitally recorded and transcribed verbatim. Framework analysis was used to interpret the data to address the goal of the research. Results in total, 45 people (26 unpaid carers, 2 people with dementia, 9 continence and 8 dementia HCPs) took part. The causes of toilet-use and incontinence problems were reported to be multi-faceted and complex including those related to dementia (e.g. lack of insight into toileting needs or how to use the toilet), those which are physical (e.g. existing bladder or bowel issues or poor mobility), psychosocial (e.g. inability to ask for help for incontinence) or societal (e.g. fear of stigma), or related to care systems (e.g. lack of expert knowledge) or products (e.g. poor fit or confusing for users). Consequences included harms to physical and mental health, social isolation, increased carer workload and care system resource implications. Conclusion this study provides the first detailed characterisation of the causes and consequences of and potential solutions for incontinence problems for PLWD at home and their carers. Multifaceted and complex problems were identified, layering dementia, physical, psychosocial, societal and care system factors and highlighting contextual variation. This new knowledge provides the essential basis for the (now underway) development of urgently needed practical and implementable interventions for this underserved population.

وصف الملف: text

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6c30cb175c1d8f69d6395ec57882a50cTest
https://doi.org/10.1093/ageing/afaa262Test

المؤلفون: Alice O’Donoghue, Clare MacMahon, Millie O'Gorman, Riona Mulcahy, Anne O'Mahony, Adriana O'Halloran, Marie Doyle, George Pope, Margaret Bolger, Maged Henin, Niamh Phelan, Emma Grant, Catherine Murphy, John Cooke, Rudo Masombo, Suzanne Roche, Desmond O'Donnell, PJ Hartnett

المصدر: Age and Ageing. 48:iii17-iii65

مصطلحات موضوعية: Older person, Aging, Patient referral, Patient care team, Nursing, Critical pathways, business.industry, Medicine, General Medicine, Geriatrics and Gerontology, Patient-centered care, business, Integrated care

الوصف: Background Our Integrated Care Hub has been operating since mid-2017 providing patient-centred multidisciplinary team (MDT) care operating via a number of specialised care pathways. There has been an early emphasis on the response to crisis presentations and with the introduction of the Hub we now have an extensive and organised response to such presentations. We wanted to assess does this system result in earlier referral of the ‘Crisis’ patient to an Integrated Care Hub. Methods We performed a retrospective quantitative analysis of data comparing two time-periods January to June 2018 with January to April 2019 (year-to-date). The number and type of MDT contacts were classified into 4 categories: Immediate Crisis (would present to the Emergency Department within 48 hrs if not reviewed), Emerging Crisis (would present to the Emergency Department within 2 weeks if not reviewed), Stable Situation (needs optimisation), Stable Situation (no intervention). Data were extracted from File-Maker Pro. Results There were 424 MDT contacts in January-June 2018 compared with 658 MDT contacts in the year-to-date 2019. The number of patients in these time-periods presenting in ‘Immediate Crisis’ was reduced in the year-to-date 2019 - 4.41% when compared to the same time-period in 2018 – 11.79%. There was a similar reduction in ‘Emerging’ Crisis presentations in these time-periods: 15.65% in 2019 vs. 24.29% in 2018. While the patients attending that were classified as Stable Situation (needs optimisation) increased in 2019 compared to 2018 – 66.57% vs. 47.88%. Conclusion We can see from our data that the creation of our Integrated Care Hub has resulted in an increased demand for our service, however, interestingly we have found that the crisis patient load has, in fact, decreased. This suggests that we are influencing referral patterns by both recognising and intervening at an earlier stage to manage, stabilise and reverse crisis in these patients in an organised manner within the MDT.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::1771fe0f28667a4d1c2c48014680955fTest
https://doi.org/10.1093/ageing/afz103.194Test

المؤلفون: Catherine Murphy, Suzanne Roche, Riona Mulcahy, Niamh Phelan, Margaret Bolger, John Cooke, PJ Harnett, Emma Grant, George Pope

المصدر: Age and Ageing. 48:iii17-iii65

مصطلحات موضوعية: Aging, Nursing, business.industry, Medicine, General Medicine, Geriatrics and Gerontology, business, Integrated care

الوصف: Background The development of an Integrated Care Hub has resulted in a complete review of the triage system for older people referred to our service. Our aim was to develop a multidisciplinary triage process (MTP) to ensure patients are seen by the right person at the right time for a First Contact Assessment (FCA). Methods A quantitative retrospective analysis of referrals and frequency of multidisciplinary team input from January 2018 – June 2018, highlighted the majority of patients were seen for FCA by the staff nurse. This subsequently resulted in onward referrals to Allied Health Professionals within the ‘Hub’, and patients attended for multiple visits. A working group was formed to address these issues. This resulted in the development of the MTP where patients are triaged by the Multidisciplinary team (MDT) and allocated to the most appropriate team member based on the referring information. Following the introduction of this triage process, data analysed from November 2018 - April 2019 highlighted its impact on our service. Results In the first reference period the proportion of patients seen for FCA by each discipline was as follows; Staff nurse (SN) 53%, Clinical Nurse Specialist (CNS) 18%, Occupational Therapist (OT) 16% and Physiotherapist 9%. In the second reference period the proportions changed to the following; SN 12%, CNS 31%, OT 33%, Physiotherapist 20% and Dietitian 4%. It has reduced the number of patient visits to the ‘Hub’ and the waiting times to see the right person within the team. Conclusion Empowering supported MDT members to triage and the use of this new MTP has resulted in patients having rapid access to the most appropriate team member for FCA. It has resulted in a change in the distribution of the caseload to ensure patients are seen by the right person within the team, and at the right time for early patient centred intervention.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::8f1e2d749c3fbcc4e3bad2a187aa33ebTest
https://doi.org/10.1093/ageing/afz103.128Test

المؤلفون: Suzanne Roche, John Cooke, Catherine Murphy, Emma Grant, Maggie Bolger, Jacinta Brennan, Millie O'Gorman, Niamh Phelan, Riona Mulchay, Marie Doyle, George Pope

المصدر: Age and Ageing. 48:iii17-iii65

مصطلحات موضوعية: Aging, Nursing, business.industry, Medicine, General Medicine, Geriatrics and Gerontology, business, Integrated care

الوصف: Background The Occupational Therapy (OT) service in the integrated care HUB team was established in January 2018. Prior to this, there was an established memory clinic, however with inconsistent access to OT. The streamlining and structuring of memory clinics further highlighted the need for post-diagnostic support for example individual sessions focusing on memory education and practical strategies to enable independence in daily activities. The integration of OT enabled person-centred strategies to be provided to individuals experiencing memory loss. Methods A retrospective analysis was completed comparing the number of OT memory patient contacts between January to June 2018 and November 2018 to April 2019 also reflecting the memory care pathway developed during this period. OT assessed all new patients experiencing memory difficulties that impacted on functional activities to initiate referral process. In April 2018, the Memory Technology Resource Room (MTRR) opened and the OT HUB using to facilitate patient contacts. The design/implementation of cognitive rehabilitation groups in May 2018 added another step to pathway. Dementia cafés were established in public cafés in the city and county area, sponsored by local care provider, also supported by HUB team. Feedback was gathered from surveys given to individuals, carers and HUB team in the Café and MTRR. Results From January to June 2018 there were 50 memory streamed patient contacts completed by the OT. From November 2018 to April 2019, 206 patient contacts were completed. These include both individual and group cognition focused sessions. Positive qualitative feedback was retrieved from attendees to MTRR and Café all indicating at least one positive outcome from post-diagnostic supports and services. Conclusion A multi-domain cognitive OT service when initiated by an integrated care HUB proves to be an effective and acceptable memory care pathway. The development of this holistic pathway enabled the person to be seen in the right place, at the right stage of their journey with memory difficulties.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::8285499ddad53d2dfd7d87d268dc7f50Test
https://doi.org/10.1093/ageing/afz103.129Test

المؤلفون: Millie O'Gorman, Thomas Gantly, Catherine Murphy, Alice O’Donoghue, Triona Wall, Caitriona Whyte, Marie Doyle, Riona Mulcahy, Jacinta Brennan, Cooke John, PJ Harnett, George Pope, Christina Naughton, Maggie Bolger, Niamh Phelan

المصدر: Age and Ageing. 48:iii1-iii16

مصطلحات موضوعية: Waiting time, Aging, Rehabilitation, business.industry, medicine.medical_treatment, General Medicine, Patient-centered care, medicine.disease, Integrated care, Patient referral, medicine, In patient, Medical emergency, Geriatrics and Gerontology, business

الوصف: Background The Inpatient rehabilitation service serves a population of 116,176 of whom 17,371 are aged 65yrs and over. Access to these units was traditionally via referral from the acute hospital sector with the minority of referrals coming from the community. Review of the existing rehabilitation pathway was undertaken and highlighted barriers of access to appropriate in-patient rehabilitation. The referral criteria were revised and an updated pathway was devised. Methods A quantitative retrospective review of all referrals received in four timeframes, commencing 1st July 2017 to date, was carried out. Each referral was classified into four subgroups: (1) Immediate Crisis (2) Emerging Crisis (3) Stable but Needs Optimisation (4) Stable and No in-patient Intervention required. The origin of the referral was also categorised into four subgroups: (1) Day Hospital (2) GP (3) AHP (4) Other. The Average Length of Stay (AvLoS) was calculated for, acute and community admissions, for each period breakdown. Results We compared 1st July 2017 to 31st December 2017 pre-establishment of the new referral pathway and the same six month period in 2018 post-establishment of the pathway. The new streamlined pathway facilitated improved access to in-patient rehabilitation from multiple sources and resulted in an increase in referrals from 25 to 79. Waiting time for admission was reduced from 37 days to 5 days. Community admissions increased from 16 to 48. There was no difference in AvLoS between the two time periods: Acute 22 & Community 17 to Acute 22.25 & Community 18. Conclusion This work highlights the effectiveness of an improved co-ordinated referral pathway, within an integrated care hub, from community to in-patient rehabilitation beds with improved accessibility and reduced waiting times. AvLoS figures suggest that appropriate patients were admitted to the rehabilitation units. Also, it confirms the efficiency of a patient centred approach in maximising appropriate services for Right Person, Right Place, Right Time.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::b4b2e9cb377d7d0dc49d102dc871f44dTest
https://doi.org/10.1093/ageing/afz102.66Test

المؤلفون: Catherine Murphy, Christine de Laine, Margaret Macaulay, Miriam Avery, Mandy Fader

المصدر: Age and Ageing

مصطلحات موضوعية: Aging, independent living, Health Personnel, General Medicine, ageing/7, toilet-use, older people, AcademicSubjects/MED00280, Urinary Incontinence, Caregivers, Qualitative Paper, incontinence, qualitative, family carers, Humans, Dementia, Geriatrics and Gerontology, Qualitative Research

الوصف: Background most people living with dementia (PLWD) will develop incontinence problems with associated harmful consequences. Well-contained incontinence is often the main treatment goal. It would therefore be expected that poorly contained incontinence would have a negative impact. Aim to investigate differences in how well-contained or poorly contained incontinence impacts on the experience of living with incontinence for PLWD at home and their carers. Design secondary analysis of a qualitative study. Methods semi-structured interviews were undertaken with PLWD, carers and healthcare professionals (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were recorded and transcribed verbatim. Framework analysis was used. Results forty-five people (twenty-six carers, two PLWD, nine continence nurses and eight dementia nurses) participated. Despite poorly contained incontinence, some PLWD/carer dyads appeared relatively unaffected by incontinence. Conversely, one or both members of some dyads who achieved good containment found incontinence care highly challenging. Four themes were identified, together forming a preliminary model of incontinence containment and impact, as follows: Conclusion reliable containment is an important goal for PLWD living at home and their carers, but it is not the only goal. Other factors, such as behaviours that challenge or carer coping strategies, can mean that even well-contained incontinence can have a negative impact. This paper proposes a preliminary model for evaluation.

وصف الملف: text

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::47dd05e636594257165603a6521f2b74Test
https://pubmed.ncbi.nlm.nih.gov/34888621Test

المؤلفون: Theresa Kehoe, John Cooke, Riona Mulcahy, Catherine Murphy, Caitriona Whyte, Triona Wall, Collis Montgomery, Alison Hearne, Millie O' Gorman, Barbara Murphy, Sharon Geoghagan, AnneMarie Lyng, George Pope, Thomas Gantly

المصدر: Age and Ageing. 47:v13-v60

مصطلحات موضوعية: Aging, Rehabilitation, business.industry, medicine.medical_treatment, Dashboard (business), medicine, General Medicine, Medical emergency, Geriatrics and Gerontology, Older people, medicine.disease, business

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::a69f71a21bc6b1d6b535f3bc41763ee0Test
https://doi.org/10.1093/ageing/afy140.74Test

المؤلفون: Mandy Fader, Christine Laine, Catherine Murphy

المصدر: Alzheimer's & Dementia. 16

مصطلحات موضوعية: Epidemiology, business.industry, Health Policy, medicine.disease, Psychiatry and Mental health, Cellular and Molecular Neuroscience, Qualitative analysis, Developmental Neuroscience, Nursing, Health care, Medicine, Dementia, Neurology (clinical), Geriatrics and Gerontology, Family carer, business

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::bc65fc2a903c9be0728b0499774ff87aTest
https://doi.org/10.1002/alz.040896Test