Postcode Lottery in Healthcare? Findings from the Scottish National Comprehensive Geriatric Assessment in Secondary Care Audit 2019.

Comprehensive Geriatric Assessment (CGA) is provided differently across Scotland. The Scottish Care of Older People (SCoOP) CGA Audit was a national audit conducted in 2019 to assess this variation in acute hospitals. Two versions of audit questionnaires about the provision of CGA were developed (one each for larger hospitals and remote/rural areas) and piloted. The questionnaires were sent to representatives from all hospitals in Scotland using the REDCap (Research Electronic Data Capture) system. The survey asked each service to provide information on CGA service delivery at the 'front door'. The questionnaire was open for completion between February and July 2019. Of the 28 Scottish hospitals which receive acute admissions, we received information from 26 (92.9% response rate). Reporting sites included seven hospitals from remote and rural locations in the Scottish Highlands and Islands. Significant variations were observed across participating sites for all key aspects studied: dedicated frailty units, routes of admission, staffing, liaison with other services and rehabilitation provision. The 2019 SCoOP CGA audit highlights areas of CGA services that could be improved and variation in specialist CGA service access, structure and staffing at the front door across Scotland. Whether this variation has an impact on the outcomes of older people requires further evaluation.

Variability in the clinical management of iron deficiency anaemia in older adults: results from a survey of UK specialists in the care of older people.

BACKGROUND: Iron deficiency anaemia in older adults is common, but its management presents unique challenges in diagnosis and management. Little is known about compliance with current best practice guidelines. METHODS: We undertook an online survey of physician members of the British Geriatrics Society to ascertain how they managed older patients with potential iron deficiency anaemia. RESULTS: There were 141 respondents (96% from UK). Almost a third indicated they would accept haemoglobin levels <100 g/dl without further investigation. A quarter said they would only occasionally or never check ferritin levels. Only 30% would sometimes or always use parenteral iron when oral supplements were not tolerated. CONCLUSIONS: Responses suggest a high level of variation in clinical practice and low adherence to best practice guidelines. Possible explanations include an inadequate evidence base to guide management and a lack of knowledge on the challenges of managing iron deficiency anaemia in this population.

Variation in acute and community service provision of care of the elderly services across Scotland: findings from the Scottish Care of Older People (SCoOP) initial scoping survey.

BACKGROUND: This scoping survey is a preliminary part of the Scottish Care of Older People (SCoOP) audit programme, which aims to assess specialist service provision for older people with frailty in Scotland, and provide benchmarking data for improving services. METHODS: The survey was distributed to nominated consultant geriatricians based in 12 of the 14 Scottish health boards who completed data to the 'best of their knowledge'. Data collected were: consultant and specialty doctor level workforce; days of frailty unit operation; multidisciplinary team discussion frequency; and, physiotherapy and occupational therapy availability. Consultant cover was correlated with population data, and scores for service components used to derive separate acute and community service provision scores. RESULTS: Consultant geriatrician availability varies widely across Scottish health boards with a median of 1.45 [range: 0.54-2.40; interquartile range (IQR): 0.71-2.28] full-time equivalent consultant geriatricians per 10,000 people ≥65 years. Variation was also present in the service provision scores [score range 0 (none) to 1.0 (very good)]: for acute services, the median national service provision score was 0.81 (range: 0.50-0.89; IQR: 0.75-0.85) and for community services 0.60 (range: 0.48-0.82; IQR: 0.52-0.65). CONCLUSIONS: This report clearly demonstrates mismatch between workforce and services in both acute and community settings in the context of the population size. Future surveys will build on this preliminary information to audit service provision for older people at an individual hospital level.

Effect of nonmeat, high-protein supplementation on quality of life and clinical outcomes in older residents of care homes: a systematic review and meta-analysis.

Context: Care home residents are at risk of malnutrition owing to reduced food intake, anabolic resistance in aging muscle, and a high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding the effectiveness of a high-protein diet on quality of life or clinical outcomes in care home residents. Objective: The aim of this review was to evaluate the effectiveness of nonmeat, high-protein supplementation on health-related quality of life (HRQOL) and relevant clinical and nutritional outcomes in older people in a care home setting. Data Sources: The following databases were searched (to February 2018) for randomized controlled trials: Embase, AMED, CINAHL, MEDLINE, the Cochrane Central Registry of Controlled Trials, OpenGrey, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, the ISRCTN registry, and the NIHR Clinical Research Network Portfolio. Study Selection: Trials were selected if they assessed a nonmeat, high-protein dietary intervention provided to care home residents who were aged 65 years or older. Data Extraction: Data from included trials were extracted if they assessed care home residents aged 65 years or older and compared those residents who received protein supplementation with those who did not. Trial quality was assessed using the Cochrane risk-of-bias tool. Meta-analysis was undertaken when appropriate. Results: Seventeen studies with 1246 participants fulfilled the inclusion criteria. All studies were of low or moderate quality. There was no evidence of improved HRQOL when the Short Form 36 (SF-36) was used to assess outcomes (standardized mean difference [SMD] = -0.10; 95%CI, -0.51 to 0.31; P = 0.62), although significant improvement was seen in the 1 trial that used the EQ-5D instrument (SMD = 2.58; 95%CI, 2.05-3.10; P < 0.00001). Conclusions: Nonmeat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such supplements on HRQOL in older adults in care homes. Systematic Review Registration: PROSPERO registration number: CRD42015029313.

Care Home Research: Future Challenges and Opportunities.

The historical view of care homes as isolated communities is fading, with a new strong focus on offering person-centred care for residents that keeps them integrated in their community [...].

Optimising Nutrition and Hydration in Care Homes-Getting It Right in Person Rather than in Policy.

The scoping review by Bunn et al. identifies an important, but often invisible, challenge of malnutrition and specifically sub-optimal hydration and nutrition in the care home environment. Those requiring residential care are generally the frailest members of society, and likely to be affected by the anorexia of ageing: a multifactorial process whereby older people fail to adequately regulate food and nutrient intake resulting in unintentional weight loss. Adequate training of all healthcare professionals to recognise the risk of malnutrition at an early stage is fundamentally important, and the window of opportunity for intervention may be at a much earlier stage than admission to the care home. The specific needs of older adults must be considered in planning interventions with regard to the effects of ageing on physiology, digestion, and absorption of nutrients. Most importantly, we must offer person-centred care which offers residents an element of personal choice in whether or not they wish nutritional intervention, and any intervention offered must have the effect of improving quality of life rather than numbers on a scale.

Sharing experiences of user involvement in shaping new services: the story of a national patient group.

When the Cancer Genetics Pilots Programme was established in 2004, Macmillan Cancer Support undertook to create and facilitate the work of a "National User Reference Group". The purpose of this group was to give service user representatives (patients and carers) from each of the seven pilot projects regular opportunities to meet and share experiences and thus strengthen the influence of patients on the services. Macmillan commissioned a narrative writer to record key aspects of the national user group's work and influence. The emerging narrative accounts, created in collaboration with its members, provide a picture of a diverse group of skilled and enterprising individuals, enthusiastic about helping future patients. Service users have contributed to shaping projects, improving written information and sustaining the local services. In addition, project staff responsible for user involvement highlighted the value of training for user representatives and the need to remove financial and logistical barriers to participation. The national user group itself received vital support from Macmillan in the form of a dedicated "group facilitator", as well as continuous guidance and encouragement from a senior manager (an "organisational sponsor") present at all the group's meetings. By the end of 2006, the group discussions indicated that user involvement had developed to varying degrees and in different forms across the pilot projects. In the best case, patient representatives were being "treated as part of the team".