Older people and their families' perceptions about their experiences with interprofessional teams.

Aim: To examine older people and their families' perceptions about their experiences with interprofessional teams. Design: Naturalistic inquiry using qualitative descriptive methods to provide a comprehensive summary of older people and their families' experiences with interprofessional teams. Methods: Interviews were conducted with 22 people from 11 families. The families had experiences with teams in a variety of settings, such as community, residential care and hospital. Data were analysed using inductive content analysis. NiVivo was used to record preliminary codes. Analysis included comparing and contrasting families' experiences. Results: Older people and their families wanted communication about what was going on, regardless of whether the news was good, bad or unknown. They also wanted care that took the concerns of the older person into consideration. Communication was a necessary ingredient to ensuring that the older person's unique concerns were known to the interprofessional team. These percepectives were discussed in the themes of communication and patient-centred care.

The Care of Older Adults Experiencing Cognitive Challenges: How Interprofessional Teams Collaborate.

We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O'Malley's methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families' perspectives in team decisions. More research to understand processes interprofessional teams use is needed.

Reducing falls among geriatric rehabilitation patients: a controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of an intervention programme to reduce falls among geriatric rehabilitation patients. DESIGN: Pre/post-test design with independent pre-test and matched post-test samples. SETTING: Inpatient geriatric wards in a rehabilitation hospital. PARTICIPANTS: Seventy-six matched pairs (n = 152) of geriatric rehabilitation patients from one control and one intervention ward participated in the study, and 36 nursing staff surveys were completed. INTERVENTION: The intervention programme was developed based on interviews and systematic reviews. Educational materials were distributed to patients and families, and preventive measures were implemented. MAIN OUTCOME MEASURES: The rates of falls before and after the intervention both within and between the wards were compared, and surveys were completed. RESULTS: The matched patients presented no significant differences on age, gender or medical conditions. The falls rates, proportion of fallers and length of stay was higher among those in the control ward (P< 0.043). The percentage of fallers and the rate of falls/1000 patient days were lower on the intervention ward after implementation: odds ratio (95% confidence interval) = -2.9 (-6.6, -1.2) and -1.8 (-6.0, 0.5). Thirty of 36 respondents considered the tool to be helpful and beneficial for use on other wards. CONCLUSION: The intervention programme was effective in reducing falls among geriatric rehabilitation patients.

Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis.

BACKGROUND: Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals. METHODS AND FINDINGS: We searched six electronic databases using comprehensive search strategies developed for each database. Estimates of sensitivity and specificity were plotted in ROC space graphs and pooled across studies. Our search identified three studies which assessed the prediction properties of falls prediction tools in a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies; the other identified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For a STRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) and pooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the tools across studies indicated that the DOWNTON tool has the highest sensitivity (92%), while the PJC-FRAT offers the best balance between sensitivity and specificity (73% and 75%, respectively). All studies presented major methodological limitations. CONCLUSIONS: We did not identify any tool which had an optimal balance between sensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals.

Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review.

OBJECTIVE: To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. DATA SOURCES: Eligible studies were systematically searched on 16 databases from inception to December 2010. REVIEW METHODS: The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. RESULTS: A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. CONCLUSION: Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.