Examining the Hospital Elder Life Program in a rehabilitation setting: a pilot feasibility study.

BACKGROUND: The Hospital Elder Life Program (HELP) has been shown to effectively prevent delirium and functional decline in older patients in acute care, but has not been examined in a rehabilitation setting. This pilot study examined potential successes and implementation factors of the HELP in a post-acute rehabilitation hospital setting. METHODS: A mixed methods (quantitative and qualitative) evaluation, incorporating a repeated measures design, was used. A total of 100 patients were enrolled; 58 on the pilot intervention unit and 42 on a usual care unit. Group comparisons were made using change scores (pre-post intervention) on outcome measures between pilot unit patients and usual care patients (separate analyses compared usual care patients with pilot unit patients who did or did not receive the HELP). Qualitative data were collected using focus group and individual interviews, and analyzed using emergent coding procedures. RESULTS: Delirium prevalence reduced from 10.9 % (n = 6) to 2.5 % (n = 1) in the intervention group, while remaining the same in the usual care group (2.5 % at both measurement points). Those who received the HELP showed greater improvement on cognitive and functional outcomes, particularly short-term memory and recall, and a shorter average length of stay than patients who did not. Participant groups discussed perceived barriers, benefits, and recommendations for further implementation of the HELP in a rehabilitation setting. CONCLUSIONS: This study adds to the limited research on delirium and the effectiveness of the HELP in post-acute rehabilitation settings. The HELP was found to be feasible and have potential benefits for reduced delirium and improved outcomes among rehabilitation patients.

Care transitions: a systematic review of best practices.

This article reports results from a systematic review used to inform the development of a best practice guideline to assist nurses in understanding their roles and responsibilities in promoting safe and effective client care transitions. A care transition is a set of actions designed to ensure safe and effective coordination and continuity of care as clients experience a change in health status, care needs, health care providers, or location.

Measuring quality of life in cancer survivors: a methodological review of existing scales.

BACKGROUND: Studies examining quality of life (QoL) in cancer survivors have relied on instruments specific to the cancer patient population. METHOD: MEDLINE and PsycINFO were systematically searched to identify instruments and papers reporting the psychometric qualities of relevant instruments. Two reviewers undertook data extraction with respect to reliability, validity, predictive validity, responsiveness, acceptability, readability, cross cultural acceptability and feasibility. RESULTS: Forty-two instruments were identified. Most were either measures of general health-related QoL or developed for individuals in active treatment. Nine were developed specifically for cancer survivors. None met the rigorous psychometric standards set by the review. All established acceptable levels of validity, however, only one instrument (Quality of Life-Cancer Survivors) demonstrated adequate test-retest reliability. Acceptability, feasibility and predictive validity remain unexamined. Readability was examined in only two (Cancer Survivors' Unmet needs and Quality of Life in Adult Cancer Survivors (QLACS)). Only two instruments (QLACS and Impact of Cancer) have been developed with a wide range of cancer survivors. Generally, shorter-term cancer survivors (1-5 years) are underrepresented. CONCLUSION: There is a need for a psychometrically credible QoL instrument for cancer survivors who are 1-5 years post diagnosis.

Assessing subjective fall concerns in residential living seniors: development of the activities-specific fall caution scale.

OBJECTIVES: To examine subjective fall concerns of seniors in residential care and to develop a tool applicable to both nursing home and assisted living settings. DESIGN: Used focus groups with residents and staff for construct examination and item generation; surveyed staff and interviewed residents for item verification; and conducted psychometric testing using Rasch analysis for scale refinement. SETTING: Seventeen residential care facilities in Ontario, Canada. PARTICIPANTS: Convenience samples totaling 57 staff and 234 residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Activities-specific Fall Caution (AFC) Scale, developed inductively with residents and staff, with items pertaining to residential living (eg, moving around a room full of people, furniture, or walkers). RESULTS: Resident terms (being cautious or careful) and qualifications (whether alone and proximity of gait aids) guided tool development. Rasch analysis showed that the final 13-item AFC Scale was hierarchic and unidimensional, with good person (.86) and item (.95) reliability. CONCLUSIONS: The AFC scale is a promising new tool for assessing subjective fall concerns in residential care residents. This tool can be administered via interview in about 10 minutes to most residents with Mini-Mental State Examination scores of 12 or greater, using practice questions to determine understanding and a 4-point color response card similar to a traffic light to facilitate responding.

Reliability, construct validity, and clinical feasibility of the activities-specific fall caution scale for residential living seniors.

OBJECTIVE: To examine the reliability, validity, and feasibility of the Activities-specific Fall Caution (AFC) Scale. DESIGN: Cross-sectional studies with test-retest and interrater reliability. SETTING: Residential care facilities in Ontario, Canada: 10 in study 1 and 6 in study 2. PARTICIPANTS: Convenience samples of 101 and 31 residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In study 1, the AFC Scale was readministered to 44 residents, 64 were assessed using the Berg Balance Scale, Timed Up & Go, and Self-Paced Walk Test, and the Nursing Home Life-Space Diameter was completed for 80 residents. In study 2, staff administered the AFC Scale to 31 residents on 2 occasions. RESULTS: In study 1, test-retest reliability (intraclass correlation coefficient [ICC]) was .87 (95% confidence interval, .78-.93). AFC scores were associated with physical performance and mobility patterns (P<.001) and able to discriminate on the basis of gait aid use (P<.001), balance disorders (P<.05), and transfer assistance and walk speed (P<.01). Comparatively, general fear of falling showed weaker associations and a sex bias. In study 2, staff administration was fairly consistent (ICC=.71) and similar associations emerged for AFC scores. CONCLUSIONS: The AFC Scale shows good reproducibility, convergent and discriminative validity, and is feasible for clinical as well as research use.