Introduction:
The hospital environment can exacerbate symptoms of delirium; as such there is a move to promote early supported discharge for patients with delirium. However, the occupational therapy ...role and impact of intervention is not well known. Our study evaluated an occupational therapy delirium pathway facilitating early assessment, intervention and supported discharge to home compared with hospital-based care.
Method:
A before and after, observational study design. Data was collected regarding hospital use, patient function (Functional Independence Measure/Functional Assessment Measure) and the carer experience (Preparedness for Caregiving Scale).
Results:
Ninety patients (43 control and 47 intervention group patients) were recruited with a mean patient age of 82.8 years (SD 7.6). There was a significant difference in hospital re-presentations (n = 3 in the intervention group compared to n = 10 in the control group (p = 0.026)). Hospital length of stay did not significantly differ between the groups (p = 0.534). The mean score for the Preparedness for Caregiving Scale was 3.3 indicating that most carers felt ‘pretty well prepared’. However, patients continued to experience significant functional decline (p = 0.006).
Conclusion:
An occupational therapy delirium pathway reduced hospital re-presentations and could be implemented in clinical practice to better support patients recovering from delirium as they transition from hospital to home.
Objective
To assess the effects of fall prevention services initiated in the emergency department (ED) to support patients after discharge.
Methods
A systematic review and meta‐analysis were ...conducted. Analysis of pooled data used random‐effects modelling with results presented as a risk ratio (RR).
Results
Eleven studies were identified (n = 4,018). The proportion of older adults who fell did not differ between the intervention and control groups (RR 0.93; 95% CI, 0.82‐1.06, I2 68%, P = 0.28). There was a significant (P = 0.01) reduction in the monthly rate of falling (RR 0.69; 95% CI, 0.52‐0.91, I2 93%), fall‐related injuries (RR 0.72; 95% CI, 0.59‐0.88, I2 0%, P = 0.001), and hospital admissions (RR 0.76; 95% CI, 0.64‐0.90, I2 0%, P = 0.002).
Conclusions
ED fall prevention services did not significantly reduce the proportion of older adults who had future falls. However, multifactorial intervention significantly reduced fall‐related injuries and hospital admissions with low heterogeneity.
Introduction:
Prompt identification of patients susceptible to falls is required by occupational therapists to initiate early falls prevention and management strategies. This study identified the ...intrinsic and extrinsic risk factors of patients who experience early inpatient falls (within 48 hours of admission).
Method:
A retrospective case-control study was completed at a tertiary hospital. Data were extracted from medical records. Adults aged 18 years and older, admitted with any diagnosis, to any ward within the hospital between July 2019 and June 2020 were included. Cases were identified as those who fell within 48 hours of admission and controls did not experience a fall.
Results:
The study sample included 218 patients (109 cases and 109 control patients). Most falls occurred in the patient’s room (n = 54) or bathroom (n = 47), as a result of slipping (n = 50) or while patients were toileting (n = 32). Multivariate regression analysis identified significant predictors of inpatient falls, including unassisted mobilisation (odds ratio (OR) 5.25), impaired balance (OR 7.25), reduced muscle strength (OR 5.25) and impulsivity (OR 19.57). Receiving occupational therapy reduced risk of falling by 81%.
Conclusion:
Falls risk factors that are predictive of early inpatient falls should be identified at admission and used to prioritise patients for occupational therapy.
Introduction
Low implementation rates of occupational therapy home assessment recommendations have previously been reported. The objective was to identify and describe the barriers and facilitating ...factors that influence implementation of home assessment recommendations.
Methods
A mixed methods systematic review consisting of studies involving adults living in the community who received an occupational therapy home assessment was conducted. Seven databases were last searched in August 2021. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools (SUMARI) dependent on study design. Data synthesis followed the convergent integrated approach. Findings were mapped to the theoretical Capability Opportunity Motivation Behaviour (COM‐B) model of health behaviour change.
Results
From 5,540 citations, 22 articles met the criteria for the systematic review. Implementation of occupational therapy home assessment recommendations ranged between 55% and 90%. Six synthesised findings were identified. Capability barriers included a patient's cognitive and physical ability. Motivation barriers included a perceived lack of need and stigma; patient reported decreased involvement and lack of choice. Opportunity barriers included limited family or carer involvement, carer stress, level of service provision available, including funding, therapy dosage and timing and environmental restrictions. Overall facilitators included patient‐centred care, including choice and understanding need, individualised tailored recommendations, involvement of families and carers, provision of written record and strategies to support implementation. Results were limited by methodological weaknesses in identified studies and heterogeneity in the definition and measurement of implementation impacting on comparison. Specific intervention components were often poorly described.
Conclusion
The theoretical model elucidates priority factors to address for promoting implementation of home assessment recommendations. Future high‐quality research clearly defining intervention components is required to support short‐ and long‐term implementation of recommendations in the home environment. Behaviour change techniques could be utilised to support home assessment practices in future research.
Older women have higher levels of frailty resulting in disability and reduced quality of life. Presentation to an Emergency Department (ED) is an opportunity to address frailty and provide tailored ...interventions to promote function. An ED allied health team integrated frailty assessment and interventions into care through a ‘Frailty Intervention Team’ (FIT) program.
A prospective study informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate the FIT program tailored to female older adults. The purpose of this project was to evaluate the FIT program over a three-month period and use the findings to further develop the intervention.
Over three-months, 192 older females (>70 years) were identified with mild frailty and discharged directly home. Ninety percent were offered the FIT program with 83.3 % accepting all recommended frailty management strategies. Ninety percent of patients were satisfied with the FIT program, however staff and patient barriers to provision of frailty services were identified.
The FIT program was largely adopted by staff and accepted by older female patients with mild frailty in the ED. However, program effectiveness was limited by gaps in communication about frailty in the ED and implementation of frailty management strategies after discharge.
The primary objective was to examine whether the Emergency Department (ED) treatment of older adults who fall in Australia is concordant with falls prevention and management clinical guideline care ...recommendations.
A retrospective medical records audit was completed for patients 65years and older, who attended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines.
One thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p < 0.001) in an observation ward (p < 0.001).
Older patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur.
Objective
To assess the ability of the Australian Modified Lawton's Instrumental Activities of Daily Living (IADL) Scale (Modified Lawton's Scale) to screen for cognitive impairment in patients ...without physical or sensory deficits.
Methods
Prospective single‐blind study of diagnostic accuracy.
Results
Data were available for 249 patients. At ≤25 points on the Modified Lawton's Scale, the area under the receiver operating characteristic curve (AUC) for patients with dementia was 0.90 (95% CI 0.83, 0.96), with sensitivity of 95% and specificity of 84%. The scale had decreased ability to identify patients with mild cognitive impairment (MCI) with the AUC highest at 0.76 (95% CI 0.67, 0.84), with a sensitivity of 77% and specificity of 74% at ≤26 points. The Modified Lawton's Scale had a significant strong correlation with the Mini‐Mental State Examination (0.73) (P ≤ 0.001).
Conclusion
A score of ≤25 on the Modified Lawton's Scale may indicate cognitive impairment impacting on IADL.
Health services are capitalizing on the rise of telehealth and seeking to develop sustainable models incorporating telehealth into standard care. Further research is required to explore the service ...and clinical outcomes of telehealth in occupational therapy hand and upper limb practice. This research utilized a case-control study to explore the feasibility and clinical outcomes of case matched patients who received a telehealth hybrid model versus traditional in-person care. One hundred and two patients were recruited (n=51 in the controls and cases) with a mean age of 45 years. Telehealth was not inferior to standard care with no significant increase in therapy time (p=0.441) or length of referral (p=0.047). There was no difference in clinical adverse events (p=0.741). Patients who received telehealth had significantly less withdrawals from the service (p = 0.031). Patient and therapist satisfaction were high, supporting the ongoing use and continued implementation of telehealth in occupational therapy.
Introduction
Occupational therapists assess older patients attending Memory Clinics to address multiple facets, including memory, activities of daily living function, mobility and falls risk. ...Identifying deficits in motor and functional abilities represents a crucial and necessary component of cognitive diagnosis. The aim of this research was to compare performance on the TUG between patients with normal (NC), mild cognitive impairment (MCI) and dementia.
Methods
A prospective single‐blind single‐centre cohort study was conducted in a Memory Clinic. Patients underwent comprehensive medical assessment, including the Mini Mental Status Examination (MMSE) to determine a cognitive diagnosis. The occupational therapist, blinded to any diagnosis, completed the TUG.
Results
A total of 158 patients aged 60 years and older were recruited. The average TUG was 15.4 s, which was similar between men and women (p = .87). A TUG greater than ≥14 s was significantly associated with the use of a walking aid (p ≤ .001). The TUG increased with age and a slower TUG was associated with a greater number of previous falls (p = .023). The TUG did not significantly differ between patients with dementia, MCI and NC (p = .095). However, there was a significant difference comparing patients with NC and MCI (14.3 s) to those with dementia (16.4 s) (p = .048). There was a significant weak negative correlation between the MMSE and the TUG of −0.253 (p = .003). Univariate models showed that a patient's ability to ambulate independently contributed to 33% of the variance in the TUG, whereas previous falls contributed to 4%, highlighting the importance of physical function and intervention to target this.
Conclusion
A simple TUG test should be considered for use by occupational therapists in a Memory Clinic to screen patients at risk of falling. Patients diagnosed with dementia have a significantly slower TUG. However, this tool cannot assist with the early detection of patients with MCI.
