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Standards of medical care for nursing home residents in Europe
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
minimizing the risk factors, aiming at excellent results and independence within the limits imposed by age. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.247 P247
Expert’ opinions of practices in dysphagia screening & management among post-stroke patients – need for a protocol C. Takizawa a,∗ , K. Altman b , R. Martino c , L. Derex d , R. Speyer e Health Economics, Nestle Health Science, Vevey, Switzerland b Voice Center, Mount Sinai School of Medicine, New-York/NY, USA c Speech Language Pathology, University of Toronto, Toronto, Canada d Neurologie, hôpital neurologique de Lyon, Bron, France e Institute Of Health Studies, HAN university of Applied sciences, Nijmegen, Netherlands
a
Background.– Dysphagia is common health condition associated with stroke. However, no clear picture of dysphagia screening and management appears in the literature. This study aims at understanding dysphagia management usual practices in four different countries, to identify commonalities and gaps and to begin to work toward an international clinical protocol for dysphagia among poststroke patients. Method.– A focus group was conducted with two medical doctors and two Speech-Language Pathologists (SLP), from the USA, France, Canada and The Netherlands respectively, to share their opinion about dysphagia management among post-stroke patients. Based on literature search and their practice, we designed the commonalities and differences between these four countries. Results.– North American & European guidelines recommend screening for dysphagia after a stroke, but no guidelines exist regarding which test to use. There is consensus on the screening and diagnostic pathway: with nurses administering screening, a full clinical assessment performed by SLPs is required in cases with a positive screen, instrumental evaluation (VFS or FEES) is required only if the clinical assessment result is unclear, otherwise patients go directly on to intervention. In contrast, there is variation between countries regarding the clinician who conducts the instrumental evaluation and which behavioral strategies are the common treatment base. Conclusion.– This study reflects usual dysphagia management practices with in-patients in teaching hospitals across four countries. Further assessments of practices in other countries would help understanding and raising the importance of a common dysphagia management protocol. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.248 P248
Enhancing the quality and safety of older people in Canadian hospitals by developing a national collaboration on standards A. Juby a,∗ , B. Parke b , B. Liu c Medicine, Division Of Geriatrics, University of Alberta, Edmonton/AB, Canada b Faculty Of Nursing, University of Alberta, Edmonton/AB, Canada c Medicine, Division Of Geriatrics, University of Toronto, Toronto/ON, Canada a
Introduction.– The efficiencies embedded within acute care systems and processes, and the omission of gerontologically sensitive interventions, gives rise to potentially preventable harm to older people in hospital. Text.– Objectives.– The objectives were to establish a national collaboration to influence policy and practice change in hospital care
S107
for older adults in Canada; and to reach national consensus on recommended quality and safety standards. Method.– Accumulating evidence exists on effective care models and protocols designed for older patients. For this project, a three phase methodology was used including: a scoping literature review; interactive workshops at three Canadian national conferences – Canadian Association of Gerontology (2011), Canadian Gerontological Nursing Association (2011), Canadian Geriatrics Society (2011); and a round table meeting of Canadian experts (2012) (funded by Canadian Institutes of Health Research) using nominal group process and Delphi electronic voting. These activities identified senior friendly initiatives underway across Canada, and selected priority content for development of national quality standards. Results.– The following dimensions were identified: care systems and processes of care; organizational policies, procedures and supports; social, emotional and behavioral environment; ethical considerations in clinical care and research; and physical environment and architectural design. Participants in the workshops and round table rated the priority issues in each of these domains. Pockets of excellence and innovation were identified. Conclusions Significant disparity exists across Canada in provision of elder care, and in the mandate for improvement of standards. This project develops a national strategy to coordinate efforts and facilitate synergies to narrow the care gap. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.249 P249
Standards of medical care for nursing home residents in Europe R. Briggs ∗ , S. Robinson , F. Martin , D. O’Neill Medical Gerontology, Trinity College Dublin, Dublin, Ireland
Introduction.– Nursing home inhabitants represent the most vulnerable and frail group of older people. They have more complex medical backgrounds and more significant care requirements. With an ever-ageing European population, the number of people requiring nursing home care will only increase. It is important then that we optimise the medical care of older people living in nursing homes. Methods.– Formalized care standards are essential to optimal care but we feel that such guidelines are lacking. We decided to investigate this by means of a survey on nursing home care standards sent to the geriatric medicine societies around Europe. Results.– Only 5/26 (19.2%) countries surveyed have a requirement for specific training in geriatric medicine for doctors working in nursing homes, while only 2/26 (7.7%) countries have written medical care standards applicable to nursing home care provided by professional organizations. Four out of 26 (15.3%) had a nursing home doctor society and one of these, The Netherlands, provided written medical care standards for nursing homes.: these have also been adopted by the relevant national society of general practitioners. Discussion.– The Europe-wide deficiency of documented care standards for nursing homes is alarming. It should be a prerequisite that physicians dealing with these complex patients have undertaken some level of specific training in geriatric medicine. It is important that geriatricians, old age psychiatrists and family doctors across European countries engage more formally on the development of appropriate models for both developing care standards and specifying appropriate training and support for doctors working in nursing homes. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.250
minimizing the risk factors, aiming at excellent results and independence within the limits imposed by age. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.247 P247
Expert’ opinions of practices in dysphagia screening & management among post-stroke patients – need for a protocol C. Takizawa a,∗ , K. Altman b , R. Martino c , L. Derex d , R. Speyer e Health Economics, Nestle Health Science, Vevey, Switzerland b Voice Center, Mount Sinai School of Medicine, New-York/NY, USA c Speech Language Pathology, University of Toronto, Toronto, Canada d Neurologie, hôpital neurologique de Lyon, Bron, France e Institute Of Health Studies, HAN university of Applied sciences, Nijmegen, Netherlands
a
Background.– Dysphagia is common health condition associated with stroke. However, no clear picture of dysphagia screening and management appears in the literature. This study aims at understanding dysphagia management usual practices in four different countries, to identify commonalities and gaps and to begin to work toward an international clinical protocol for dysphagia among poststroke patients. Method.– A focus group was conducted with two medical doctors and two Speech-Language Pathologists (SLP), from the USA, France, Canada and The Netherlands respectively, to share their opinion about dysphagia management among post-stroke patients. Based on literature search and their practice, we designed the commonalities and differences between these four countries. Results.– North American & European guidelines recommend screening for dysphagia after a stroke, but no guidelines exist regarding which test to use. There is consensus on the screening and diagnostic pathway: with nurses administering screening, a full clinical assessment performed by SLPs is required in cases with a positive screen, instrumental evaluation (VFS or FEES) is required only if the clinical assessment result is unclear, otherwise patients go directly on to intervention. In contrast, there is variation between countries regarding the clinician who conducts the instrumental evaluation and which behavioral strategies are the common treatment base. Conclusion.– This study reflects usual dysphagia management practices with in-patients in teaching hospitals across four countries. Further assessments of practices in other countries would help understanding and raising the importance of a common dysphagia management protocol. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.248 P248
Enhancing the quality and safety of older people in Canadian hospitals by developing a national collaboration on standards A. Juby a,∗ , B. Parke b , B. Liu c Medicine, Division Of Geriatrics, University of Alberta, Edmonton/AB, Canada b Faculty Of Nursing, University of Alberta, Edmonton/AB, Canada c Medicine, Division Of Geriatrics, University of Toronto, Toronto/ON, Canada a
Introduction.– The efficiencies embedded within acute care systems and processes, and the omission of gerontologically sensitive interventions, gives rise to potentially preventable harm to older people in hospital. Text.– Objectives.– The objectives were to establish a national collaboration to influence policy and practice change in hospital care
S107
for older adults in Canada; and to reach national consensus on recommended quality and safety standards. Method.– Accumulating evidence exists on effective care models and protocols designed for older patients. For this project, a three phase methodology was used including: a scoping literature review; interactive workshops at three Canadian national conferences – Canadian Association of Gerontology (2011), Canadian Gerontological Nursing Association (2011), Canadian Geriatrics Society (2011); and a round table meeting of Canadian experts (2012) (funded by Canadian Institutes of Health Research) using nominal group process and Delphi electronic voting. These activities identified senior friendly initiatives underway across Canada, and selected priority content for development of national quality standards. Results.– The following dimensions were identified: care systems and processes of care; organizational policies, procedures and supports; social, emotional and behavioral environment; ethical considerations in clinical care and research; and physical environment and architectural design. Participants in the workshops and round table rated the priority issues in each of these domains. Pockets of excellence and innovation were identified. Conclusions Significant disparity exists across Canada in provision of elder care, and in the mandate for improvement of standards. This project develops a national strategy to coordinate efforts and facilitate synergies to narrow the care gap. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.249 P249
Standards of medical care for nursing home residents in Europe R. Briggs ∗ , S. Robinson , F. Martin , D. O’Neill Medical Gerontology, Trinity College Dublin, Dublin, Ireland
Introduction.– Nursing home inhabitants represent the most vulnerable and frail group of older people. They have more complex medical backgrounds and more significant care requirements. With an ever-ageing European population, the number of people requiring nursing home care will only increase. It is important then that we optimise the medical care of older people living in nursing homes. Methods.– Formalized care standards are essential to optimal care but we feel that such guidelines are lacking. We decided to investigate this by means of a survey on nursing home care standards sent to the geriatric medicine societies around Europe. Results.– Only 5/26 (19.2%) countries surveyed have a requirement for specific training in geriatric medicine for doctors working in nursing homes, while only 2/26 (7.7%) countries have written medical care standards applicable to nursing home care provided by professional organizations. Four out of 26 (15.3%) had a nursing home doctor society and one of these, The Netherlands, provided written medical care standards for nursing homes.: these have also been adopted by the relevant national society of general practitioners. Discussion.– The Europe-wide deficiency of documented care standards for nursing homes is alarming. It should be a prerequisite that physicians dealing with these complex patients have undertaken some level of specific training in geriatric medicine. It is important that geriatricians, old age psychiatrists and family doctors across European countries engage more formally on the development of appropriate models for both developing care standards and specifying appropriate training and support for doctors working in nursing homes. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.250