Developing an evidence-based intervention to improve health care for, and prevent avoidable hospital admission of, older care home residents with frailty or dementia.
Award Number
RP-DG-0610-10034Programme
Programme Grants for Applied ResearchStatus / Stage
CompletedDates
1 November 2011 -31 January 2013
Duration (calculated)
01 years 02 monthsFunder(s)
NIHRFunding Amount
£96,661.00Funder/Grant study page
NIHRContracted Centre
Bradford Teaching Hospitals NHS Foundation TrustContracted Centre Webpage
Principal Investigator
Professor Murna DownsPI ORCID
0000-0003-3062-5223WHO Catergories
Methodologies and approaches for risk reduction researchRisk reduction intervention
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 152 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | RP-DG-0610-10034 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20111101 |
| End Date | 20130131 |
| Duration (calculated) | 01 years 02 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | Bradford Teaching Hospitals NHS Foundation Trust |
| Contracted Centre Webpage | |
| Funding Amount | £96,661.00 |
Abstract
The overarching aim of the proposed programme grant is to develop and pilot test an evidence-based intervention to improve health care for, and prevent avoidable hospital admissions of, care home residents with frailty and/or dementia. 1. What is the international evidence about improving health care in, and avoiding hospital admission from, care homes? 2. What is the frequency of avoidable admission and how is it measured? 3. What are the care processes and decision processes associated with quality health care and avoidable hospital admissions from care homes in the UK? 4. What are the optimal processes to ensure quality health care and prevent avoidable hospital admissions? 5. What is the preliminary evidence for the feasibility, acceptability and effectiveness of a pragmatic complex intervention to improve health care and prevent avoidable hospital admissions from care homes in the UK? There are over 400,000 people in care homes in the UK and this number will rise in line with the projected growth in the number of older people (1), and in particular those with dementia (2). 3/4 of care home residents are estimated to have dementia, of whom almost 40% have severe dementia. Between 10% and 30% of care home residents are over 85 (3,4). Those over 85 are the fastest growing segment of the population. The number of nursing home residents admitted to hospital is of particular concern as many of these admissions are considered avoidable and in the best interest of neither the person nor the health services (5). Estimates from studies of avoidable admissions conducted in the US (6) and UK (7) range from 23% to 67% of all admissions. There are 2 broad types of avoidable admissions: 1. admissions where, with appropriate knowledge, skills and care practices, facilities and training, the clinical problem (eg urinary infections) could have been managed adequately in the care home setting and crises avoided; 2. admissions which are futile given where the person is in the trajectory of their life course. The main focus in this proposal is the first of these categories, ie avoidable admissions for conditions that, if detected and treated earlier, could have been treated in the nursing home. These conditions are often referred to as ambulatory care sensitive conditions (ASCDs) ie conditions which could have been treated in the home. They include cardiovascular conditions (congestive heart failure, chest pain), respiratory conditions (COPD, pneumonia, bronchitis), uro-sepsis and fever, dehydration, skin conditions, gastro intestinal disorders (constipation, diarrhoea) and urinary tract infections (6, 7). Athough hospitalisation can be both necessary and clincially effective, there are times when the benefits are outweighed by the human and financial costs. Hospitals are less than ideal environments, particularly for people with dementia and frailty, and can lead to personal discomfort, disorientation and the development of iatrogenic conditions (8). In addition, transfer to hospital disrupts an older person’s pattern of care and relationships. In economic terms, avoidable hospital admissions are costly to the NHS (9). A range of interdependent and multi-facteted factors including knowledge, skills and care practices have been identified as necessary conditions to prevent avodiable hosptial admissions. These factors involve, and need to be shared between, professional staff, case assistants, residents and families. The need for an informed and effective workforce for the growing number of people with dementia, particularly in care homes (10). General practitioners are often poorly prepared, less than 40% have specalist training in the needs of older people. Practice nurses and nurse practitioners have a beneficial effect on health care quality and can reduce rates of avoidable admission (13, 14). Geriatricians’ involvement in care homes has declined
Aims
The overarching aim of the proposed programme grant is to develop and pilot test an evidence-based intervention to improve health care for, and prevent avoidable hospital admissions of, care home residents with frailty and/or dementia.