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- Andersson Hammar, Isabelle, et al.
(author)
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Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships.
- 2024
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In: BMC geriatrics. - 1471-2318. ; 24:1
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Journal article (peer-reviewed)abstract
- Self-determination in old age is essential for people's experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people.This study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75≥from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher's exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning.Nearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition.Perceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people's wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction.ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
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- Ottenvall Hammar, Isabelle, 1984, et al.
(author)
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From Intervention Trial to Full-scale Implementation Research: Positive Tendencies for Frailty and Self-rated Health in Frail Older People.
- 2018
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In: International Journal of Geriatrics and Gerontology. - 2577-0748. ; 2018:2
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Journal article (peer-reviewed)abstract
- A continuum of care for frail older people was created to link the chain between the hospital, and discharge to the person’s home. Despite earlier positive findings, it remains unclear if the benefits are sustainable in a real-life context. The present longitudinal study aimed at evaluate the effects of the implementation of a full-scale process program for frail older people in a real-life context regarding levels of frailty, self-rated health and activities of daily living up to one year later. The sample consisted of a total of 143 frail people aged 75 years and older, divided in the two groups: 77 participants from the full-scale process program and 66 historical controls. The findings showed that at the six months follow-up, the participants partaking in the full-scale process program had a significantly higher odds of displaying decreased frailty (p=0.015), and at twelve months, this sample had a significant lower likelihood of reporting decreased self-rated health (p=0.023). Thus, the findings showed positive results on frailty level and self-rated health when implementing the intervention in real life, indicating that a person-centred, multi-professional team with a case manager is beneficial for frail older people.
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- Westgård, Theresa, 1969, et al.
(author)
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Can comprehensive geriatric assessment meet frail older people’s needs? Results from the randomized controlled study CGA-swed
- 2020
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In: Geriatrics (Switzerland). - : MDPI AG. - 2308-3417. ; 5:4
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Journal article (peer-reviewed)abstract
- © 2020 by the authors. Licensee MDPI, Basel, Switzerland. Background: The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person’s medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people’s activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. Methods: A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. Results: One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. Conclusion: Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.
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- Westgård, Theresa, 1969
(author)
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Comprehending the Comprehensive Geriatric Assessment. Feasibility, outcomes and experiences of frail older people
- 2020
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Doctoral thesis (other academic/artistic)abstract
- ABSTRACT Despite existing knowledge on how to approach frail people in health care, the care they receive is commonly not designed to meet their complex needs and support them in maintaining their activities of daily living. One way to support frail older people when needing health care could be to enable them to share their life-stories and communicate their wants and wishes. Learning about a person’s social history can be a key element in comprehending older people in their care needs. The overall aim of this thesis was to evaluate the Comprehensive Geriatric Assessment (CGA) for frail older people aged 75 or older and to explore their experiences of care following a CGA. Methods: A pilot study with 30 frail older people (>75 years) was performed to determine the feasibility of the CGA, the process and procedures, instruments and proof of principle. Participants were included to the CGA intervention group or the control group that received regular medical care. After the pilot was determined to be feasible, the full RCT was carried out with an additional 125 participants. The 155 participants were followed up at one and six months. During the RCT 10 participants from the CGA ward partook in additional qualitative interviews, which explored through narratives 1) what personal resources they had and how they experienced health care services using three dimensional-analysis, and 2) how they experienced receiving a CGA, using a conventional content analysis. Results: Identifying and screening frail older people who might benefit from a CGA was successful, and those receiving the intervention were met by staff practicing increased attention to safety, ADLs, assistive devices, and discharge planning (Study I). The participants to a high extent agreed that the CGA care met their needs (Study II). The CGA participants experienced having a voice when receiving health care services by using their personal resources (Study III), and they felt respected as a person who could communicate, understand and participate in their care (Study IV). Conclusion: CGA provides care that is better adapted to frail older people’s needs, as they themselves felt that the care met their needs; however, no statistically significant effects for frail older people receiving care based on CGA were achieved. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings leading to a risk of low statistical power. In addition, a CGA during a single hospital stay is probably not enough to have long-term effects, since frail older people are in need of integrated care provided by multidisciplinary teams. To best benefit frail older people when receiving health care, an organized continuum of care is needed. In order to secure the care is based on what people need, a person-centered approach is fundamental.
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- Westgård, Theresa, 1969, et al.
(author)
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Comprehensive geriatric assessment is associated with increased antidepressant treatment in frail older people with unplanned hospital admissions-results from the randomised controlled study CGA-Swed
- 2022
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In: Bmc Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment. Aims: The aims of this study were threefold: to investigate the prevalence of depression in frail hospital patients, to identify factors associated with depression, and to compare depression management in patients receiving and not receiving Comprehensive Geriatric Assessment (CGA). Methods: This secondary analysis from the CGA-Swed randomized control trial included 155 frail older people aged 75 years and above. Instruments included Montgomery Asberg Depression Rating Scale (MADRS), the ICE Capability measure for older people (ICECAP-O) and the Fugl-Meyer Life Satisfaction scale (Fugl-Meyer Lisat). Depression was broadly defined as MADRS score >= 7. Regression models were used to identify variables associated with depression and to compare groups with and without the CGA intervention. Results: The prevalence of a MADRS score indicating depression at baseline was 60.7%. The inability to do things that make one feel valued (ICECAP-O) was associated with a fourfold increase in depression (OR 4.37, CI 1.50-12.75, p = 0.007). There was a two-fold increase in odds of receiving antidepressant medication in the CGA intervention group (OR 2.33, CI 1.15-4.71, p = 0.019) compared to patients in the control group who received regular medical care. Conclusion: Symptoms of depression were common among frail older people with unplanned hospital admission. Being unable to do things that make one feel valued was associated with depression. People who received CGA intervention had higher odds of receiving antidepressant treatment, suggesting that CGA improves recognition of mental health needs during unplanned hospital admissions in frail older people.
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- Westgård, Theresa, et al.
(author)
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Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital : a feasibility study
- 2018
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In: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 4
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Journal article (peer-reviewed)abstract
- Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.
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- Westgård, Theresa, 1969, et al.
(author)
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Feeling respected as a person: a qualitative analysis of frail older people's experiences on an acute geriatric ward practicing a Comprehensive Geriatric Assessment
- 2019
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In: Geriatrics. - : MDPI AG. - 0016-867X .- 2308-3417. ; 4:1
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Journal article (peer-reviewed)abstract
- Comprehensive geriatric assessment (CGA) practices multidimensional, interdisciplinary, and diagnostic processes as a means to identify care needs, plan care, and improve outcomes of frail older people. Conventional content analysis was used to analyze frail older people’s experiences of receiving CGA. Through a secondary analysis, interviews and transcripts were revisited in an attempt to discover the meaning behind the participants’ implied, ambiguous, and verbalized thoughts that were not illuminated in the primary study. Feeling “respected as a person” is the phenomenon participants described on a CGA acute geriatric ward, achieved by having a reciprocal relationship with the ward staff, enabling their participation in decisions when engaged in communication and understanding. However, when a person was too ill to participate, then care was person-supportive care. CGA, when delivered by staff practicing person-centered care, can keep the frail older person in focus despite them being a patient. If a person-centered care approach does not work because the person is too ill, then person-supportive care is delivered. However, when staff and/or organizational practices do not implement a person-centered care approach, this can hinder patients feeling “respected as a person”.
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- Westgård, Theresa, 1969, et al.
(author)
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Voices of Ill Frail Older People: Personal Resources and Experiences of Health Care Services : Special Issue Article “Healthy Aging and Elder Care”
- 2021
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In: Gerontology and Geriatric Research. ; 4:1
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Journal article (peer-reviewed)abstract
- Background: For many older people, ageing may become associated with frailty. Frequently reduced physical functioning and health are common in frailty; however, this is only one part of the big picture that may affect a frail older person’s wellbeing. To understand a frail older person’s unique capability, the study aimed to identifying their personal resources’ to comprehend how they experienced receiving health care services. Method: Ten participants aged 75 or older, screened as frail were interviewed one month after discharge from the hospital ward practicing the Comprehensive Geriatric Assessment. Result: Frail older people have personal resources established earlier in life and these remained intact and useful when receiving health care services. These personal resources were service: being service minded, having confidence in organizing and conversing and negotiating; and inherent abilities: being resilient and being hopeful and optimistic. Conclusion: Even though people have, personal resources it does not meant that they could use them, since it was dependent upon a collaboration between a person ’s social networks, physical environments and person resources. Identifying personal resources could give frail older people the boost they need to experience that they are still competent and capable when needing and receiving health care services. This would require that the health care staff and the health care organization support frail older people by practicing integrated care that is person-centered.
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