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  • 1.
    Dahlqvist, Jenny
    et al.
    Region Östergötland.
    Ekdahl, Anne
    Lund Hosp, Sweden; KI, Sweden.
    Friedrichsen, Maria
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum.
    Does comprehensive geriatric assessment (CGA) in an outpatient care setting affect the causes of death and the quality of palliative care? A subanalysis of the age-FIT study2019Ingår i: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, nr 3, s. 455-462Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Key summary pointsAimDoes comprehensive geriatric assessment (CGA) affect the causes of death and the quality of palliative care when patients receive care at the end of life when in an outpatient care setting compared to usual care?FindingsCGA does not affect the causes of death. CGA affects the frequency of referral to specialised palliative care teams, but CGA does not affect the quality of palliative care given to the patients. These effects are measured in outpatient care settings and in comparison with usual care.MessageFurther studies are needed to evaluate the CGA effects on causes of death and palliative care quality in outpatient care settings. AbstractPurposeThe purposes of this study were to retrospectively study whether comprehensive geriatric assessment (CGA) given to community-dwelling old patients with high health care usage has effects regarding: (1) the cause of death and (2) the quality of the provided palliative care when compared to patients without CGA-based care.MethodThis study includes secondary data from a randomised controlled trial (RCT) with 382 participants that took place in the periods 2011-2013. The present study examines all electronical medical records (EMR) from the deceased patients in the original study regarding cause of death [intervention group (IG) N=51/control group (CG) N=66] and quality of palliative care (IG N=33/CG N=41). Descriptive and comparative statistics were produced and the significance level was set at pamp;lt;0.05.ResultsThe causes of death in both groups were dominated by cardiovascular and cerebrovascular diseases with no statistical difference between the groups. Patients in the intervention group had a higher degree of support from specialised palliative care teams than had the control group (p=0.01).ConclusionThe present study in an outpatient context cannot prove any effects of CGA on causes of death. The study shows that CGA in outpatient care means a higher rate of specialised palliative care, but the study cannot show any effects on the palliative quality parameters measured. Further studies with statistical power are needed.

  • 2.
    Ekdahl, Anne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration2014Ingår i: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 5, nr 1, s. 35-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In the coming half-century, the population of old people will increase, especially in the oldest age groups. Therefore, the prevalence of multiple chronic conditions, and consequently, the need of health care including care in hospital, is rising. Materials and methods: This article includes results from three mainly qualitative articles (interviews with frail old people, physicians, and an observational study in acute medical wards) and a cross-sectional survey of newly discharged elderly patients. Results: Health care does not take a holistic approach to patients with more complex diseases, such as frail old people. The remuneration system rewards high production of care in terms of numbers of investigations and operations, turnover of hospital beds, and easy accessibility to care. Frail old people do not feel welcome in hospital, with their complex diseases and a need of more time to recover. The staff providing care feels frustrated, and often guilty when taking care of old people. Discussion and conclusion: To improve quality of care of frail elderly, a model is suggested with the following main components: more hospital wards which can address the patients whole situation medically, functionally, and psychologically, i.e comprehensive geriatric assessment (CGA). Better identification of frail elderly people is necessary, together with a change in remuneration system, with a focus on the patients functional status and quality of life. More training in geriatrics is required for staff to feel confident when treating frail old people.

  • 3.
    Mazya, A. L.
    et al.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN. Danderyd Hospital, Sweden .
    Eckerblad, Jeanette
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Hellström, Ingrid
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Milberg, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, LAH Linköping. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum. Vrinnevi Hospital, Sweden .
    Unosson, Mitra
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Westöö, A.
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN.
    Ekdahl, Anne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Geriatriska kliniken ViN.
    The Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT) - A randomised controlled trial aimed to prevent hospital readmissions and functional deterioration in high risk older adults: A study protocol2013Ingår i: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 4, nr 4, s. 242-247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Care of old people with multimorbidity living at home is often fragmented with lack of coordination and information exchange between health care professionals, the elderly and their relatives. This paper describes the protocol of a randomised, controlled study, which aims to compare the efficacy of caring for older people with multimorbidity and three or more hospital admissions in the previous year at a geriatric ambulatory department based on Comprehensive Geriatric Assessment (CGA) versus usual care.

    Participants and methods

    A total of 400 community-dwelling old people with multimorbidity who are living in the city of Norrköping (Sweden) and one of their relatives are recruited for this trial and randomized to an intervention and a control group. Participants in the intervention group receive interdisciplinary care after a CGA at an Ambulatory Geriatric Unit with easy accessibility during working hours in addition to usual care. The control group receives usual care provided by the primary care or hospital.

    Outcomes

    The primary outcome is number of hospitalisation, the secondary outcomes are health-related outcomes including measures of frailty, cognition, symptom burden, feeling of security, quality of life of participants and relatives and as well as costs for health and social care. Participants will be followed for 2 years.

    Discussion

    This study will contribute to evidence of the effect of two different care models. The study has the potential to change care for older people with multimorbidity.

  • 4.
    Nägga, Katarina
    et al.
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Clinical Memory Research Unit Lund University.
    Mayer, Sibylle
    Cinical Memory Research Unit Lund University.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Evaluation of short cognitive screening tests in 85-year-old men and women2015Ingår i: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 6, nr 6, s. 545-550Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The study aimed to investigate different aspects of cognition using the Cognitive Assessment Battery (CAB) in community-dwelling older adults aged 85 years. We also investigated the eventual influence of sex on the results and aimed to identify predictors for further cognitive decline after 1 year. Methods: CAB consists of 10 subtests covering the cognitive domains of speed and attention, learning and episodic memory, visuospatial abilities, language, and executive functions. Cognitive tests were performed at baseline (n = 335) and follow-up after 1 year (n = 270). Results: Univariate statistics revealed that men performed better than women on episodic memory (P < 0.05) and on the naming test (P < 0.001). However, floor effects in the paragraph memory test were revealed. There was a high rate of abnormal results on Token Test (67%), PaSMO (50%), Clox (48%), and the cube copying (40%) tests in participants with normal cognition. Logistic regression showed that impaired results on the Stroop III test (odds ratio, 2.38; P < 0.05) was independently associated with an increased risk of cognitive decline. Conclusion: Men performed better than women on the memory and on the naming test. However, due to floor effects in the paragraph memory test in 85 year olds, these results can be disputed. The high rate of abnormal results on the Token Test, PaSMO, Clox, and the cube copying tests in cases with normal cognition indicate that these tests are less suitable for screening in the age group. Impaired result on the Stroop test increased the risk more than two-fold for cognitive decline after 1 year.

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