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ABSTRACT: To compare nurses' and physicians' documentation of geriatric issues and explore double documentation and undocumented areas of importance in an acute care setting in two Nordic countries.
158 participants, aged 75+, of whom the Minimum Data Set for Acute Care (MDS-AC) instrument was conducted at admission and from which 56 variables were taken in comparison with notes from patient records documented by nurses and/or physicians in two acute care hospitals, in Finland and Iceland.
Documentation of the impairment of personal Activities of Daily Living (ADL) was missing in 40-60% of the nurses' reports and 80-97% of the physician's reports. Even poorer was the documentation of the impairment of Instrumental Activities of Daily Living (IADL), of which 75% was not reported by the nurses and 85-96% by the physicians. Cognitive function was recorded in only 30-40% of the cases.
The traditional patient record in acute care setting lacks several variables of functional abilities of the older patients. Nurses took more responsibility in the documentation of functional abilities, compared with physicians, but they could improve. Using a standardized instrument such as the MDS-AC can improve documentation and make a basis for a clearer delineation in responsibilities for documentation between nurses and physicians and thereby improve outcome of care.
Scandinavian Journal of Caring Sciences 10/2008; 22(3):341-7. · 0.89 Impact Factor
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ABSTRACT: Objective: PNHA is a standardized evaluation of the elderly which everyone who applies for an admission to long term care (LTC) in Iceland must undergo. The objective of this study is to describe the elderly who asked for an admission to LTC in The Reykjavík metropolitan area and in Akureyri over a 10 year period. A special attention is paid to factors that could possibly predict survival after PNHA. Material and methods: Every PNHA evaluation is stored in a database by SKYRR Inc. Information from that database regarding all who lived in the greater Reykjavík area and Akureyri and had undergone their first PNHA during the period from January 1st 1992 to 31st of December 2001, was collected. Information about survival was collected from the the Icelandic national registry. There were 4272 individuals in the study group. SPSS was used for statistical analysis. Results: The average enrolment age of men in nursing homes(NH) in Reykjavík was 82.7 -/+ 0.5 years and for women 84.4 -/+ 0.4 (p<0.01). Men were about one third of residents in NH's. The average waiting time for men from the first PNHA to NH placement was 219 -/+ 20 days and for women 290 -/+ 22 days (p<0.01). Of those who were waiting for NH's, 22% of men and 14% of women died without being admitted (p<0,01). The mean survival of men in NH's in Reykjavík was 2.5 -/+ 0.2 years and for women 3.1 -/+ 0.2 years (p<0.01). Factors predicting longer survival for men in Reykjavík were lower age, good mobility and being able to eat but for women the factors were lower age and good mobility. Conclusions: It's in all stakeholders' interest that elderly people are enabled to live at home for as long as possible. Factors that predict survival should be taken into account when the elderly are prioritized for admission to NH's so that elderly who are predicted to have the lowest survival rate of assessed are those admitted first.
Laeknabladid 03/2004; 90(2):121-129. · 0.23 Impact Factor
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ABSTRACT: Objective: It is increasingly emphasized that the elderly should be supported to live at home as long as possible. The purpose of this study was to describe the health and conditions of people in home care. Material and methods: Individuals who received home care in the Reykjavik area in autumn of 1997 were assessed with the Minimum Data Set-Resident Assessment Instrument for Home Care, MDS-RAI HC. Results: The study evaluated 257 individuals at four primary care health centers. The mean age was 82.7 years, women were 78.6%, living alone were 62.5%, and they had received home care on average of 2.4 years. Almost all were independent in primary activities of daily living, ADL, but about half needed help with instrumental activities of daily living (IADL). Impaired cognition was observed in 40% of individuals, depressive symptoms in 18%, daily pain was noted in 47% and 47% assessed their health as poor. Loneliness was expressed by 21%, 18% had not gone out doors in over 30 days and 27% were always alone during the day. The mean number of hours during two weeks was 3.5 hours in nursing care and 9.5 hours in home help. Thirty-four percent took 9 or more medications. Conclusion: Individuals in home care were independent in ADL but needed assistance with IADL. There are important quality of life issues that are of concern. Further research is needed in home care with particular emphasis on improvement of well being.
Laeknabladid 05/2003; 89(4):313-318. · 0.23 Impact Factor
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ABSTRACT: Objective: Firstly to outline the theoretical and practical framework for geriatric rehabilitation in Iceland and other Nordic countries and secondly to survey the scientific medical publications for evidence based geriatric rehabilitation. Methods: Brain storming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programs for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for overview. The papers were divided into four groups according to diseases, infirmity and resource settings; 1) stroke, 2) hip-fractures, 3) acute admissions and 4) programs conducted in nursing homes, day hospitals and home services. Results: A spectrum of biological and social events creates the conditions underlying most causes for illness and disability in old people. The process of established geriatric services promotes the efficiency of geriatric rehabilitation. The literature survey included 27 scientific studies (8586 patients) on randomized studies with valid endpoints. Geriatric rehabilitation programs for stroke patients in geriatric settings, six studies (1138 patients), reduced mortality and the need for nursing home placement but the outcome for ADL. Function and length of stay was more variable between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies, six studies (2171 patients). Eight studies were found comparing the outcome between acute admission of frail elderly to either geriatric (GEMU, GRU) or general medical wards. The outcome as regards to mortality rate at one year, placement to a nursing home, physical function, contentment with services, readmission rate and cost was all significantly better in the geriatric settings. Internal comparisons of geriatric programs in nursing homes, day hospitals and in home service, seven studies (1261 patient), revealed some differences in outcomes in function, contentment and costs. Conclusions: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programs. Rehabilitation of frail elderly people poses a major challenge for the future and has to be developed further for the sake of quality of life of elderly people as well as for economic reasons.
Laeknabladid 02/2002; 88(1):29-38. · 0.23 Impact Factor
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ABSTRACT: Objective: The prevalence of diseases increases with age and so does use of medications. Thus illness related to medications use does also become more prevalent. This study aims at evaluating medications of elderly people admitted to an acute care hospital, and demonstrate adverse reactions and quality indicators. Material and methods: This is a study of patients 75 years of age and older admitted acutely to internalmedicine at the Reykjavik Hospital over a three month period in the spring of 1995. All medications and diagnoses were registered and the medical records reviewed. The contribution of adverse medication effects to the admission was assessed. Quality of treatment was evaluated according to evidence based medicine for the diagnoses chosen. The study included 208 individuals, 133 women and 75 men with the mean age of 82.4 years. Results: Mean length of stay for women was 19.9 days and men 15.2 days. Number of drugs on admission and discharge ranged from 0 to 18. The mean number of drugs were for women 5.8 and 6.9 and men 6.6 and 7.7 on admission and discharge, respectively. In 16 cases or 7.7% it was judged that there was a high likelihood of the admission being due to an adverse effect. Potential drug interactions according to a computer software package were not judged to be of clinical importance in any case. Conclusions: Treatment for coronary heart disease, heart failure, osteoporosis, insomnia and long term prednisolon treatment is not completely optimal according to evidence based medicine. The results of this study indicate that treatment could be improved for example with use of clinical guidelines.
Laeknabladid 02/2000; 86(1):11-16. · 0.23 Impact Factor
