Editor's view |
Editor's view
Editor, Age and Ageing
With improving life expectancy, an increasing number of older people are dying of end-stage chronic illness. Previous work suggests that hospice care is mainly directed towards malignant diseases, and that older people with other chronic illnesses have reduced access to palliative care. The authors of a Research Letter (pp. 327–330) have performed a retrospective case-note analysis of older hospital in-patients dying from chronic diseases. They report that specialist palliative care input only occurred in patients with malignancy, but suggest that those dying from other chronic conditions could also have benefited from palliative care support. They conclude that adoption of the Liverpool Care Pathway may provide a means of measuring and improving the care of older patients with end-stage chronic diseases. Although this is only a small retrospective audit, it highlights the need for further research into palliative care of older people with non-malignant, terminal chronic illnesses.
At least 10% of all in-patients, during their hospital stay, experience adverse events which are potentially avoidable and may result in disability or death. In this issue, Sari et al. report the results of a retrospective case-notes audit of 1,006 in-patients, of whom 332 were aged above 75 years (pp. 265–269). They found significantly more adverse events in the older patients, the commonest of which were hospital-acquired and post-operative infections, drug interactions, pressure sores and falls. Nevertheless, there was no relationship between age and preventability, or resulting death or disability. The authors conclude that adverse events are common in older people and speculate that case-note reviews may be helpful in their future prevention, through investigation and identification of the appropriate lessons. In an accompanying editorial (pp. 243–245), Ramanath and Hendra suggest that a multi-disciplinary team approach of total quality management, including incident reporting, pharmacist surveillance and case-note review, may help in reducing adverse events in older in-patients. Although structured case-note reviews are time consuming and require training, the authors suggest that they are an important way of educating healthcare professionals about the quality of any care their patients receive.
One of the most important and topical adverse effects of hospital admission is hospital infection with methicillin-resistant Staphylococcus Aureus (MRSA). A research paper by Eveillard et al. (pp. 294–299) examined MRSA carriage in a French long-term care facility, with molecular typing of MRSA strains using pulsed-field gel electrophoresis (PFGE). The authors report that MRSA carriage was common in this population (37.6%) and was related to the widespread use of broad-spectrum antibiotics. There was also a 5-fold increased risk of MRSA carriage in patients who had undergone imaging in the past 12 months, suggesting that this may be an important mode of MRSA transmission. Although this cross-sectional study has its limitations, future longitudinal research using PFGE may provide further information about the carriage and transmission of MRSA in older people.
In this issue, Vassallo et al. report the results of a prospective validation study comparing two tools (STRATIFY and the Downton Score) with nurses' clinical assessment in the prediction of falls in 200 patients in a geriatric rehabilitation hospital (pp. 277–281). The nurses' assessment of wandering conferred better predictive accuracy than either of the formal scores, but was associated with significantly lower sensitivity. Ashburn et al. also investigated potential predictors of future falls in 122 patients discharged from a stroke ward (pp. 270–276). The participants were then followed up for 12 months, during which time 63 experienced one or more falls. The occurrence of near-falls in hospital, and poor upper limb function predicted falls with 70% specificity and 60% sensitivity, but the authors conclude that they were unable to make accurate predictions of the risk of falling from the information available at the time of discharge. In an accompanying commentary to these two papers (pp. 248–250), David Oliver discusses the reasons why the falls prediction tools are of limited value and emphasises that if we concentrate all our attention on falls prediction, without understanding the limitations of such tools and the evidence for their use, we are working in a fool's paradise.
Finally, many of us who lead stressful professional lives will be reassured by the feature in the News and Reviews section that there is no apparent association between occupational stress and the development of dementia (pp. 246–247). Unfortunately, this should be tempered by the observation that dementia is more common in those who previously showed an adverse response to stress. This may provide another incentive for all of us to develop strategies to reduce and cope with stress in our working lives.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||