Background: Falls are one of the most common and serious problems facing the elderly and are known to be associated with significant mortality, morbidity, decreased functioning and premature institutionalization. In Hong Kong, the prevalence of falls among community-dwelling older adults is 19.3%. Moreover, the incidence of falls among older people in institutions is almost three times the fall rates for the community-dwelling elderly. Institutional falls are regarded as common adverse events in hospitalized older patients. Significant mortality, morbidity and healthcare costs associated with institutional falls led institutions to recognize falls as a high-priority safety risk for hospitalized patients. This demonstrated the significance of providing the health care providers with an evidenced-based practice guideline of an effective multifactorial fall prevention programme in order to prevent in-patient falls. Objectives: The objectives of the study are to systematically review and present the best evidence for the effectiveness of multifactorial fall prevention interventions in reducing falls in hospitals, to translate the reviewed evidence and to develop evidence-based practice guidelines for the multifactorial fall prevention programme as well as to develop a plan for implementing and evaluating the multifactorial fall prevention programme. Methods: The relevant literature was searched by several electronic databases. The related literature was then retrieved, reviewed and synthesized. The quality assessment of the studies was performed according to the methodological checklist for controlled trials designed by the Scottish intercollegiate Guideline Network (SIGN). Evidenced-based practice guidelines for the multifactorial fall prevention programme were then synthesized according to the findings of the reviewed literature, while the implementation potential being assessed in terms of transferability, feasibility and the cost-benefit ratio. Results: Five studies were identified according to the inclusion and exclusion criteria set. “Evidence-based guidelines of fall prevention programme for hospitalized older patients” were formulated based on the review of the selected studies. Fourteen recommendations of the evidence-based guidelines are formulated and graded according to the grading system of Scottish Intercollegiate Guidelines Network (SIGN). The evidence-based recommendations can offer nurses and other health care professionals the standards and strategies required for implementing multifactorial fall risk assessment and multifactorial fall prevention interventions, including environmental modifications, knowledge, medication reviews and exercise. A communication plan for various parties in hospitals including a pilot test for determining the feasibility of the innovation and an evaluation plan to determine the effectiveness of the fall prevention programme were subsequently developed. Conclusion: This study reviewed evidence for the effectiveness of the multifactorial fall prevention programme in reducing the incidence of falls, translated the reviewed evidence and developed evidence-based guidelines for a multifactorial fall prevention programme, which can provide the health care practitioners with an evidence-based approach in fall risk assessment and management so as to prevent in-patient falls. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Many elderly patients remain in acute care hospitals while they await transfer to Long Term Care (LTC) facilities. Complex problems, common for this special group of patients, place them at risk for delayed discharge. Discharge planning, for these patients, has become an increasingly critical activity for social workers. / This study examined factors that predict the risks for inappropriate hospitalization for 244 patients waiting for LTC in 1999, and it explored the LTC application process to identify barriers to delayed discharges. / It was found that 63% of the hospitalization of these patients was inappropriate. System related factors, such as the timing of the LTC application, were identified as predictors. Timeline investigations revealed areas for improvement in the discharge process and were discussed with a view to social work implementation, for example, the introduction of a high-risk screening protocol.

No description available.

published_or_final_version / Social Work / Master / Master of Social Work

The purpose of this study was to describe the meaning of caring from the perspective of community-dwelling individuals 65 years and older, who claim a Polish American ethnic identity. As background and preparation for the study the researcher spent 2 years in the Polish American community from which the key informants were chosen, explored the concept of caring cross culturally in the Human Relations Area Files, and spent a summer in Poland--the country of origin for the second generation sample. These experiences revealed that the care expectations by one group of people who are elderly and identify themselves as Polish American are unknown. Interviews were used to collect data from 7 informants. Participation, observation and written resources within the ethnic community supplemented the interview process. Tape recorded interviews were transcribed; field notes were compiled. All written data were analyzed, organized into categories and validated by the informants. Ten categories represented the Polish American elder's view of caring: kinds of Polish symbols, kinds of greeting, kinds of acknowledgment, kinds of caring, places for Polish people to meet, reasons for joining the Arizona Polish Club, reasons for going to the Arizona Polish Club, reasons for giving acknowledgment, care expectations: characteristics of a caring nurse, and ways to express caring. A primitive view of a 3-staged model was developed for generating universal conceptualizations of care from the Polish American elder's view of caring. Relationships among the categories were inferred from the data by the researcher and discussed as themes. Themes included: Arizona Polish Club as a caring place, being with my own kind, togetherness, neighboring, get moving in the morning, being there, taking time out, and having heart. The themes were discussed in relation to the research questions and the concept of caring that guided the study. This study revealed some of the characteristics, attributes, and conditions of caring that will be useful in expanding nursing's definition of caring, devising psychometric instruments to measure caring, and developing a cross cultural, cross age taxonomy of caring. Recommendations for nursing included care and research strategies with elders and suggestions for future study.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.

The purpose of this study was to investigate whether elderly clients in an acute care setting perceived themselves as being treated with dignity and respect, and whether clients with a higher socioeconomic status are more likely than clients with a lower socioeconomic status to be treated with dignity and respect. Sixty-two elderly clients who had been in hospital at least five days, were alert and oriented during their hospitalization, and could speak English were selected for the study. Using a convenience sampling technique, the clients were selected from medical and surgical units of two major teaching hospitals. They were interviewed within three days after discharge to respond to items on a questionnaire selected from the Medicus Quality Assurance Tool. The results of the study show that elderly clients may not perceive that they are consistently treated with dignity and respect. Older clients (75+ years) are less likely than younger older clients (65-74) to be treated with dignity and respect, and elderly clients with a lower socioeconomic status and women, are less likely to be treated with dignity and respect. / Applied Science, Faculty of / Nursing, School of / Graduate

No description available.

A three-day food intake was recorded for 100 elderly patients who were subsequently interviewed to determine the relationship of income level, educational level completed, and sex of the person with the nutrient intakes of these patients. Three-day caloric and nutrient intakes were recorded and compared to the 1974 Reconmended Daily Allowances (RDA). Mean intake for a three-day period of seven nutrients showed patient averages met at least 100 percent of the RDA for all nutrients except calcium. The females had a mean intake of ninety-six percent of the RDA for calcium. The patients with the lower incomes had dietary patterns that were less adequate than the patterns for those with higher incomes, and these patients ate more carbohydrate and less protein than did the patients with higher income. Nutrient intake was increased for the patients as their level of education increased. There were no significant differences in the nutrient intakes between sexes. The males had a higher nutrient intake and had a higher percentage of protein in their diets than did the females, however, the differences were slight. It was concluded from the above results that certain beneficial changes in the study menu could be made. Especially important areas such as calcium and fat intake may need modification at some time in the future as more light is shed on these areas. / Master of Science