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College for Geriatrics
1. State of the Art2. Project ’s results3. SWOT analysis
2003
Thierry Pepersack on behalf of the college for geriatrics
J.P.Baeyens et al. BVGG 2000
1. State of the art
• Peer review 2000: 103/160 geriatric units– 13 admissions/bed/year (median)– 50% admissions from private home– 46% home discharge– Median age = 82 yrs– Length of stay 22 days– median occupation rate 90%– multidisciplinary team
State of the art
• 21 formation centers
• 37 fellows places available
http://www.health.fgov.be/AGP/fr/professions/medecins/maitre_de_stage/specialites/geria.htm
2. College ’s projects
• 2000: Peer review
• 2001: Nutrition
• 2002: Continence
• Collaborations with the colleges for:– radiotherapy,– nephrology,– and emergency medicine
2001 Nutrition programme
Nutrition program 2001
OUTCOMES OF CONTINUOUS PROCESS
IMPROVEMENT OF NUTRITIONAL CARE PROGRAM
AMONG GERIATRIC UNITS IN BELGIUM
Nutrition program 2001
Methodology: 2 phases
Observation• Comprehensive
geriatric assessment and MNA
• Routine nutrition
Intervention• Comprehensive
geriatric assessment and MNA
• « Flow Chart»• « Meals on Wheels »
approach
0 3 6 months
Nutrition program 2001
Outcomes
• to assess the quality of care concerning nutrition among Belgian geriatric units descriptive statistics of nutritional status during phase 1
• to include more routinely nutritional assessments and interventions into comprehensive geriatric assessment sensitize the teams to nutritional aspect of the comprehensive
geriatric assessment
• to assess the impact of nutritional recommendations on nutritional status an on the length of hospitalisation comparison of nutritional parameters and hospitalisation
stays between phase 1 and phase 2
±Std. Dev.
±Std. Err.
Mean
Phase 1 Phase 2
STA
Y (
da
ys
)
0
10
20
30
40
50
60
Nutrition program 2001
Conclusions
• High prevalence of malnutrition among geriatric hospitalized patients
• Significant decreased hospitalization stay during 2nd phase (Confounding factor?)
• Significant increased PAB concentrations during 2nd phase
2002 Continence programme
DRIP
Detect, Reduce, Incontinence, Programme
Thierry Pepersack on behalf of the College of Geriatrics
Continence 2002
Introduction
• urinary incontinence is a straightforward condition, its cause easily identified and treated, treatment can have a major impact on the older person's quality of life
Two phases project
Continence 2002
Part 1: Outcomes
Prevalence of urinary incontinence among
geriatric units
Classification of incontinence
Characterisation of the geriatric teams and of the
professionals implicated in the management of
incontinence
Continence 2002
Part 1: Methodology
• Survey design: transversal
• Questionnaire by mail, web site
• Data collect of the characteristics of– hospitals– teams– patients
Continence 2002
ResultsPrevalence of incontinence
(N=834 patients)
26% A cute
5 7 % fu n c tion a l 1 5 % u rg e 1 4 % overflow 6 % D H IC 2 % re flex
74% C hronic
45% of incontinent pa tients
Continence 2002
Types of chronic incontinence
overflow14%
stress6%
urge15%
reflex2%
functional57%
DHIC6%
Characteristics of the teams/patientsFactors associated with the absence of incontinence management
0% 10% 20% 30% 40% 50% 60%
severe cognitiveimpairment
severe functionalimpairment
burnout of the team
lack of profesionalformation/interest
functional impairment
17%
diuresis control17%
decubitus ulcer(s)
24%
palliative approach
17%
retention25%
Characteristics of the patients13% under continued catheterization, why?
Continence 2002
Characteristics of the patients13% under intermittent catheterization, why?
diuresis control50%
decubitus ulcer(s)
8%
residu42%
Continence 2002
Relationship between % of incontinent patientsand patients’ and teams’ characteristics
Continence 2002
Discussion (1)
• 45% of incontinent patients in geriatric units
• 26% of transient incontinence
• Functional incontinence represents more than the half of the chronic situations
• Incontinence is associated with:– High length of stay– High proportion of demented patients
Discussion (2)
• A interventional proposition will complete this survey based on valided guidelines
Part 2: 2004?
Continence 2004
Part 2: Objectives
• enhance quality of care among geriatric unit providing suggestions about topics which are considered important for the majority of the patients.
• improve not only the quality of life of our patients but also the quality of life of the geriatric team’s professionals.
2003 AGGIR-PATHOS-SOCIOS
Geriatrics 2003
3. SWOT analysis
Strength
EBM, Comprehensive Geriatric AssessmentNew medical culture, multidisciplinary,comprehensivepsychosocial > biomedical modelCGA associated with low dependence, low
institionalization realistic approach in view of care situationNational Scientific Society associated with the CollegeMotivation, EAMAdemographic data
Weakness
• lack of geriatricians, formation services, academic• lack of attractivity, ‘ faire savoir ’• disproportion between allowed ressources and the
burden– caregivers, staff
– geriatricians
• lack of financial incentive• lack of alternative services
– day hospitals, day centers, familial caregivers,
Opportunities
• Education & Formation– GP, caregivers, specialists
• Geriatric programme for impatients• European, governmental research• GP partnership (CGA)
Threats
• « Everybody practice geriatrics » (lack of professionalism)
• « Wrong » geriatrics (Fountain of Youth)
• lack of defence and promotion
• appropriation by lobbies
• Burn-out
Priorities
• Geriatric programme• Beds programmation• Adapted financial ressources• Alternative services
– day hospital– inpatients geriatric consultation service
(multidisciplinary)– for geriatric problems (confusion, denutrition, falls,
incontinence, etc.)
College ’s role
Objectives• Quality• Partnership• « Education »,
awareness campaign, • promotion of a
broader concept of health
Ressources advisory board Scientific Society Surveys (Nutrition,
continence) Comprehensive
geriatrics focused on:• maintenance of function and
comfort• presence of satisfactory
support systems