12^th International Conference on Geriatrics, Gerontology & Elderly Care November 07-08, 2022 Rome, Italy

Biography:

Caroline Van Dullemen has more than 25 years of experience in international relations in various roles. She obtained her PhD in 2017 from the VU University Amsterdam on her research of The Politics of Aging and has been affiliated with the Faculty of Social Sciences ever since. She previously worked at the Ministry of Foreign Affairs, as director of a political party's academic bureau and as consultant at BPPS regarding micro-pensions. She is the founder of World Granny, an NGO focused on aging and development issues. She is supervisor of Stichting Amsterdamse Gezondheidscentra (SAG) that consists of seventeen health centers spread across the Dutch capital of Amsterdam and offers care to over 90,000 residents. Since 2022, she is also affiliated to the Ben Sajet Centre as senior researcher, investigating intra-professional cooperation in innovative dementia care.

Abstract:

The current study investigates new forms of inter-professional cooperation and the engagement of staff taking care of older people with dementia. The number of dementia patients in the Netherlands is expected to rise to more than half a million in 2040. The healthcare costs for dementia will rise accordingly: from €6.6 billion in 2015 to €15.6 billion in 2040. Dementia is therefore developing into the leading cause of death in the Netherlands and among the most expensive diseases. In the Dutch capital of Amsterdam, the number of people with dementia is expected to increase by 56% between now and 2030. And instead of a steady growth of caretaking personnel, an increasing shortage is trending. The shortage for this year is an estimated 49 thousand persons; the estimated deficit in 2030 is expected to rise to almost 117 thousand caretakers. The largest insufficiencies are expected associate’s degree/vocational training 3 (mbo 3) and nurses level 4 and applied university level. In view of these worrying developments and the relevance of the theme of innovation in dementia care, research is needed into binding and engaging caregivers for people with dementia. This is possible by examining practices in small-scale innovative projects. An example of this is ‘’De Nieuwe Sint Jacob’’ in Amsterdam. From April 1, 2022 onwards, care institute Amstelring has realized 36 new apartments in the eastern part of the city a small-scale form of living for people with dementia. The Nieuwe Sint Jacob works according to the "social approach". This implies that people with dementia are defined as little as possible as a ‘’medical problem’’. The residents are treated less like patients.

This maximizes their sense of being “human” and provides them with agency. This will reduce their insecurity, increase self-confidence, which will also have positive consequences for their social network. In order to implement this new approach, a form of strategic HR was applied. Not only professional caregivers with regular care training were recruited, but also people with other kind of experiences. Teams would be composed of 50 percent of caretakers with a regular professional background and 50 percent of new (novel) personnel (level 2) that has followed a reduced training. A vacancy has been published under the title "happy makers" in which people were addressed to work in: "A team of real hands-on characters who naturally sense what someone needs. And will give loving attention with passion and courage. That is why these competences of the ‘’happy makers’’ are most important: communication skills, collaboration, self-reflection, sense of responsibility and empathy.” More than 80 interested people responded to the vacancy. Finally, a little less than a quarter was offered the job. The position has been renamed 'Personal Supporter' (PO). This research will bring about new knowledge about the cooperation between professional caretakers with different social and educational backgrounds. There have been studies conducted with respect to inter-professional cooperation amongst nurses, but not so much is known about new forms of inter-professional cooperation in dementia care in a more cosmopolitics setting. Also, not much research is conducted about the level in which mixed teams are prepared for their jobs and how they can be stimulated to stay interested and engaged. The urgency of the problem and the academic relevance result in the following research questions:

• What are the experiences of the team members to work with colleagues with different professional backgrounds and length of education? In what way their experiences match their expectations? (Trust, cooperation, accepted as a full team member).

• How is the cooperation between caretakers with different backgrounds taking shape? What are the critical success factors?

• In what way do the new team members feel prepared for by the educational institute and how do they evaluate the coaching on the job? What are points of improvement?

In the study, data are collected via interviews and observations. The theoretical framework is primarily based on Relational Coordination Theory. This theory proposes that shared goals, shared knowledge and mutual respect support a frequent, timely, precise and problem-solving communication. This results in a better coordination of work across boundaries. The level of coordination is measured in 5 dimensions: 1. Cooperation; 2. Tasks & responsibilities; 3. Dealing with failures; 4. Learning organization and 5. Social connectedness. Hypotheses are that the collaboration will be not as smooth as expected, due to on the one side lack of professional communication (no common language) and on the other hand, a strict division of labour based on the different levels of the care takers (no joint feeling of responsibilities as a team). Coaching on the job is addressing these issues and is feeding the results back to the educational institute in order to improve the schooling of the team as a whole.

Biography:

Emmaculate Kimeu is an Occupational Therapist, goal-oriented with vast knowledge and experience in both hospital, school and community rehabilitation. She is a hard worker and eager to learn and help people regain their lost function through rehabilitation and motivate then achieve their maximum independence. Experienced in working with patients of varying cases and age ranges (Geriatrics). She embody a holistic, client-centered approach and effective communication that aids team work. A recurring theme throughout her career has been her commitment to rehabilitation of patients of all ages helping them overcome barriers to leading healthy and fulfilling lives.

Abstract:

The proportion of older adults needing health and clinical care is rapidly growing thereby posing an increased burden for health and clinical care chain. The aim of this study is to gain more insight in to potential improvement opportunities of the care process for the old adult. For old adults, the perceptions of their health conditions maybe not only limited to the acute illness experience, but may also include the understanding of a changing state of health and well-being that is managed and supported through the use of multiple, assistive technologies and environmental design modification. Today, old adults are increasingly more technology-prone in digital setting and capable of utilizing technological artifacts for their own needs and safety. These devices are meant to support older adults to manage their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) such as, Dietary, schedules, medication intake, shopping, feeding, grooming, toileting exercises, etc. The use of health-related home assistance systems will help in quick reaction to emergency. Knowledge about assistive technology support will be enhanced particularly concerning individuals with increasing age and eminent danger of a geriatric phenotype. Those devises approves the old adult core objectives of autonomy with large independence from care givers (especially outside family) as well as from institutionalized care.

In conclusion, quality health care produces a better return on investment than more familiar ways of working for old adults. It enables them to be independent in performance of activities of daily living, participate and contribute as productive members of society. Recommendations are made to emphasis on new ways effective on enhancing health, independence in activity performance, improve on their self-esteem, care to match goals and preferences and reducing exposure to potentially harmful medication and help improve on mobility.

Biography:

Ryan Saffer is affiliated from Florida Atlantic University, USA.

Abstract:

Returns to the hospital within 30 days of initial discharge are common among geriatric patients and burden the healthcare system. Older patients commonly have polypharmacy, which is associated with hospital returns, especially with cardiovascular and psychotropic drugs. More than half (51.7%) of dementia patients have at least two comorbid conditions which increases the risk of hospitalization. Polypharmacy increases the likelihood of Drug-Related Problems (DRPs), including drug-drug interactions, adverse drug reactions and noncompliance, as well as increases morbidity and mortality. Impaired cognition (i.e., dementia) also increases the risk for DRPs. Dementia and DRPs are both frequently implicated in hospital admissions (and readmissions) in the geriatric population. The aims of this study were to examine the relationship between polypharmacy and returns to the hospital among patients both with and without dementia, as well as to determine why patients with dementia and polypharmacy return to the hospital within 30 days of initial discharge. We hypothesized those patients 75 years old and older with dementia and polypharmacy are more likely to return to the hospital within 30 days than geriatric patients with neither dementia nor polypharmacy.

This is a retrospective descriptive analysis of an existing Quality Improvement database created for the Safe Transitions for At Risk Patients (STAR) Program, which was designed to reduce returns to the hospital. Patient population includes patient’s ≥ 75 years old who were admitted to a community hospital between July 2015 and June 2017. Patients who were admitted directly to the ICU, hospice patients and those who expired in the hospital were excluded. Patients were divided into those with dementia and those without dementia based on ICD-10 codes (F00.x-F03.x, F05.1, G30.x and G31.1) and physician and nursing notes and medications for dementia. Polypharmacy was defined as the prescription of ≥ 9 routine medications, excluding vitamins except vitamin D. Hospital returns were defined as ED visits, observation stays and inpatient admissions within 30 days of discharge from any hospital admission (either inpatient admission or observation stay). Groups were compared using a chi-square test with a p-value<0.05 for statistical significance.

Patients with both dementia and polypharmacy were most likely to return to the hospital within 30 days of discharge. Those with polypharmacy alone were the second most likely to return, followed by patients with dementia alone. Patients with neither dementia or polypharmacy were least likely to return to the hospital. Hypoalbuminemia, COPD and Congestive Heart Failure and mild anemia were also associated with higher returns to the hospital. These comorbidities could account in part for the association between dementia and polypharmacy and returns to the hospital. Return visits within 30 days of initial discharge were most frequently related to cardiovascular diagnoses, followed by infectious disease, pulmonary diagnoses, gastrointestinal diagnoses and trauma. Further research should explore the specific diagnoses associated with returns to the hospital among patients with both dementia and polypharmacy, in order to develop interventions to reduce unnecessary hospital returns.

Biography:

Brunilda Elezi is Faculty of Technical Medical Science, Alexander-Xhuvani University in Elbasan, Albania.

Abstract:

Mental health such as depression and anxiety are the most important health indicators that cause considerable morbidity in elderly people. Providing elderly mental healthcare in Elbasan city, especially during the pandemic COVID-19 time is challenging due to many reasons such as the unusual situation that this pandemic caused, also the growth of the elderly population and limited health resources. We examined the prevalence of depression and anxiety, as well as the risk factors of these mental health issues among elderly over 65 years old in Elbasan city. This is a cross-sectional study conducted on 617 persons ≥ 65 years old that living in Elbasan city. A google form or a face-to-face interview with a pre-tested questionnaire was carried out by all participants. General Anxiety Disorder Assessment (GAD) for anxiety assessment and Patient Health Questionnaire (PHQ-9) for depression assessment were incorporated into the questionnaire. Data were analyzed by chi-square test. All statistical analyses were done using SPSS version 20.0. P-values less than 0.05 were considered statistically significant.

The prevalence of depression and anxiety in this study resulted in 87.8% and 88% respectively. More of the patients 80.2% (495/617) had passed the COVID-19 disease. According to the severity of anxiety and depression, in most of the cases, 77.9% (325/417) resulted in mild anxiety, while 71.4% (302/417) resulted in mild depression. The highest prevalence is observed in age groups (65 to 75 years old). Women were an almost double number of cases 66% compared to males. The women were 1.8 times at risk for anxiety compared to males for 95% CI [0.45-3.42] p-value resulted =0.02 and 1.4 times in risk for occurrence of depression compared to men for CI 95% [0.39-3.12] p-value resulted =0.03. There was found a strong association between marital status, level of monthly income, comorbidities and living conditions with anxiety and depression. The findings of this study suggested a higher prevalence of anxiety and depression during the COVID-19 pandemic time. Women were the most affected gender and persons between the ages of 65-75 years old. We strongly recommended raising community awareness of mental health, encouraging social participation and supportive counseling is also essential in combating anxiety and depression among adults. Taking action to address the burden of major depressive disorder and anxiety disorders should be an immediate option for all medical staff and stakeholders.

Biography:

Merav Maisel is affiliated from Carmel Medical Center, Israel.

Abstract:

Carmel Medical Centre is a 500-bed general hospital, located in the north of Israel. The hematology unit provides a large verity of procedures and treatments including chemotherapy and advanced biological and immunotherapy protocols. Following the histotype-tailored chemotherapy order made by the oncologist, treatment preparation takes place in the pharmacy by experienced pharmacists. In the last few years we have witnessed an exciting scientific breakthrough in the development of biologic and immunotherapy drugs used in hemato malignancies. New medications are based on biological mechanism and are safer for use. Their efficiency, together with relatively high safety, allows a vast of geriatric patient to use those medications. The geriatric patient usually has chronic diseases and chronic medications and so a specific compatibility is needed between those and the medication used for the hematological disease. Polypharmacy is a known risk factor among elderly patients and the risk increases significantly as they are facing chemotherapy treatments. The aim of our project is to supply a personal package, including geriatric evaluation and pharmacological consultation, for geriatric patient that are being treated in the hemato-oncology unit for improving the patient treatment in all aspects and providing him with a "tailored suit” treatment.

After the need which was flooded by the hematologists, a multidisciplinary team was formed: a geriatrician, a pharmacist specialized in hematological medications, a pharmacist specialized in the geriatric population and a nurse from the hematology unit. Patient from the age of 75 and above and are due to begin chemical and/or biological treatment, are invited for a 1 hour consultation with the team. The patient is asked to bring all his medications and usually is accompanied by a family member. The geriatric doctor performs a geriatric assessment and the medications are being examined by the pharmacists. The patients are also asked to bring all herbal medications, vitamins etc. The patient and his caretaker have time to ask questions. After the meeting, 2 consultation summaries are provided-geriatric and pharmacologic. The summary includes recommendations for the hematologic doctor, for the family physician and for the patient himself. Medication Information sheets written by the pharmacists allow the hemato-oncology medical team a clear and accessible approach to pharmacological knowledge. In 2021, 20 patients were examined. All were given detailed recommendation letters. The medical team and the consultation have many advantages: Receiving geriatric assessment and pharmacological consultation, Providing the opportunity to explain his condition and ask specific questions, Receiving detailed explanation about the patient, his ability to the undergo chemotherapy treatment and a full revaluation of the patients medications including specific adjustments, Receiving medical Information sheets that can provide the team with more accessible information and can which help him explaining the patient about the treatment.