Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity

Objectives: The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period. Methods: A cross-sectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population. Results: The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis. Conclusion: Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations.</p

Successful transition to elementary and the implementation of facilitative practices specified in the Reggio-Emilia philosophy

Systematic, mandated facilitation of school transitions is an important but understudied aspect of the Reggio-Emilia approach to early childhood education admired internationally as best practice. We studied the links between Northern Italian transition practices and academic achievement, school liking, cooperativeness, and problem behaviors. We followed 288 students across a transition from preschool to elementary school. Schools varied in their implementation of transition practices. High implementation of Reggio-type transition practices was related to significantly more school liking and significantly fewer problem behaviors after the transition. At follow-up at the end of the post-transition year, high-implementation schools were still characterized by lower levels of problem behavior. These data indicate that the facilitation of school transitions in the Reggio-Emilia tradition is associated with successful post-transition adjustment

Key stakeholders' perspectives on the development of a national transfer document, for older persons, when transferring between the residential and acute care settings: a qualitative descriptive study.

Aims and objectives: This study has aimed to examine key stakeholders’ perspectives, views and experiences regarding transfer documents, used when an older person is being transferred from a residential to an acute care setting. The objective of the study is to inform, in part, the development of an effective national transfer document. Background: For the effective and safe transfer of older persons from residential to acute care settings it is important to ensure that the transfer document encapsulates relevant, current and person-centred information to ensure a smooth, quality and safe transition. Evidence highlights that, where documentation has lacked vital and relevant information, the older persons experience negative impacts during the transfer process. Design: A qualitative descriptive study was conducted, following the COREQ checklist, to establish participants’ perspectives, views and experiences of using transfer documents. Methods: Focus group interviews (n=8) were conducted with a convenience sample of key stakeholders (n=68) in an Irish setting. The data were analysed using content analysis. Results: The findings have highlighted the important aspects for consideration in the development of future transfer documentation. The three broad categories, used to present the data findings are 1) existing transfer documentation, 2) design framework, and 3) essentials of care. Conclusions: The transfer document of the future is required to be concise, regularly reviewed, and with a user friendly colour coded design. Essential and current information, with an emphasis on person centeredness, must be in the first page, with more detailed supporting information in the subsequent sections