Did you know that the live version of the Geriatric Medicine Journal Club held at the University of Toronto, is on the fourth Friday of the month from 08:00-09:00 ET? Postgraduate subspecialty trainees in Geriatric Medicine take turns leading the critical appraisal. The first 45 minutes of the hour is devoted to the presentation and discussion of the long article and the latter 15 minutes is reserved for presentation and appraisal of the short article. The live version is also broadcast to several different hospitals in several different cities via the Ontario Telemedicine Network.
#GeriMedJC, the Twitter-complement to the traditional format journal club, has been up and running for over a year. The intention is to engage an international dialogue across all time zones as a tweetchat should have no time restrictions.
The first (long) article will look at hip fracture care models. The link to the article can be accessed here.
Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.Lancet. 2015 Apr 25;385(9978):1623-33.
BACKGROUND:
Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care.
METHODS:
We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914.
FINDINGS:
We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010).
INTERPRETATION:
Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.
For the second (short) article, we'll take a look at medical education. Great news! The full text is available free here:
Medical students' and doctors' attitudes towards older patients and their care in hospital settings: a conceptualisation. Age Ageing. 2015 Sep;44(5):776-83.
BACKGROUND:
despite assertions in reports from governmental and charitable bodies that negative staff attitudes towards older patients may contribute to inequitable healthcare provision for older patients when compared with younger patients (those aged under 65 years), the research literature does not describe these attitudes in any detail.
OBJECTIVE:
this study explored and conceptualised attitudes towards older patients using in-depth interviews.
METHODS:
twenty-five semi-structured interviews with medical students and hospital-based doctors in a UK acute teaching hospital were conducted. Participants were asked about their beliefs, emotions and behavioural tendencies towards older patients, in line with the psychological literature on the definition of attitudes (affective, cognitive and behavioural information). Data were analysed thematically.
RESULTS:
attitudes towards older patients and their care could be conceptualised under the headings: (i) beliefs about older patients; (ii) older patients' unique needs and the skills required to care for them and (iii) emotions and satisfaction with caring for older patients.
CONCLUSIONS:
our findings outlined common beliefs and stereotypes specific to older patients, as opposed to older people in general. Older patients had unique needs concerning their healthcare. Participants typically described negative emotions about caring for older patients, but the sources of dissatisfaction largely related to the organisational setting and system in which the care is delivered to these patients. This study marks one of the first in-depth attempts to explore attitudes towards older patients in UK hospital settings.
