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