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Background low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. Methods a quasi-experimental three-group comparative design (N  = 366): pre-implementation, i.e. control group (n  = 150), immediate post-implementation (n  = 144) and 2-year post-implementation (n  = 72). Results mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F  = 15.778 P  < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F  = 16.250, P  < 0.01. Conclusions the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation. [ABSTRACT FROM AUTHOR]

Aim: This study explores the potential benefit of combining clinicians' risk assessments and the automated 30‐day readmission prediction model. Background: Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate. Methods: This prospective multisource study was based on self‐reported surveys of clinicians and data from electronic health records. The survey was performed at 15 internal medicine wards of three general Clalit hospitals between May 2016 and June 2017. We examined the degree of concordance between the Preadmission Readmission Detection Model, clinicians' readmission risk classification and the likelihood of actual readmission. Decision trees were developed to classify patients by readmission risk. Results: A total of 694 surveys were collected for 371 patients. The disagreement between clinicians' risk assessment and the model was 34.5% for nurses and 33.5% for physicians. The decision tree algorithms identified 22% and 9% (based on nurses and physicians, respectively) of the model's low–medium‐risk patients as high risk (accuracy 0.8 and 0.76, respectively). Conclusions: Combining the Readmission Model with clinical insight improves the ability to identify high‐risk elderly patients. Implications for Nursing Management: This study provides algorithms for the decision‐making process for selecting high‐risk readmission patients based on nurses' evaluations. [ABSTRACT FROM AUTHOR]

Aims: To (a) assess patients' interest and perceived capability of participating in haemodialysis; (b) assess nurses' perceptions of patients' interest and perceived capability of participating in haemodialysis; and (c) examine associations between patient characteristics and interest and perceived capability of performing haemodialysis self‐care. Design: Cross‐sectional, questionnaire‐based study. Methods: Data were collected from dialysis patients and their nurses between October 2018–May 2019. Patients' interest and perceived capability of participation were assessed by a 10‐item Likert‐type scale developed and tested for this study, with responses ranging from 1 (not interested/no perceived capability) to 5 (already doing task independently). Multivariate linear regression was used to assess the relationship between patient characteristics, including age, sex, education level and severity of illness to ratings of activation level and haemodialysis self‐care scale scores. The STROBE checklist was used as a guideline for this study. Results: Ninety‐one patients and 31 nurses participated. Overall, patients expressed interest (2.43 ± 0.93) and perceived themselves capable (2.34 ± 0.9) of participating in various haemodialysis‐related tasks. Nurses assessed lower interest (2.19 ± 0.77) than patients, but similar average capability (2.31 ± 0.8). Both greater interest and perceived capability were correlated with more years of education and higher patient activation; additionally, interest was associated with disease severity and perceived capability was associated with age. Conclusion: Haemodialysis patients are interested and perceive themselves capable of participating in the tasks involved in dialysis care. Nurses underestimate patient interest in participation. Relevance to clinical practice: Self‐care behaviours among haemodialysis patients are important, as they may affect quality of life and survival. Determining interest and perceived capability of participation is a first step towards evaluating the feasibility of self‐care in a supervised haemodialysis setting. [ABSTRACT FROM AUTHOR]

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Aim: To assess the relationship between continuity in nursing assignment in older adults' acute hospitalization and patient experience and functional decline. Background: In‐hospital functional decline affects up to 40% of hospitalized older adults. Nurses are responsible for performing functioning‐preserving interventions. Whether continuity of nursing care contributes to patients' functional outcomes is unclear. Method: A retrospective observational study of 609 patients aged ≥70 admitted to internal medicine units. Patients were surveyed on their functional (cognitive and physical) status and satisfaction with the hospital care experience. Dispersion and sequence of nursing assignment were measured by the Continuity of Care Index and Sequential Continuity Index. Multivariate logistic regressions were modelled for each continuity score and outcome. Results: Achieving 25% of the maximum Continuity of Care Index was associated with lower odds of cognitive decline (OR = 0.64, 95% CI = 0.43–0.94) and higher odds of satisfaction (OR = 1.52, 95% CI = 1.06–2.17). Achieving 25% of the maximum Sequential Continuity Index was associated only with higher odds of satisfaction (OR = 1.43, 95% CI = 1.01–2.02). Continuity scores were not associated with physical functioning decline. Conclusion: Continuity in nursing assignment is related to a positive patient experience and cognitive functioning of hospitalized older adults. Implications for Nursing Management: Continuity should be prioritized in scheduling and assignment algorithms. [ABSTRACT FROM AUTHOR]

Around hospitalization, older adults often experience functional decline which can be a reflection of their need for nursing care. Given a shortage of nurses, determining the relationship between functional change and patients' satisfaction with nursing care can help to gauge the need for care. We assessed this relationship in a mixed prospective-correlational cohort study with 393 patients, 70 years or older. The art, tangible aspects and general satisfaction with nursing care were measured through interviews conducted at discharge. Patients' functional status was assessed at admission and discharge. Decline in functioning during hospitalization was the most powerful predictor of higher satisfaction with art and tangible aspects of nursing care in multivariate regression (β = 0.17-0.19, P < 0.01). This finding suggests that patients whose functioning deteriorates during hospitalization, have a greater need for and more contact with professional nursing care, and therefore report higher satisfaction with specific aspects of nursing care. [ABSTRACT FROM AUTHOR]

In this article we present the design, development and implementation of the Psychiatric Rehabilitation Routine Outcome Measurement (PR-ROM) project, the first systematic effort to implement mental health routine outcome measures in Israel. The goal of the PR-ROM is to provide updated information about the process and impact of psychiatric rehabilitation services in Israel and to establish a sustainable infrastructure and foundation for routine outcome monitoring of rehabilitation services to improve care, inform policy, generate incentives for service improvement, increase informed decision-making and provide data for research purposes. The rehabilitation services evaluated and the characteristics of the population being served are described and the methods and nature of the collected data as well as some preliminary findings are presented. We discuss the major barriers encountered, our efforts to deal with them and lessons learned during the process. We conclude with a description of the current state of the initiative and plans for the future. [ABSTRACT FROM AUTHOR]

The current study aimed to develop a patient selection process for muiltimorbid care management that balances the needs to accurately identify patients who are at risk for future high costs and assures that those selected can clinically benefit from proactive care management. Six physicians were surveyed on characteristics of their current (2012) patients to elicit clinical considerations for high-risk patient identification. Data from 2010-2011 were extracted from Clalit Health Services' (Israel's largest managed care organization) comprehensive database to derive the Adjusted Clinical Groups (ACG) predictive model risk scores for risk of future high costs. Model discriminatory power was assessed using the c-statistic and positive predictive value (PPV), before and after application of the clinical exclusion criteria. Inclusion criteria were refined based on physician input from a survey on 375 patients. Recommended reasons for exclusion: active cancer, schizophrenia, dialysis, residence in nursing homes or long-term care facilities, and age 95 years or older. The high-risk group included 5341 patients (mean 50 patients per physician). The c-statistic of the ACG model before and after exclusions applied was 0.80 and 0.75, respectively. After exclusion, the PPV for the 6% highest risk patients was 40%. High-risk patients' age, number of chronic conditions, and utilization were substantially higher than those of all other patients. This study shows that a validated predictive modeling tool provides acceptable discriminatory power for selecting multimorbid patients for participation in proactive care management, even after some of the highest risk patients are excluded because of priori clinical considerations. ( Population Health Management 2015;18:15-22) [ABSTRACT FROM AUTHOR]

Objectives: To explore the effects of four types of support (psychological support, instrumental support, supervision of instrumental support, and explanation of medical care) on the level of depressive symptoms among hospitalized older adults. Method: The sample consisted of 468 older adults admitted to the internal medicine units of a large tertiary care medical center in northern Israel. Respondents filled out self-report questionnaires upon admission and discharge. Information regarding severity of illness, chronic health status, and length of hospital stay was gathered from their medical records. Multivariate regression was used to test the association between the four types of caregiving support and depressive symptoms. Results: Psychological support from informal caregivers was found to be negatively related to depressive symptoms, and instrumental support to be positively related to depressive symptoms among respondents who were more independent in their functioning before the hospitalization. These relationships remained significant after controlling for previously-identified precursors of depressive symptoms: age, gender, education, widowhood, functional and cognitive status, severity of illness, co-morbidities, and length of hospital stay. Supervision of instrumental support and explanation of medical care were not related to depressive symptoms. Conclusion: Results of this study suggest that functional status, the kind of support, and the setting in which it is given are important in understanding the influence of informal support on the well-being of older adults. The potentially positive as well as negative consequences of various types of support in the hospital setting should be recognized and addressed. [ABSTRACT FROM AUTHOR]

gur-yaish n., zisberg a., sinoff g. & shadmi e. (2011) Development and psychometric testing of a measure of informal caregiving for hospitalized older adults. Journal of Advanced Nursing 68(4), 931-938. Abstract Aim. This paper is a report of the development and psychometric testing of the questionnaire evaluating informal caregiving for hospitalized older adults. Background. Informal caregiving of hospitalized older adults is an understudied phenomenon that lacks a valid and reliable measure to capture its multi-dimensionality. Methods. An instrument development procedure, followed by an empirical study, was conducted from February to November 2009. Instrument development included item generation and content validity, which was established by five experts. The validation study utilized a retrospective between-patients design. The sample consisted of 279 patients, aged 70 and older, who were hospitalized in a large medical centre in northern Israel. The internal consistency reliability, construct, convergent and divergent validity of the measure were tested. Results. The 14-item scale describes various aspects of informal caregiving for older adults in the hospital setting. The scale has four dimensions: Instrumental care, Supervision of care, Psychological support and Ensuring and Explaining care. Confirmatory factor analysis supported the theoretical model of the four dimensions of care. Reliability analysis revealed acceptable-to-high estimates for the total and for the dimensional scores (ranging from 0·78 to 0·89). The convergent and divergent validity coefficients were all in the expected direction. Conclusions. The preliminary psychometric properties of the measure showed acceptable results. The measure should be further explored in different cultural settings and for its ability to link between caregiving attributes, as captured by the measure, and hospitalization outcomes in older adults. [ABSTRACT FROM AUTHOR]