Nursing home; Residential facilities; Geriatric assessment; Qualitative research; Mobile health unit
Abstract :
[en] Background Nursing home residents (NHR) have complex health needs due to their multimorbidity and frailty, challenging interorganisational collaboration, particularly between nursing homes (NH) and hospitals. Coronavirus disease pandemic highlighted the need to strengthen the expertise of NHs care teams. Geriatric mobile teams (GMT) exist in several countries and aim to provide interdisciplinary advice to reinforce the primary care expertise. To develop GMTs in Belgium, we chose a participatory and systemic approach. The aim focuses on identifying areas of partnership between hospitals and NHs based on the geriatric needs of residents, from the perspective of the stakeholders involved in their care. Additionally, it examines the essential requirements for fostering collaboration among these stakeholders. Method Qualitative study using semi-structured interviews of 20 healthcare professionals working in a Belgian academic hospital or within its affiliated NH network. Themes were extracted using thematic analysis, employing simultaneously an inductive approach for the partnership areas and a deductive approach constructed around Karam's framework of interorganizational and interprofessional collaboration. Results Participants highlighted the increasing complexity of NHRs' healthcare needs and the crucial role of geriatric expertise in managing behavioural and psychological symptoms of dementia, assessing complex medical situations, and advance care planning. While all supported enhanced collaboration, key challenges included formalizing processes and facilitating care integration between providers. Balancing high-level care with the risk of overmedicalization also remains a critical issue. These findings are reflected in three main themes: empowering nursing homes with geriatric expertise; The high importance of integration and formalisation; and balancing tension between a place of residence and high skilled care. Conclusion This study provides a comprehensive overview of expected collaboration areas and practical strategies to manage constraints. By using a qualitative approach, we integrated the perspectives of all key stakeholders, ensuring that proposed initiatives align with actual needs. Strengthening collaboration between NHs and geriatric services requires formalized frameworks and co-designed protocols with frontline caregivers. Such an initiative has the potential to dismantle compartmentalized care pathways for NHRs.
Disciplines :
Geriatrics General & internal medicine
Author, co-author :
Merche, Julie; Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium ; Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
Van Durme, Thérèse; Faculty of Public Health, Université catholique de Louvain, Institute of Health and Society, Brussels, Belgium
Sibille, François-Xavier; Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium ; Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
Buret, Laetitia ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale
Schoevaerdts, Didier; Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium ; Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
De Brauwer, Isabelle; Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium ; Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
De Saint-Hubert, Marie; Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Belgium ; Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
Language :
English
Title :
Geriatric assessment in Belgian nursing homes: qualitative insights
Perspectives de la population. https://statbel.fgov.be/fr/themes/population/perspectives-de-la-population. Accessed 28 Apr 2022.
Van den Bosch K, Willemé P, Geerts J, Breda J, Peeters S, Van De Sande S, Vrijens F, Van de Voorde C, Stordeur S. Soins résidentiels pour les personnes âgées en Belgique: projections 2011–2025. In: KCE Reports. Bruxelles: Centre Fédéral d’Expertise des Soins de Santé (KCE); 2011. https://kce.fgov.be/sites/default/files/2021-12/KCE_167B_soins_residentiels_en_Belgique.pdf. Accessed 27 Jul 2023.
Lafon M. Intervention d’une équipe mobile gériatrique en EHPAD. Pourquoi? Comment? DIU de médecin coordinateur en EHPAD. Université René Descartes - Paris V. Faculté Cochin - Port-Royal; 2007. https://ehpad.org/wp-content/uploads/2022/02/LAFON-Monique-2007.pdf. Accessed Apr 2021.
A. Piotrowski M. Meyer I. Burkholder D. Renaud M.A. Muller T. Lehr S. Laag J. Meiser L. Manderscheid J. Koberlein-Neu Effect of an interprofessional care concept on the hospitalization of nursing home residents: study protocol for a cluster-randomized controlled trial Trials 21 1 411 32423463 7236352
M.A. LaMantia L.P. Scheunemann A.J. Viera J. Busby-Whitehead L.C. Hanson Interventions to improve transitional care between nursing homes and hospitals: a systematic review J Am Geriatr Soc 58 4 777 782 20398162 4407558
R. Briggs T. Coughlan R. Collins D. O’Neill S.P. Kennelly Nursing home residents attending the emergency department: clinical characteristics and outcomes QJM 106 9 803 808 23818688
L. Bosson I. Laniece B. Moheb V. Lapouge-Bard J.L. Bosson P. Couturier Difficulties encountered by the general practitioner in the management of the elderly people in complex medical and psycho-social condition: role of mobile teams Geriatr Psychol Neuropsychiatr Vieil 14 1 23 30 27005334
Achard N. Évaluer l’efficacité d’une équipe mobile gériatrique: l’exemple au CHU d’Angers. 2008.
J. Robison N. Shugrue M. Porter R.H. Fortinsky L.A. Curry Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults J Aging Soc Policy 24 3 251 270 22720886
A. Nouvenne C. Caminiti F. Diodati E. Iezzi B. Prati S. Lucertini P. Schianchi F. Pascale B. Starcich P. Manotti et al. Implementation of a strategy involving a multidisciplinary mobile unit team to prevent hospital admission in nursing home residents: protocol of a quasi-experimental study (MMU-1 study) BMJ Open 10 2 e034742 32071189 7045229
Y. Rolland C. Mathieu C. Piau F. Cayla C. Bouget B. Vellas B.P. de Souto Barreto P Improving the Quality of Care of Long-Stay Nursing Home Residents in France J Am Geriatr Soc 64 1 193 199 26782872
D. Brucken J. Unterkofler S. Pauge J. Bienzeisler C. Hubel S. Zechbauer R. Rossaint W. Greiner B. Aufenberg R. Rohrig et al. Optimal@NRW: optimized acute care of nursing home residents using an intersectoral telemedical cooperation network - study protocol for a stepped-wedge trial Trials 23 1 814 36167557 9513974
S. Fristedt P. Nystedt O. Skogar Mobile Geriatric Teams - A Cost-Effective Way Of Improving Patient Safety And Reducing Traditional Healthcare Utilization Among The Frail Elderly? A Randomized Controlled Trial Clin Interv Aging 14 1911 1924 31806947 6842824
E. Santosaputri K. Laver T. To Efficacy of interventions led by staff with geriatrics expertise in reducing hospitalisation in nursing home residents: A systematic review Australas J Ageing 38 1 5 14 30294903
L.M. Murray S.B. Laditka Care transitions by older adults from nursing homes to hospitals: implications for long-term care practice, geriatrics education, and research J Am Med Dir Assoc 11 4 231 238 20439041
D. Abdoulhadi P. Chevalet L. Moret M.H. Fix M. Gegu P. Jaulin G. Berrut L. de Decker Appropriateness of direct admissions to acute care geriatric unit for nursing home patients: an adaptation of the AEPf GRID Geriatr Psychol Neuropsychiatr Vieil 13 1 15 21 25786419
R. Backhaus H. Verbeek E. van Rossum E. Capezuti J.P. Hamers Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies J Am Med Dir Assoc 15 6 383 393 24529872
World Health O WHO global strategy on integrated people-centred health services: interim report Geneva World Health Organization
C. Swine D. Schoevaerdts 25 ans de gériatrie dans le contexte d’une population vieillissante (1995–2020) Ethica Clinica 100 68 79
Denzin NK, Lincoln YS, Giardina MD, Cannella GS, editors. The SAGE Handbook of Qualitative Research. Sixth edition. SAGE; 2024.
A. Tong P. Sainsbury J. Craig Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups Int J Qual Health Care 19 6 349 357 17872937
B.C. O’Brien I.B. Harris T.J. Beckman D.A. Reed D.A. Cook Standards for reporting qualitative research: a synthesis of recommendations Acad Med 89 9 1245 1251 24979285
M.M. Hennink B.N. Kaiser V.C. Marconi Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough? Qual Health Res 27 4 591 608 27670770
Blais M, Martineau S. L’analyse inductive générale: Description d’une démarche visant à donner un sens à des données brutes. Recherches Qualitatives. 2006;26. https://doi.org/10.7202/1085369ar
M. Karam I. Brault T. Van Durme J. Macq Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research Int J Nurs Stud 79 70 83 29202313
Decelle G. Équipe mobile de gériatrie intervenant en EHPAD: enquête de satisfaction auprès des médecins généralistes du bassin de santé d’Annecy. 2012.
B.C. Moheb H.V. Roger Équipe Mobile de Gériatrie Extra-Hospitalière intervenant en EHPAD. Expérience de 3 ans d’activité au Centre Hospitalier de la Région d’Annecy (CHRA) La Revue de Gériatrie. 37 746 748
A. Buisson E. Ojardias A. Viceriat E. Fakra T. Celarier Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions Encephale 45 4 327 332 30879781
E. Gilles de Pelichy K. Ebbing A. Matos Queiros C. Hanon A. von Gunten Z. Sellah H. Verloo Demographics, Clinical Characteristics, and Therapeutic Approaches among Older Adults Referred to Mobile Psychiatric Crisis Intervention Teams: A Retrospective Study Dement Geriatr Cogn Dis Extra 8 3 402 413 30483306 6243965
V.T. Sherr O.C. Eskridge S. Lewis A mobile, mental-hospital-based team for geropsychiatric service in the community J Am Geriatr Soc 24 8 362 365 939899
M. Crotty J. Halbert D. Rowett L. Giles R. Birks H. Williams C. Whitehead An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing Age Ageing 33 6 612 617 15385274
P.M.S. Anrys G.C. Strauven V. Foulon J.M. Degryse S. Henrard A. Spinewine Potentially Inappropriate Prescribing in Belgian Nursing Homes: Prevalence and Associated Factors J Am Med Dir Assoc 19 10 884 890 30056012
B.K. Tamura C.L. Bell K. Lubimir W.N. Iwasaki L.A. Ziegler K.H. Masaki Physician intervention for medication reduction in a nursing home: the polypharmacy outcomes project J Am Med Dir Assoc 12 5 326 330 21450207
L. Pivodic T. Smets N. Van den Noortgate B.D. Onwuteaka-Philipsen Y. Engels K. Szczerbińska H. Finne-Soveri K. Froggatt G. Gambassi L. Deliens et al. Quality of dying and quality of end-of-life care of nursing home residents in six countries: An epidemiological study Palliat Med 32 10 1584 1595 30273519 6238165
M. Cardona-Morrell J.C.H. Kim M. Brabrand B. Gallego-Luxan K. Hillman What is inappropriate hospital use for elderly people near the end of life? A systematic review Eur J Intern Med 42 39 50 28502866
Paulus D, Van den Heede K, Mertens R. Position paper: organisation des soins pour les malades chroniques en Belgique. In: KCE Reports. Bruxelles: Centre Fédéral d’Expertise des Soins de Santé (KCE); 2012. https://kce.fgov.be/sites/default/files/2021-11/KCE_190B_organisation_soin_malades_chroniques_0.pdf. Accessed 18 Mar 2024.
I. Ericsson A.W. Ekdahl I. Hellstrom “To be seen” - older adults and their relatives’ care experiences given by a geriatric mobile team (GerMoT) BMC Geriatr 21 1 636 34742233 8572495
B. Graverholt L. Forsetlund G. Jamtvedt Reducing hospital admissions from nursing homes: a systematic review BMC Health Serv Res 14 36 24456561 3906881
F.R. Herrmann D. Zekry R.W. Kressig C.E. Graf The Presence of a Geriatrician in a Nursing Home Could Prevent Hospitalization J Am Med Dir Assoc 21 1 139 140 31590921
M. Fedecostante G. Onder P. Eusebi G. Dell’Aquila E. Zengarini B. Carrieri E. Manes Gravina C. Falsiroli A. Corsonello R. Luzi et al. Predictors of Functional Decline in Nursing Home Residents: The Shelter Project J Gerontol A Biol Sci Med Sci 75 8 1600 1605 31858108
E. Piot B.F. Leheup S. Losson L. Gedor L. Domina C. Behem M. Amanzouggarene Intervention of mobile palliative care team on nursing homes: retrospective study Geriatr Psychol Neuropsychiatr Vieil 12 4 347 353 25515898
P. Anrys G. Strauven S. Roussel M. Vande Ginste J. De Lepeleire V. Foulon A. Spinewine Process evaluation of a complex intervention to optimize quality of prescribing in nursing homes (COME-ON study) Implement Sci 14 1 104 31829252 6907338
E. Kjelle K.B. Lysdahl Mobile radiography services in nursing homes: a systematic review of residents’ and societal outcomes BMC Health Serv Res 17 1 231 28335759 5364720
T. De Blauwe La gériatrie, essor d’une « jeune » spécialité Louvain Médical 139 01 32 29
R. Fontanini E. Visintini G. Rossettini D. Caruzzo J. Longhini A. Palese Italian Nurses’ experiences during the COVID-19 pandemic: a qualitative analysis of internet posts Int Nurs Rev 68 2 238 247 33730760 8250969
