Here are some further recent reviews and meta-analyses on the subject of delirium.

Khan, B.A. Zawahiri, M. Campbell, N.L. [et al]. (2012). Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research: a systematic evidence review. Journal of Hospital Medicine. September 2012; 7(7): 580-9. Review. Full Text Link. [This review is not so recent, but considered worth mentioning again here by virtue of the full text link].

de Lange, E. Verhaak, P.F. [and] van der Meer, K. (2013). Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. International Journal of Geriatric Psychiatry. February 2013; 28(2): 127-34.

Teslyar, P. Stock, V.M. Wilk, C.M. [et al]. (2013). Prophylaxis with antipsychotic medication reduces the risk of post-operative delirium in elderly patients: a meta-analysis. Psychosomatics. March – April 2013; 54(2): 124-31.

Martinez Velilla, N. [and] Franco, J.G. (2013). [Subsyndromal delirium in elderly patients: a systematic review.]. Revista española de geriatría y gerontología. March 5th 2013. [Epub ahead of print]. Spanish.

Meagher, D.J. McLoughlin, L. Leonard, M. [et al]. (2013). What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. American Journal of Geriatric Psychiatry. March 25th 2013. [Epub ahead of print].

Death rates in elderly nursing and care homes in England are to be monitored by the Care Quality Commission in renewed plans to eliminate poor care. The regulator is piloting a system whereby higher than expected numbers of deaths can trigger an investigation.

Care homes are required already to report to the CQC when a resident dies, but the BBC’s Panorama (tonight) has found that some homes have not been complying.

Read more: BBC News: Care Quality Commission monitoring deaths in homes.

Reference

Care Quality Commission monitoring deaths in homes. London: BBC Health News, June 17^th 2013.

See also: BBC News. Human cost of failures in elderly care homes.

Reference

Holt, A. (2013). Human cost of failures in elderly care homes. London: BBC Health News, June 17^th 2013.

A review of emergency services and emergency care, led by NHS medical director Sir Bruce Keogh, has recommended that the NHS in England needs a simpler and more coordinated system of round-the-clock urgent and emergency care. The review has identified that many patients are confused about where to go for help when they need urgent medical treatment, so tend to attend over-stretched A&E units by default.

Read more: BBC New: NHS ‘needs to simplify urgent care’.

Reference

Parkinson, C. (2013). NHS ‘needs to simplify urgent care’. London: BBC Health News, June 17^th 2013.

This relates to:

Full Text Link (a)

Reference

High quality care for all, now and for future generations: transforming urgent and emergency care services in England: the Evidence Base from the Urgent and Emergency Care Review. London: NHS England, June 17^th 2013.

Full Text Link (b)

Reference

High quality care for all, now and for future generations: transforming urgent and emergency care services in England. Emerging principles from the Urgent and Emergency Care Review. London: NHS England, June 17^th 2013.

Full Text Link (c) (Online)

Reference

NHS England asks patients, the public and staff to help shape the future of urgent and emergency care. London: NHS England, June 17^th 2013.

Mosaic Community Care, the firm at the centre of a BBC News scandal about the poor care of an elderly woman in her own home, has been suspended the UK Homecare Association. The UKHCA is investigating Mosaic Community Care and will not recommend Mosaic to elderly or disabled people in the near future.

Read more: BBC News: Elderly care firm suspended over woman’s treatment.

Reference

Elderly care firm suspended over woman’s treatment. London: BBC Health News, June 14^th 2013.

The NHS England strategy for ensuring CCGs receive suitable commissioning support services is outlined in this document. CCGs should be enabled to exercise informed choice about how they obtain commissioning support and from whom. An effective market of viable commissioning support providers is required, providing access to “best in class” providers from the public, voluntary and independent sectors.

Read more: NHS England announces vision for future of commissioning support services. NHS England.

Full Text Link

Reference

Towards commissioning excellence: a strategy for commissioning support services. Leeds: NHS England: June 12^th 2013.

Section headings in this report comprise:

• Executive summary.
• Context: Creating an excellent commissioning system.
• Introduction to commissioning support services.
  • What are commissioning support services?
  • Who are the customers for commissioning support services?
  • Who provides commissioning support services?
• What are excellent commissioning support services?
• Creating a market.
  • A managed approach to developing the market is in the interest of all commissioners.
  • What NHS England will do to support CCGs and providers develop the market.
  • Freedoms.
  • Requirements.
  • The pace of change.
  • Key risks and dependencies.
  • Costs and benefits of a managed approach.
  • Value for money.
• Enabling full autonomy for CSUs.
  • Roadmap.
• Summary.
• Appendix A: Developing Informed Customers.
  • Context.
  • What support we will offer to help customers become better informed.
  • Next Steps.
• Appendix B: Buying commissioning support services.
  • The Challenge.
    • The procurement approach NHS England proposes to support.
    • An explanation of framework agreements.
    • An explanation of collaborative / joint procurements.
    • Responsibilities to NHS staff.
  • Next steps.
• Appendix C: Continuity of supply.
  • Context.
  • Objectives.
  • Approach.
  • Next steps.
• Appendix D: CSU development.
  • Context.
  • Creation of CSUs.
  • Developing fully autonomous CSUs.
  • Risk.
  • Approach.
  • CSU Assurance.
  • CSU Development.
  • Next Steps.
• Appendix E: Creating a fair playing field for all commissioning support providers.
  • The Challenge.
  • Ensuring fair and transparent procurement and contracting.
  • Managing the transfer of staff between providers.
  • A forum for providers of commissioning support services.
  • Engagement and integration of the voluntary and SME sectors.
  • Engagement of Local Authority Commissioners and providers.
• Appendix F: Assurance of CCG in-house provision of commissioning support services.
  • Objectives.
  • Approach.
  • Next Steps.
• Appendix G: What success would look like.
• Appendix H. How this strategy supports delivery of the Francis Inquiry recommendations and the Winterbourne View Review Concordat.
  • Supporting delivery of the Francis Inquiry recommendations.
  • Supporting delivery of the Winterbourne View Review Concordat actions.
• Annex.
  • Case studies from a review of comparable public sector reforms.

Information Governance and Risk Stratification

Full Text Link

Reference

Thomson, K. [and] Lewis, G. (2013). Information governance and risk stratification: advice and options for CCGs and GPs. London: NHS England, June 2013.

The principles of the NHS entail promoting equality and diversity as central to the delivery of high quality services. This report from the NHS Confederation’s BME Leadership Forum presents examples of service providers and commissioners which have developed innovative approaches to engaging with BME communities and meeting their needs.

Full Text Link

Reference

NHS Confederation (2013). Engaging with BME communities: insights for impact. Personal views from NHS leaders. London: NHS Confederation / Black and Minority Ethnic (BME) Leadership Forum, June 2013.

The incidence of hip fracture among people admitted to internal medicine units in Spain was analyzed. 1127 (0.057%) people received a diagnosis of hip fracture during hospitalisation, and the hospital mortality rate was 27.9%. (versus 9.4% for comparable non-fracture patients). Their mean length of stay was significantly longer (20.7 days versus 9.8 days) and costs were higher (€6927 per person versus €3730 in non fracture patients).

The risk factors related to fracture were found to be increasing age, female gender, admission from nursing homes, dementia, malnutrition, delirium and anaemia.

The authors propose that since in-hospital hip fractures increase hospital mortality, and double both the length of stay and the costs per admission, there are strong justifications for applying multi-disciplinary / multi-factorial approaches for reducing the incidence of falls and hip fractures in hospitalised patients.

Note: Readers may be interested in the recently published NICE Clinical Guideline CG161 “Falls Assessment and Prevention in Older People”.

Full Text Link

Reference

Zapatero, A. Barba, R. [and] Canora, J. [et al] (2013). Hip fracture in hospitalized medical patients. BMC Musculoskeletal Disorders. January 8^th 2013, 14: 15, pp.1-6. (Click here to view the PubMed  abstract).

Approximately 110,000 people in England, 11,000 people in Wales and 4,000 people in Northern Ireland have a stroke each year. Although most people survive their first stroke there are usually lasting effects. Over 900,000 people in England live with the effects of stroke.

This National Institute for Health and Care Excellence (NICE) clinical guideline covers offers evidence-based guidance on the care of adults (and young people aged 16 years and older) who have had a stroke and suffer from continuing impairment, activity limitation or participation restriction.

This guideline reviews the interventions that can be used in stroke rehabilitation. It states that multidisciplinary teams, consisting of both health and social care professionals, are needed to deliver effective stroke rehabilitation services.

“Key aspects of rehabilitation care include multidisciplinary assessment, identification of functional difficulties and their measurement, treatment planning through goal setting, delivery of interventions which may either effect change or support the person in managing persisting change, and evaluation of effectiveness”.

Read more: Stroke Rehabilitation CG162.

The main section headings in “NICE Clinical Guideline 162” comprise:

• Introduction.
• Patient-centred care.
• Terms used in this guideline.
• Key priorities for implementation.
• Recommendations.
• Research recommendations.
• Other information. (Related Guidelines).
• The Guideline Development Group, National Collaborating Centre and NICE project Team.
• About this guideline.

Full Text Link

Reference

Stroke rehabilitation: Long-term rehabilitation after stroke. London: National Institute for Health and Care Excellence (NICE), June 13^th 2013. NICE Clinical Guideline 162.

NICE Stroke Care Pathway

The NICE Pathway has been updated to include this guidance:

Stroke Care Pathway. NICE Pathways. London: National Institute for Health and Care Excellence, Created May 2011, Updated June 2013. Full Text Link.

This article presents the results of a Canadian Academy of Geriatric Psychiatry (CAGP) survey into the brief cognitive screening instruments used for the assessment of dementia in Canada.

The survey assessed the perceived characteristics and frequency of use of 14 instruments. The assessment tests used most commonly are the Clock Drawing Test (CDT), Mini-Mental State Exam (MMSE), Montreal Cognitive Assessment (MoCA), and Delayed Word Recall. Effectiveness, ease of administration, and speed of administration are the main reasons reported for using these instruments. This survey indicates that the MMSE is no longer the most popular dementia screening tool (in Canada), and that newer instruments such as the Montreal Cognitive Assessment (MoCA) are used widely.

Full Text Link

Reference

Ismail, Z. Mulsant, BH. [and] Herrmann, N. [et al] (2013). Canadian academy of geriatric psychiatry survey of brief cognitive screening instruments. Canadian Geriatrics Journal: CGJ, June 3^rd 2013, Vol.16(2), pp.54-60. (Click here to view the PubMed abstract).

This National Institute for Health and Care Excellence (NICE) clinical guideline covers the assessment and prevention of falls in older people. This guideline updates and replaces the earlier guidance on “Falls (NICE Clinical Guideline 21)” and includes information on the assessment and prevention of falls in older people in hospital.

“All people aged 65 or older are covered by all guideline recommendations. People aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition are also covered by the guideline recommendations about assessing and preventing falls in older people during a hospital stay”.

Read more: Falls.

The main section headings in “Falls Assessment and Prevention in Older People: NICE Clinical Guideline 161” comprise:

• Introduction.
• Patient-centred care.
• Key priorities for implementation.
• Recommendations.
• Research recommendations.
• Other information. (Links to related guidelines).
• The Guideline Development Group, Internal Clinical Guidelines Team, and NICE Project Team 2013.
• The Guideline Development Group, National Collaborating Centre and Additional Assistance 2004.
• About this guideline.

Full Text Link

Reference

Falls: assessment and prevention of falls in older people. London: National Institute for Health and Care Excellence (NICE), June 13^th 2013. NICE Clinical Guideline 161.

NICE Falls Pathway

A new NICE Pathway has been created to provide a succinct “map of medicine” style graphic summary of this guidance:

Falls in older people pathway. NICE Pathways. London: National Institute for Health and Care Excellence (NICE), June 2013. Full Text Link.