1. College for Geriatrics 1. State of the Art 2. Project ’s results 3. SWOT analysis 2003 Thierry Pepersack on behalf of the college for geriatrics

2. 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

3. 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

4. 2. College ’s projects 2000: Peer review 2001: Nutrition 2002: Continence Collaborations with the colleges for: –radiotherapy, –nephrology, –and emergency medicine

5. 2001 Nutrition programme

6. Nutrition program 2001 OUTCOMES OF CONTINUOUS PROCESS IMPROVEMENT OF NUTRITIONAL CARE PROGRAM AMONG GERIATRIC UNITS IN BELGIUM

7. 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

8. 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

10. Nutrition program 2001 Conclusions High prevalence of malnutrition among geriatric hospitalized patients Significant decreased hospitalization stay during 2 nd phase (Confounding factor?) Significant increased PAB concentrations during 2 nd phase

11. 2002 Continence programme

12. DRIP Detect, Reduce, Incontinence, Programme Thierry Pepersack on behalf of the College of Geriatrics

13. 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

14. 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

15. Continence 2002 Part 1: Methodology Survey design: transversal Questionnaire by mail, web site Data collect of the characteristics of –hospitals –teams –patients

16. Continence 2002 Results Prevalence of incontinence (N=834 patients)

17. Continence 2002 Types of chronic incontinence

18. Characteristics of the teams/patients Factors associated with the absence of incontinence management

19. Characteristics of the patients 13% under continued catheterization, why?

20. Continence 2002 Characteristics of the patients 13% under intermittent catheterization, why?

21. Continence 2002 Relationship between % of incontinent patients and patients’ and teams’ characteristics

22. 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

23. Discussion (2) A interventional proposition will complete this survey based on valided guidelines  Part 2: 2004?

24. 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.

25. 2003 AGGIR-PATHOS-SOCIOS

26. Geriatrics 2003 3. SWOT analysis

27. Strength  EBM, Comprehensive Geriatric Assessment  New medical culture, multidisciplinary,comprehensive  psychosocial > biomedical model  CGA associated with low dependence, low institionalization  realistic approach in view of care situation  National Scientific Society associated with the College  Motivation, EAMA  demographic data

28. 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,

29. Opportunities Education & Formation –GP, caregivers, specialists Geriatric programme for impatients European, governmental research GP partnership (CGA)

30. Threats « Everybody practice geriatrics » (lack of professionalism) « Wrong » geriatrics (Fountain of Youth) lack of defence and promotion appropriation by lobbies Burn-out

31. 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.)

32. 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