Participants in each group, assisted by a facilitator, discussed research priorities for each healthcare setting acute care, community, long-term care. The questions generated from each group were collated. The facilitators taped all sessions and took written notes. Following each session, participants reviewed the research questions generated and ranked the ten most important questions by assigning a numeric value from "1" to "10" for each question.
About This Item
The rankings were summarized by the Q — sort methodology, in which the numerical values for the ranking were inverted so that questions with the lowest priority "1" were given the numeric value of "10", and vice versa [ 13 ]. Then for each question, the assigned numeric values were summed across all participants' lists. During the final half day of the workshop, the list of ranked research questions was presented to the entire group for discussion. This allowed participants to review and change rankings and ensure there was broad consensus about the results.
Questions which were similar were amalgamated. The research questions developed through this process are listed in order of priority sorted by healthcare setting Tables 1 to 3. The research questions proposed by the workshop participants were diverse. They ranged from risk factors and outcomes for different infections, the impact of infections on quality of life, to the effect of nutrition on infection and the role of alternative and complementary medicine in treating infections Tables 1 , 2 , 3.
Health service issues participants deemed to be important included barriers to immunization, prolongation of hospital length of stay by infection, use of care paths for managing infections, the impact of infection on quality of life, and decision-making in determining the site of care for individuals with infections. Clinical questions included risk factor assessment for infection, the effectiveness of preventative strategies, and technology evaluation, such as the utility of videos in swallowing assessement.
These questions are of direct relevance to researchers in a variety of fields including primary care, nursing, nutritional science, public health, health services, gerontology, geriatrics, infection control, and infectious diseases. The question of whether a critical pathway for frail older adults with pneumonia can reduce length of hospital stay and improve quality of life received the highest priority ranking for the acute care setting.
The Capital Study, a randomized trial for treatment of community acquired pneumonia using a clinical pathway, demonstrated that patients managed using the pathway had a reduced stay in hospital and a quality of life equivalent to patients managed with usual care [ 14 ].
Whether a critical pathway, in addition to reducing time in hospital, leads to improved quality of life in patients over the age of 85 is unknown however. Ranked second for the acute care setting was the issue of whether admission of older adults over the age of 85 to intensive care for sepsis actually reduces mortality. This question obviously has important implications for patients, their families, and clinicians.
Health Management for Older Adults: Developing an Interdisciplinary Approach | KSA | Souq
Although reasonable rates of long-term survival in critically ill elderly patients requiring intensive care has been demonstrated [ 15 , 16 ], outcomes of intensive care for patients 85 years and older specifically for sepsis have not been assessed. For the community setting, determining the prevalence of MRSA in the community received the highest priority. Addressing this question can potentially provide information about transmission patterns of MRSA as well as the need for empiric vancomycin therapy in older adults with presumed community-acquired Staphylococcus aureus infection.
In Canada, true community acquired MRSA has been documented in the First Nations population [ 17 ], but little is known about the prevalence in the general population. The second question prioritized for the community setting asks whether neuraminidase inhibitors, new anti-viral agents, reduce complications of influenza in older adults in the community.
Although these agents reduce duration of symptoms for influenza, they have not demonstrated clear benefit in reducing complications such as hospitalization or death in the population at highest risk: older adults [ 18 , 19 ].
In the long-term care setting, the question which received the highest priority addressed factors associated with transfer to acute care hospital. Fried and colleagues found that only tachypnea and evaluation in the evening were associated with hospital versus long-term care facility evaluation and initial treatment [ 20 ].
However, their study long-term care facility was characterized by extensive physician involvement, potentially limiting the generalizability of the findings as stated by the authors. The second question prioritized for this setting asked whether institutional factors can help reduce the spread of antibiotic resistance.
Factors of potential importance may include staffing, use of handwashing, use of anti-bacterial soaps, or the availability of sinks.
Although Li and colleagues found an association between staffing levels and outbreaks in nursing homes in New York State [ 21 ], there has been no data addressing the effect of such variables on antibiotic resistance. Not surprisingly, the research questions developed in this workshop closely reflected the ideas, experience, and agenda of the participants.
To maintain feasibility, the majority of participants were from southern Ontario, limiting the choice of participants. These factors may have led to the high rank accorded to determining the prevalence of methicillin resistant Staphylococccus aureus MRSA in the community, likely a reflection of participants' interest in infection control as well as of the particularly high prevalence of MRSA in southern Ontario.
Albeit infrequently, individuals with MRSA with no obvious risk factors such as previous hospitalization are being recognized in southern Ontario and concern about this likely led to the high rank for MRSA. Another limitation was that there were few basic scientists represented at the workshop.
This lead to a list of clinically oriented questions with few basic research questions. However, despite the limitations imposed by our sample, we believe that the format used for this workshop can serve as a model for other research groups who wish to generate and prioritize research questions. Recently, research priorities have been developed in such diverse areas including critical care, physical activity and health among people with disabilities, and in emergency medical services for children [ 22 — 24 ]. Research agendas need to be comprehensive and cover the continuum of healthcare settings.
Interdisciplinary Research in Health Sciences (IRIHS)
Our experience suggests that bringing together a multi-disciplinary group of researchers to frame and prioritize research questions about aging is feasible, and that participants valued the opinions of people working in other areas. In fact, the workshop has resulted in several multi-disciplinary collaborative partnerships among the participants. We also feel that the resultant list of research questions will help not only the workshop participants but also other researchers focus their interest in infections among older adults.
In order to disseminate the list of prioritized research questions, we plan to forward the research questions to Canadian geriatric and gerontologic research units as well as infectious disease research units which can distribute the results of the workshop to their members and post them on relevant web sites. We also will forward our findings to local provincial public health units, infection control practitioner associations, physician groups, long-term care groups, provincial funding agencies and advisory councils on aging.
The questions are of direct relevance to researchers in a wide variety of fields primary care, nursing, nutritional science, public health, health services, gerontology, geriatrics, infection control, and infectious diseases. Health Canada. J Am Geriatr Soc.
- An Interdisciplinary Approach to Successful Aging.
- Technology-Enhanced Systems and Tools for Collaborative Learning Scaffolding.
- Health Management for Older Adults Developing an Interdisciplinary Approach?
- Health Management for Older Adults: Developing an Interdisciplinary Approach | JAMA | JAMA Network.
Bergman H, Clarfield AM: Appropriateness of patient transfer from a nursing home to an acute-care hospital: a study of emergency room visits and hospital admissions. Arch Intern Med. High KP: Micronutrient supplementation and immune function in the elderly. Clin Infect Dis. Nicolle LE: Nursing home dilemmas. Infect Control Hosp Epidemiol. J Aging Health. Soc Sci Med. Counsell C: Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med. Maxwell JA: Research questions: what you want to understand Chapter 4. In: Qualitative research design: an interactive approach.
London, Sage Publications. Sachs J: Using a small sample Q sort to identify item groups. An attempt was made to include sites that represent an array of approaches, differing target populations, a variety of organizational structures, and potentially interesting and useful perspectives on interdisciplinary training in the changing health care environment.
How is an interdisciplinary approach to professional education and training being implemented to meet the range of service needs of persons with disabilities? Are there unique considerations to be taken into account when training professionals to function as members of interdisciplinary teams to provide services to persons with disabilities? What has been the experience of the program in training professionals to function effectively to provide services to persons with disabilities in an interdisciplinary manner at the community level?
How is the training program addressing the delivery of services to persons with disabilities within the growing environment of managed care? Most Americans will experience disability at some point during their lives, either themselves or within their families. Some 49 million non-institutionalized Americans have disabling conditions that interfere with their life's activities; the other million Americans can expect to experience a disabling condition at some point in their lives.
The demographics of disability illustrate this point:. More than nine million people have physical or mental conditions that keep them from being able to work, attend school, or maintain a household;. Although the percentage of people with a disability increases with age, disability is found throughout the age spectrum. Furthermore, at different ages the nature of the conditions that cause disability varies.
For example, for younger adults disability is more likely due to mobility limitations resulting from spinal cord injuries, orthopedic impairments, and paralysis, whereas for older adults, chronic diseases predominate as causes of limitations. A significant trend with implications for service providers and their training needs is the growing number of people with a wide array of significant physical, mental, and cognitive disabilities that are living and participating in the community.
Several notable trends have relevance for the education and training of providers of acute and long-term services.