European Geriatric Medicine - Supplement 1 - Volume 6 - September 2015

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S168 Symposia / European Geriatric Medicine 6S1 (2015) S157 –S176
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SIG Symposium
S-12
An international overview of nursing home research: EUGMS
and AMDA I
J. Schols
Dept. HSR – Maastricht University, Maastricht, Netherlands
EUGMS – The European Union Geriatric Medicine Society aims to
develop geriatric medicine in the member states of the European
Union as an independent specialty caring for all older people of
the European Union with age-related diseases. In addition EUGMS
promotes education and continuing professional development e.g.
by developing and implementing evidence-based guidelines for
the most efficacious preventive and treatment strategies for older
people in the European Union. The EUGMS has close links with
a variety of international networks including the UEMS Geriatric
Medicine, IAGG and the European Academy for Medicine and
Ageing (EAMA). More recently contacts have been laid with AMDA
in America.
AMDA – The Society for Post-Acute and Long-Term Care Medicine
(in the past: American Medical Directors Association) is dedicated
to excellence in patient care and provides education, advocacy,
information and professional development to promote the delivery
of quality post-acute and long-term care medicine. Already for a
long time AMDA is making a concerted effort to work with medical
professionals and practitioners around the globe.
During EUGMS Rotterdam 2014, after a meeting between
representatives of the board of AMDA (incl. e.g. Prof. D. Swagerty
and Prof. John Morley) and the board of EUGMS (incl. e.g. prof.
Timo Strandberg), the idea was born to organize a symposium on
nursing home care (research) as a collaborative activity between
EUGMS and AMDA during the next EUGMS congress in Oslo 2015.
EUGMS–AMDA symposium I (90 minutes). Contributions with
specific abstracts. Chair: prof. Jos Schols, Maastricht University,
Maastricht, The Netherlands
5 presenters (each 18 minutes incl. time for 1–2 questions of the
audience)
1. Presenter: Daniel Swagerty, MD, MPH (Professor of Family
Medicine and Internal Medicine, Associate Chair for Geriatrics and
Palliative Care, Department of Family Medicine, Associate Director,
Landan Center on Aging, University of Kansas School of Medicine,
Kansas City, Kansas USA; ). Title: Palliative and
End of Life Care in the Nursing Home: A Comparison between the
Netherlands, Canada and the United States.
There is considerable evidence that nursing home (NH) residents
throughout the world do not receive optimal palliative and end-
of-life care. However, a variety of strategies have been undertaken
to improve this care required for our most venerable, frail older
adults. A comparison of the clinical approaches and systems of care
will be described and compared for the Netherlands, Canada and
the United States. Internal palliative care programs, formal hospice
services, and greater reliance on interprofessional team care will
be highlighted as improvements in usual nursing home care when
staff, family members and the NH resident face the increased and
focused care needs associated with comfort care and the dying
process.
2. Presenter: Cees Hertogh, MD, PhD (Professor of elderly care
medicine & geriatric ethics, Chair research division for elderly
care medicine, Chair University Network of Organizations for
elderly care (UNO VUmc), Department of general practice & elderly
care medicine, EMGO Institute for health and care research, VU
University Medical Center Amsterdam; .
Title: Palliative care and complex multimorbidity: the need for
new paradigms.
Older persons admitted for long term nursing home care generally
suffer from complex multimorbidity and have a limited life
expectancy, with mean length of stay until death varying from
1.5 to 2.4 years. In principle, these simple facts entitle them to
receive care inspired by a palliative care philosophy, but this is not
standard practice in nursing home care. There are various reasons
for this lack of a palliative care approach. They will be analyzed
with an emphasis on conceptual and ideological factors. Data will
be presented to illustrate the need for refocusing ‘chronic’ nursing
home care toward an emphasis on geriatric palliative care.
3. Presenter: Paul R. Katz, MD, CMD (Professor of Medicine,
Chair Department of Geriatrics, College of Medicine, Florida State
University, Chair AMDA Foundation; ), on
behalf of the investigator group including also: Arif Nazir MD,
CMD, Jurgis Karuza PhD, Charles Crecilius MD, CMD, Martin
Smalbrugge MD,PhD, Cees Hertogh MD,PhD, Sid Feldman MD, CMD,
Andrea Moser MD, CMD. Title: The Prevalence of Positive and
Negative Levels of Engagement Among Nursing Home Physicians:
An International Perspective.
The link between physician practice and quality of care in the
nursing home has previously been attributed to three critical
dimensions including commitment, competency and organizational
structure. Another heretofore unexplored dimension linking
physician practice to care outcomes in PA-LTC is “engagement”.
Low levels of engagement, often referred to as “burnout” may
be associated with medical errors, decreased patient satisfaction,
increased staff turnover, increased costs, physician impairment,
absenteeism and family disruption. Although the prevalence of
physician burnout and its potential negative impact on physician
performance and quality of care is well described, there are no
studies that explore engagement/burnout specific to the post-
acute and long term care setting. Utilizing the Maslach Burnout
Inventory (MBI for US and Canada; UBOS for Netherlands) and
the Utrecht Work Engagement Scale (UWES) physicians practicing
in nursing homes in Canada, the Netherlands and the US were
surveyed electronically in order to quantify both positive and
negative levels of engagement. Both Canadian and Dutch physicians
exhibited low levels of burnout as demonstrated in scores for
emotional exhaustion (5.33 and 4.62) and depersonalization (42.48
and 42.07) respectively. Both cohorts scored high on the subscale of
personal accomplishment. Paralleling the Personal Accomplishment
sub scale, the UWES engagement scale indicated higher levels of
physician engagement. Results for the US cohort will be compared
to the Canadian and Dutch nursing home physicians as well as