OET Reading C14

OET Reading Part C is the toughest part. Usually, there is only one question from each paragraph. However, to help you learn well, you will have more than 1 question from each paragraph.

Hospitalisation is hazardous for frail older people and particularly for those with dementia, and hospital design may influence clinical outcomes of acutely ill frail patients. Dementia-friendly environments have been proposed to promote patient well-being, mobility, independence, and meaningful interaction with other patients, staff and family members. Hospitalisation is associated with higher adverse outcomes for those with dementia, who are at a 2.5 times higher risk of inpatient falls (IF). Another recent study reported a higher incidence of such falls in dementia patients occupying single rooms as compared to those in traditional multi-bed wards (MBWs). Furthermore, for people with dementia, the risk of sustaining a serious injury following a fall is three times higher than amongst fallers with no dementia.

7.1 Clinical outcomes do NOT include:

1. Exacerbation.
2. Recovery.
3. Death.
4. Discharge.

7.3 Hospitalisation is specially hazardous for:

1. frail older people.
2. frail older people who have dementia.
3. Older people with dementia.
4. People with dementia.

7.5 In the first paragraph, what point is made about the falls-risks of patients with dementia?

1. It is easier to manage in specialist environments.
2. It can be higher if there is a history of similar events.
3. It may be reduced if they are made more aware of it.
4. It is greater than that of the general hospital population.

7.4 A hospital design is likely to:

1. Speed up the recovery of people with dementia.
2. Speed up or slow down recovery of frail patients.
3. Slow down recovery-time.
4. Exacerbate dementia or any other condition in the elderly.

7.6 Patients with dementia are at a 2.5 times higher risk of inpatient-falls:

1. At the time of hospitalisation.
2. From the time the patient gets hospitalized.
3. At the time of medical management.
4. When the patient is left alone in single rooms.

Most studies of hospital environments have centred on issues such as patient satisfaction, quality of sleep, privacy, and dignity. Few (studies) have sought to empirically address the impact of hospital design on patient safety and clinical outcomes. Although some studies have reported a higher incidence of IF and other associated adverse outcomes in single rooms, and nursing staff do express concerns over loss of wider patient surveillance, others have found that a majority of patients express a preference for private rooms. Other literature has focussed on the effect of single rooms in acute settings, predominantly addressing the impact on younger patients and those without cognitive impairment. There is very little literature, however, concentrating specifically on the impact of ward environments on outcomes for acutely unwell frail, older patients with dementia, many of whom have prolonged hospital stays due to acute illness.

8.7 What is NOT a reason why single rooms are NOT the choice of many?

1. Higher incidence of inpatient-falls.
2. Other associated adverse outcomes in single rooms.
3. Cost associated with single rooms.
4. Loss of wider patient surveillance.

8.6 The writer feels that research into hospital design tends to focus on:

1. patient-attitudes towards it.
2. the implications for staffing levels.
3. how well it caters for patients of different age groups.
4. the needs of patients facing long-term hospitalization.

8.3 When considering patients with dementia, the writer feels that most studies:

1. Are giving higher priority to patient’s outcomes.
2. Are giving high priority to hospital infrastructure.
3. Are prioritizing patient safety.
4. Are prioritizing areas other than patient safety and clinical outcomes.

8.5 What does the word ‘others’ in the second paragraph refer to?

1. research studies.
2. adverse outcomes.
3. the majority of patients.
4. concerns expressed by nurses.

The aims of a new study undertaken in South Wales were to broadly describe acutely unwell patients with dementia admitted to two different hospital environments — single rooms and traditional MBWs — and to study the clinical outcomes and predictors of adverse outcomes in these two environments. A total of fifty patients were observed at two hospitals. Most of these (73%) were admitted from their own homes, whilst others were admitted from residential care homes (17%). Significantly more patients in single rooms (88%) were admitted from their own homes compared to those in MBWs (58%) and they also had significantly better levels of independence as measured by pre-admission Bl. Besides the source of admission, however, there were no significant differences in baseline characteristics of acutely unwell patients with dementia admitted either to single rooms or MBWs.

10. In the South Wales study, patients admitted from residential care homes were:

1. at a more advanced stage of dementia.
2. less likely to be accommodated in single rooms.
3. more interested in their immediate environment.
4. no less independent according to standard measures.

In this study, it was observed that acutely unwell older people with dementia admitted to single rooms and MBWs had a largely similar demographic profile and clinical characteristics. The reasons for acute admission varied widely, though falls were the most common reason for admission to both sites. Sepsis, urinary tract infections, loss of consciousness, and confusion were other common presenting complaints. However, acute patients with dementia admitted to single rooms had a significantly longer length of stay (62.23%) than those admitted to traditional MBWs (42.47%). Besides this, no other significant differences were observed in clinical outcomes between patients in single rooms and those in MBWs. This study builds upon similar findings reported in a previous one, which attributed such discrepancies to a higher incidence of IF in patients with dementia in single rooms.

11. The ‘discrepancies’ referred to in the fourth paragraph involve:

1. different reasons for acute admission.
2. variations in how long patients remained in hospital.
3. the higher number of falls amongst certain patients in the study.
4. the proportion of patients in the different types of accommodation.

Interestingly, no significant difference was found in the incidence of IF between single rooms and MBWs. This could be due to the introduction of quality initiatives to minimise inpatient falls in single rooms. A systematic nurse training programme on the understanding and correct use of existing multifactorial falls risk assessment (FRA) tools in the single-room hospital has demonstrated a significant and sustained reduction in the mean incidence of IF. Similar rates of IF between single rooms and MBWs may therefore be looked upon in an encouraging light.

12. What does the writer find encouraging about the findings of the South Wales study?

1. A training initiative seems to have been effective.
2. Certain wrong assumptions have now been corrected.
3. Recommendations of a previous study have been followed.
4. A downward trend in the number of falls has been confirmed.

The study focused on the impact of hospital environments on quantitative, measurable clinical outcomes. As such, the researchers did not explore the experiences of older people with dementia in single rooms. In light of the reduced social interaction and relative isolation reported by some older adults in single rooms, it is possible that some older people with dementia may not always feel they benefited from single-room hospital accommodation, even where this was their preference. This is a point which could have been investigated further because various personal, cultural, socioeconomic, and medical factors may affect preferences.

13. In the sixth paragraph, the writer suggests that the South Wales study should have:

1. taken more account of the opinions of patients.
2. paid more attention to the patients’ background.
3. investigated how aware patients were of their choices.
4. explored whether patients regretted opting for a single room.

This observational study suggests hospital environments may affect clinical outcomes, with a significantly higher length of stay for acutely unwell patients with dementia admitted to single rooms as compared to those in MBWs. However, no other significant differences were observed in clinical outcomes in terms of inpatient mortality, inpatient falls, discharge to a new care home, or thirty-day re-admission. The study considered potential confounding factors such as age, delirium, pain on admission, depression, and severity of dementia, but found no significant association. It did, however, observe associations between length of stay and advancing age. Further study to explain this is also warranted.

14. In the final paragraph, the writer is suggesting that further research should:

1. consider the reasons why readmissions often occur.
2. look more carefully at the issue of patient mortality.
3. ensure that confounding factors are fully explored.
4. monitor what happens to patients after discharge.