Sitting position affects participative interaction of immobile aged care residents: A pilot study

Objectives: To determine the effect of sitting position (reclined versus upright) on the levels of participative interaction and spontaneous communication of immobile and totally dependent aged care residents. Methods: Ten frail, immobile and totally dependent female residents older than 85 years were observed in reclined and upright sitting positions. Scores measuring responsiveness to stimuli in the surrounding environment and spontaneous communication initiation were derived from observations (taken morning and afternoon). Results: There was a significant increase in the responsiveness score in the upright sitting position (P < 0.001) but no effect of sitting position on initiative score. There was no effect of time of day on either responsiveness or initiative score. Conclusions: An increased level of responsiveness was seen in upright sitting position in immobile and totally dependent aged care residents. The potential for participative interaction with the surrounding environment increases in this position which therefore may improve quality of life.     

Effects of toe and ankle training in older people: A cross‐over study

Aim: Maintenance of physical function in the elderly is important. Previous studies have focused mainly on training‐center‐based interventions, accompanied by training staff or equipped with training machinery. The purpose of this study was to investigate the effects of toe and ankle training for the elderly. Methods: The four facilities were divided into two groups that received the intervention in 8‐week shifts. An exercise program, focused mainly on ankle, foot and toe function, was conducted with the subject in a sitting position. Muscle strength, physical function, fear of falling and health‐related quality of life were assessed at the beginning of the study and at the end of each 8‐week phase. Because subjects were not randomized, significant intergroup differences were present in some baseline measurements. Therefore, the study was conducted with a cross‐over design, and ancova was included with the baseline value as an independent covariate. Results: A significant improvement was found in quadriceps strength, functional reach, stepping in sitting and Euro Qol EQ5D score, together with a possible improvement in toe flexor strength. Conclusion: These results suggest that a training program carried out with the subject in a sitting position and focused mainly on ankle, foot and toe functions is effective in improving some aspects of motor function in the elderly. This approach may help elderly individuals maintain their activity level without increasing risks. Geriatr Gerontol Int 2011; 11: 246–255.     

Measuring mobility in frail older people: reliability and validity of the Physical Mobility Scale

Objectives: The study was designed to show the validity and reliability of scoring the Physical Mobility Scale (PMS). PMS was developed by physiotherapists working in residential aged care to specifically show resident functional mobility and to provide information regarding each resident's need for supervision or assistance from one or two staff members and equipment during position changes, transfers, mobilising and personal care. Methods: Nineteen physiotherapists of varying backgrounds and experience scored the performances of nine residents of care facilities from video recordings. The performances were compared to scores on two ‘gold standard’ assessment tools. Four of the physiotherapists repeated the evaluations. Results: The PMS showed excellent content validity and reliability. Conclusions: The PMS provides graded performance of physical mobility, including level of dependency on staff and equipment. This is a major advantage over existing functional assessment tools. There is no need for specific training for physiotherapists to use the tool.     

Quality of life for older people in residential care is related to connectedness,willingness to enter care,and co‐residents

Aim: To establish associations with quality of life (QOL) of older people in long‐term residential care facilities in two New Zealand cities. Methods: The outcome measure of QOL was the Life Satisfaction Index. We used multiple linear regression to explore how broad categories of factors might contribute to QOL. Results: A total of 599 people (median age of 85 years; 74% women) participated. Response rates were 85% for facilities and 83% for residents. A resident's QOL was significantly related to the QOL of co‐residents. QOL was higher for people who were more positive about entry to residential care, more physically able, and not depressed, and for those with more family and emotional support. Conclusion: Attending to the circumstances around entry to residential care may enhance QOL, as may promoting physical activity, treating depression and ensuring older people remain emotionally connected to their families. In choosing a facility, noting the QOL of co‐residents is important.     

Palliative care in aged care facilities for residents with a non‐cancer disease: results of a survey of aged care facilities in South Australia

Objectives: This study reports the results of a cross‐sectional study of residential aged care facilities in South Australia which sought to quantify the extent of specialist palliative care involvement in residential aged care facilities as well as identifying the current need for palliative care. Method: A questionnaire was completed by 51 Directors of Care from 51 of 90 facilities targeted, representing a response rate of 57% and representing 20% of the total number of South Australian licensed beds. Facilities responding were representative of residential aged care facilities in South Australia for location, type of funding and level of care. Results: Thirty facilities (59%) used specialist palliative care services during 2001 with the average number of residents consulted being four. There were 627 deaths recorded in the 2785 licensed beds, a death rate of 23%. The majority of these deaths were from non‐cancer diseases (83%) and up to two‐thirds of all deaths occurred away from low care facilities, usually in an acute care setting. Main reasons for transfer away from the facility were; an acute care episode requiring other expertise, rapid deterioration of the resident, care needs beyond the facility, or the general practitioner or family requested a transfer. Care Directors estimated that 7% of their current residents would be considered palliative and the majority of these had non‐cancer diseases (78%). Conclusion: These findings indicate that palliative care is an important aspect of care in residential aged care facilities for clients with a non‐cancer diagnosis.     

Delirium and transition to a nursing home of hospitalized older adults: A controlled trial of assessing the interdisciplinary team‐based “geriatric” care and care coordination by non‐geriatrics specialist physicians

Aim: To examine whether a team‐based inpatient “geriatric” care model provided by non‐geriatrics specialist physicians was associated with changes in the occurrence of delirium and transition to a nursing home. Methods: We carried out an intervention (interdisciplinary; ITD group) control (usual care group) study comparing the outcomes of hospitalized older adults cared for by non‐geriatrics specialist physicians. Compared with the usual care group, the ITD intervention group provided additional value: geriatric care and care coordination by leading daily ITD team meetings. Results: After adjusting for patient demographics and clinical characteristics, the probability of transition to a nursing home in the ITD intervention group was significantly lower (odds ratio 0.52; 95% confidence intervals, 0.16–0.94; P = 0.008) than that in the usual care group. However, there was no significant difference in the predicted probabilities of delirium between the ITD intervention and usual care groups. Conclusion: As compared with the usual care group, a significantly lower probability of transition to a nursing home was observed in the ITD intervention group, but the probabilities of delirium between the ITD intervention and usual care groups did not differ significantly. Geriatr Gerontol Int 2013; 13: 342–350 .     

Falls in older people receiving in‐home informal care across Victoria: Influence on care recipients and caregivers

Aim: Older people receiving informal care at home appear at high falls risk. This study investigates frequency, circumstances and factors associated with falls risk for older care recipients, and their informal caregivers. Methods: Ninety‐six dyads, recruited from caregiver agencies, underwent a home assessment, including falls risk, function, depression, quality of life, self‐rated health and carer burden. Results: Care recipients were at high falls risk. In the past 12 months, 58% had fallen and 26% twice or more. Common falls risk factors were polypharmacy, multiple medical conditions and requiring functional assistance. Caregivers exhibited multiple health problems, moderate burden and reduced quality of life. Where care recipients had high falls risk, caregivers had significantly higher carer burden and depression. Low functional level and high care recipient health problems were independently associated with risk of falling (P < 0.05). Conclusion: Strategies to reduce falls risk in this cohort are necessary, together with supporting the needs of the caregiver.     

Associations between television viewing time and overall sitting time with the metabolic syndrome in older men and women: the Australian Diabetes, Obesity and Lifestyle study

OBJECTIVES: To examine associations between self‐reported television (TV) viewing time and overall sitting time with the metabolic syndrome and its components. DESIGN: Cross‐sectional. SETTING: Population‐based sample of older men and women living in Australia. PARTICIPANTS: One thousand nine hundred fifty‐eight participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study (aged≥60, mean age 69, 54% women). MEASUREMENTS: Self‐reported television viewing time and overall sitting time were collected using an interviewer‐administered questionnaire. The metabolic syndrome was defined according to the revised International Diabetes Federation criteria. RESULTS: Compared with those in the lowest quartile, the odds ratios (ORs) of the metabolic syndrome in the highest quartile of television viewing time were 1.42 (95% confidence interval (CI)=0.93–2.15) for men and 1.42 (95% CI=1.01–2.01) for women and in the highest quartile of overall sitting time were 1.57 (95% CI=1.02–2.41) for men and 1.56 (95% CI=1.09–2.24) for women. Television viewing time was associated with lower high‐density lipoprotein cholesterol (HDL‐C) levels and glucose intolerance in women. Overall sitting time was detrimentally associated with greater risk of high triglyceride levels in men and women, abdominal obesity in women, and low HDL‐C levels in men. All models were adjusted for age, education, physical activity, self‐rated health, employment, diet, smoking, and alcohol intake and for hormone replacement therapy and estrogen use in women. CONCLUSION: For older adults, high levels of sedentary behavior were associated with greater prevalence of the metabolic syndrome; reducing prolonged overall sitting time may be a feasible way to improve metabolic health.     

Medication‐related problems in patients referred to aged care and memory clinics at a tertiary care hospital

Aim: To investigate the prevalence of medication‐related problems (MRPs) in patients attending aged care and memory disorder clinics and explore the potential role of a clinical pharmacist to obtain medication histories and identify unresolved MRPs. Methods: The clinical pharmacist interviewed patients and reviewed their medication regimens in the outpatient clinics. Clinical significance of pharmacist‐identified MRPs was rated by an independent expert panel using validated criteria. Results: Forty‐six patients (mean age 82 years) were reviewed. They took a median of nine medications, of which three were not recorded in the medical record. One hundred and thirteen MRPs (median 2.0 per patient) were identified by the pharmacist. Independent review rated 35% of MRPs as high or extreme risk. Thirty‐seven (33%) MRPs related to medications not recorded in the medical record. Conclusions: Medication‐related problems were present for most patients. Involvement of a clinical pharmacist resulted in a more comprehensive medication history and identified unresolved MRPs.     

Statin utilisation patterns in older Australians living in residential care: 1‐year prevalence study

Despite controversy over the risks and benefits of statin therapy, statins continue to be commonly used medicines by older people. In a cohort study of participants aged ≥70 years (n = 540) living in residential care, Sydney, we found that the proportion of statin users decreased gradually from the baseline of 33.1% to 31.3% at 6 months (P = 0.13) and to 28.7% over 1 year (P = 0.002). Prevalence of statin use decreased with increasing age, with individuals aged ≥90 years being more likely to discontinue or deprescribe statins. The patterns of statin use did not change according to increasing baseline dose or baseline indication.     

Prevalence of oropharyngeal antibiotic‐resistant flora among residents of aged care facilities: a pilot study

Residents in 11 long‐term care facilities, and presenting to a single tertiary hospital site, were sampled to estimate prevalence of oropharyngeal colonization with resistant Gram‐negative bacteria. From 124 residents, only one isolate (0.8%; 95% confidence interval 0.0%, 4.4) was multi‐resistant (an extended‐spectrum β‐lactamase producing Escherichia coli) indicating that different treatment recommendations for respiratory infections in this population may not be justified.     

Intergenerational support and subjective health of older people in rural China: A gender‐based longitudinal study

Aim: To examine gender differences in the effect of intergenerational exchanges on subjective health of Chinese rural elderly. Methods: Using the data from three waves of the survey ‘Well‐being of Elderly in Anhui Province, China’ conducted in 2001, 2003 and 2006, respectively, this study uses random effect logit models for men and women separately. Results: While an increase in instrumental support from children to older people is associated with deterioration in the subjective health of older men, financial support from older people to children is associated with improvement in the formers' subjective health. Although an increase in instrumental support from older people to children, and mutual emotional support is associated with improved subjective health of older women, financial support from children to older women has a negative effect on the latter's subjective health. Conclusions: Reciprocal intergenerational transfers contribute to improvement in subjective health of older people, while increased support through demand‐based transfers appears to result in deterioration of their health.