A profile of functionally impaired elderly persons living in the community.

The Health Care Financing Administration, in cooperation with other agencies of the Department of Health and Human Services, conducted surveys in 1982 and 1984 designed to develop a better understanding of the number and circumstances of functionally impaired elderly persons living in the community. This report is based on data from the 1982 Long-Term Care Survey. There were approximately 5 million functionally impaired elderly persons living in the community in 1982. The data show that functionally impaired persons in the community are older, are more often female, have lower incomes, and have a larger proportion of black people than the general elderly population. The data also provide baseline information on what functional impairments are prevalent among them, what means they use to cope with the limitations, and from whom they receive help. The baselines data gathered in 1982 will be supplemented by longitudinal data gathered in the 1984 Long-Term Care Survey.     

Psychiatric home care of elderly persons with depression: unmet caregiver needs

The purpose of this study was to explore what nursing interventions are currently being provided to family caregivers of elderly persons with depression as a part of standard home health care; and identify unmet needs of these family caregivers. Unmet caregiver needs were examined from both the family caregiver and staff nurse perspective, using caregiver structured interviews and staff focus groups. Ten caregivers participated in structured interviews and nine staff nurses participated in three focus groups. Caregivers reported unmet needs concerning support and respite, dealing with their own feelings, learning more about care-related tasks and role changes, and stress management. Similarly, nurses speculated that nursing interventions should focus on increased counseling, family and community support, assisting caregivers with their learning needs and care-related responsibilities. These findings contribute toward a better understanding of interventions currently provided to caregivers of depressed elderly persons, as a part of standard psychiatric home care; identify unmet caregiver needs; and suggest areas for future psychiatric research in home care settings.     

Self-perceived unmet health care needs of persons enrolled in hiv care

We examined the prevalence of, and factors associated with unmet health service needs among persons with HIV disease. Data were examined from 1,851 participants in the U.S. AIDS Cost and Service Utilization Study, drawn from 26 medical care providers in 10 cities. Geographic areas with large numbers of AIDS cases, and health care providers within them were chosen as study sites. After completing a screener questionnaire, potential participants at each site were stratifed by illness stage, HIV exposure route, and insurance status; a systematic random sample within those strata were selected for the study. Participants completed a comprehensive survey of HIV-related service use and costs, which also asked them to identify unmet health service needs. Analyses identified the relationship between unmet needs and: stage of illness, type of insurance, source of care, living arrangement, and AIDS prevalence of respondents' geographic region. At least one unmet need was reported by 20% of the sample. Needs for non-institutional services, e.g., dental care, mental health, and medications were more likely to be unmet than need for emergency room and hospital care. While most factors significantly affected the odds of having an unmet need, the greatest effects were found for private insurance and HIV asymptomatic status, both of which decreased the odds of unmet needs by approximately 50%. These findings suggest that insurance coverage for services required during the chronic phase of HIV illness is inadequate and should be augmented.This study was conducted under a subcontract with Westat Inc.     

Perceptions of unmet need in four community services for elderly people

Abstract: Home-care services particularly, and food services to a lesser extent, are seen by elderly people as being critically important for their capacity to live independently in western Sydney. Home nursing and transport services are valued but are less critical. Consumers, providers of services and referral agents all identify significant levels of unmet need for community services. The home care service particularly is stretched by pressures which are likely to be exacerbated by demographic change and by cost-shifting between state governments and the Commonwealth Governments.     

Unmet needs of persons with a severe and persistent mental illness and their relationship to unmet accommodation needs

This is a cross‐sectional study of unmet needs of persons enrolled in Australia's Partners in Recovery (PIR) initiative. It aimed to explore the unmet needs reported by persons with a severe and persistent mental illness (SPMI) and to examine the associations between unmet accommodation needs and other unmet needs. The study was undertaken in the Gippsland region of Victoria from February to May 2015. Data were collected from the administrative database for the PIR initiative in Gippsland, which was held by the Gippsland Primary Health Network. Data on unmet needs, as measured by the Camberwell Assessment of Needs Short Appraisal Schedule, were analysed using proportions and logistic regression. Psychological distress, daytime activities, company/someone to spend time with and employment and volunteering were the most commonly reported unmet needs. Participants with unmet accommodation needs were less likely to receive information on their condition or access other services. They also had unmet needs relating to food, money, transport, childcare, looking after home, physical health, psychological distress and self‐care. Supported accommodation may not be enough for persons with SPMI who have poor functioning skills and are incapable of looking after themselves. Services such as Housing First that have shown promising results need to be part of a comprehensive strategy to care for persons with severe and enduring mental illness.     

The unmet needs of the elderly with diabetes in home health care

The implementation of the Prospective Payment System (PPS) in Medicare home health care has raised concern about health outcomes of elderly patients since its intention is to curb spending. This study examines the unmet needs of older diabetic patients while receiving home health care and post-discharge from home health care (N = 129) in order to explore any effects of PPS on patients' need. The study found that a higher proportion of elders had unmet needs 30 days post-discharge compared with while receiving home health care. The specific unmet needs identified by the elderly diabetic patients included social work services, home health aide, homemaker services, and need for medical equipment. The study explores the role of social work to better manage the unmet needs of diabetic elders who live in the community.     

Caregivers' experiences of caring for a husband with Parkinson's disease and psychotic symptoms

Psychotic symptoms are a common nonmotor complication in Parkinson's disease. Research exploring the impact of psychotic symptoms on coping by caregivers of people with Parkinson's disease is sparse. The aim of this study was to explore the experiences of individuals living with a partner with Parkinson's disease and psychotic symptoms. Ten female caregivers from the north west of England were interviewed and interpretative phenomenological analysis was used to identify themes within their accounts. Four themes emerged from the analysis: uncertainty and the search for understanding; adapting to symptoms over time; the contribution of psychosis to changing identities; and the use of social comparison as a coping strategy. These themes highlighted the changing identity of their partner as a person with Parkinson's disease and a number of strategies that caregivers had developed to cope with psychotic symptoms. The themes are explored in detail and clinical implications are considered.     

Ethical issues in nutrition support of severely disabled elderly persons: a guide for health professionals

Providing or withholding nutrition in severely disabled elderly persons is a challenging dilemma for families, health professionals, and institutions. Despite limited evidence that nutrition support improves functional status in vulnerable older persons, especially those suffering from dementia, the issue of nutrition support in this population is strongly debated. Nutrition might be considered a basic need that not only sustains life but provides comfort as well by patients and their families. Consequently, the decision to provide or withhold nutrition support during medical care is often complex and involves clinical, legal, and ethical considerations. This article proposes a guide for health professionals to appraise ethical issues related to nutrition support in severely disabled older persons. This guide is based on an 8-step process to identify the components of a situation, analyze conflicting values that result in the ethical dilemma, and eventually reach a consensus for the most relevant plan of care to implement in a specific clinical situation. A vignette is presented to illustrate the use of this guide when analyzing a clinical situation.     

Social and health services needs in a sample of elderly people in Catanzaro

The aim of this study is to analyze the general health state conditions of older people living in Catanzaro, using a multidimensional assessment instrument to determine their social and health needs. To this purpose, a sample of 544 individuals (344 women and 210 men) older than 65 years of age (mean age = 75.3) was selected from the general population. All subjects were administered the OARS (Older Americans Resources and Services) questionnaire that evaluates five areas: physical health, mental health, social resources, economic resources and Activities of Daily Living (ADL). The percentage of subjects with score 3 or more in each area, and therefore identified as partially or totally dependent, is higher in the area of physical health (17.9%) and ADL (16.6%). About 65% of the sample is not disabled in any of the different areas, while 8% is dependent in 3 or more areas. These subjects are partially or totally dependent elderly people, who stay at their own house in precarious conditions, and are able to remain there only because they are helped by informal caregivers. Probably these people are those for whom any domiciliary help is necessary and more urgent in order to support the existing stability and to avoid institutionalization.     

Evaluation of medication use and pharmacy services for visually impaired persons: Perspectives from both visually impaired and community pharmacists

Background

Visual impairment poses various challenges to individuals in taking their medications, but there is a lack of studies on visually impaired population and their use of medications and pharmacy services.

社区老年人高脂血症与高血压的相关性

目的调查研究社区老年人高脂血症和高血压的相关性。方法2006年1至12月，在门诊就诊的中老年人群中，随机抽取100例血脂正常者做为对照组，分别观察同时检出的100例单纯高胆固醇血症、100例单纯高甘油三脂血症、100例单纯低密度脂蛋白血症对高血压的影响。结果高胆固醇组、高三酰甘油组和低高密度脂蛋白血症组中的高血压患病率分别为57％、60％和55％，前3组相对危险度分别是对照组的1．4、1.5和1．4。研究还发现胆固醇与舒张压成正相关（P〈0．05），三酰甘油与收缩压成正相关（P〈0．05），HDL与收缩压成负相关（P〈0．05）。高脂血症与脉压差之间相关。结论高脂血症与高血压有密切关系，提示高脂血症是高血压的间接危险因素。     

Predictors of dietary intake in a functionally dependent elderly population in the community.

OBJECTIVES. The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS. All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS. Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS. Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.     

Family planning in ramsgate: a community study of unmet need

Summary A postal survey of 1051 women, aged 16–50, was undertaken to determine the differences between users and non-users of family planning services. We received 787 replies. Of those who replied 201 (26 per cent) were infertile and 330 (42 per cent) used the facilities. A non-user tended to depend on less reliable methods and to be poorly informed of the availability of services. The general practitioner was the consistently favoured adviser by women of all social classes. Continuation of education after leaving school was more closely associated with take-up of advice than social class. Of the parous respondents, 169 (55 per cent) claimed to have received no contraceptive advice during their most recent pregnancy. Younger couples showed an increased interest in sterilization as a method of birth control. The respondents asked for more information on contraceptive methods and more publicity about the facilities. We recommend the extension of general practitioner contraceptive services, education of both hospital staff and health visitors on the importance of giving family planning advice and improved publicity about local facilities.