Co-Learning With Home Care Aides and Their Clients: Collaboratively Increasing Individual and Organizational Capacities

Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, Promoting Seniors’ Health with Home Care Aides, has synergistic education, research, and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults’ homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults’ life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. The authors propose to establish “teaching home care” to ensure ongoing co-learning in gerontology and geriatrics.     

Social integrations related to institutionalized and noninstitutionalized forms of care of elderly people

This is a report about a research project analyzing costs and effectiveness of institutionalized and ambulatory care of older people. For this analysis economic factors as well as social factors are considered. On the sociological part multiple objective conditions (e.g. state health, financial situation and family relations) were correlated with subjective factors as feelings of well-being and various personal attitudes. To this purpose approximately 900 elderly persons (3 samples: 1. inhabitants of homes of the aged, 2. ambulant served (meals on wheels, home help and community nurses), 3. random sample of persons living at their own home. The 3 samples were taken in an urban, semiurban and rural area. Some remarkable differences between the 3 samples could be shown referring to the general physical and mental status and rate of impairment, in the state of care, familiar situation, social integration and subjective attitude (e.g. demonstrating that the inhabitants of homes for the aged were less socially integrated and less satisfied.     

Activating group work with residents of retirement and nursing homes

Taking care for older people in homes for the aged and nursing homes should be improved and broadened concerning a higher activity of these people. A very good method seems to be group work. In this investigation group sessions with people in a nursing home have been made during the time of half a year.     

Geriatrische Gesundheitsförderung und Prävention für selbstständig lebende Senioren

BACKGROUND: Nearly all diseases in old age that are epidemiologically important can be reduced or prevented successfully through consequent changes in individual lifestyle, a systematic provision of measures in primary prevention (i.e. vaccination programmes) and the creation of health promoting settings. However, at the moment the amount of potential for preventative interventions is neither systematically nor sufficiently utilised in Germany. METHODS: Two different preventative approaches: a) multidimensional advice session in small groups through an interdisciplinary team at a geriatric centre (seniors come to seek advice offered at a centre) or b) multidimensional advice at the seniors home through one member of the interdisciplinary team from the geriatric centre (expert takes advice to seniors home) were tested simultaneously with a well-described study sample of 804 independent community-dwelling senior citizens aged 60 years or over, without need of care and cognitive impairments recruited from general practices. Information about target group specific approaches in health promotion and prevention for senior citizens were retrieved from analyses of sociodemographic, medical, psychological and spacial characteristics of this study sample. RESULTS: The majority of the study sample (580 out of 804 or 72.1%) decided to participate: a) 86.7% (503 out of 580) attended at the geriatric centre and sought advice in group sessions and b) 13.3% (77 out of 580) decided to receive advice in a preventive home visit. A total of 224 seniors (224 out of 804 or 27.9%) refused to participate at all. These three target groups were characterised on the basis of their age, gender, education, social background, health status, health behaviour, use of preventive care, self perceived health, functional disabilities, social net and social participation and distance or accessibility of preventative approaches. The 503 senior citizens who participated in small group sessions at the geriatric centre were characterised as "investors into their health resources". They were mobile and participated actively in their environment. They were open for health promoting advice and capable of understanding and incorporating it into their daily routines (health literacy). Those 224 seniors who refused any participation were characterised as "consumers of their health resources". They did not differ in age and gender from the health investors, but showed less self-efficacy and less self-responsibility and typical behaviour that endangers health in an active way, i.e. smokers or in a passive way, i.e. low physical activity. The 77 seniors who received a preventive home visit were characterised as "people with exhausted health resources". Their mobility was clearly restricted and autonomy was confined to their home environment. This group represented frail elderly people with many risk factors in different domains. CONCLUSION: The strongest reason to refuse participation in health promoting programmes was the personal attitude related to one's own personal health. Taking account of needs and wants of the seniors who refused to participate more people expressed the reason "no interest" in the preventive home visit than in the small group session at the geriatric centre. To strengthen the integration of the GP as a trustworthy person would seem to be more successful to motivate senior citizens to participate in health promoting and preventative programmes in the future. This could succeed in a cooperation with geriatric centres to establish community centres for generally healthy senior citizens.     

Angels of the night: evening and night patrols for homebound elders in Sweden

PURPOSE: The purpose of this study was to describe the work of evening and night home care patrols in Swedish old-age care by examining how staff members view their work and the specific work content. DESIGN AND METHODS: The authors developed two questionnaires: one that was to be answered jointly by the patrol teams, and one to be completed by each individual member of a team. All patrols in the municipality of J?nk?ping, Sweden, were asked to participate. RESULTS: The most frequent kind of help provided by evening and night patrols involves personal care, but help with medications and injections are also frequent. The staff reported that it is becoming more common for the patrols to assist people with terminal illnesses. The patrols also increasingly assist people with psychiatric problems. The staff feels that the job may be becoming too diverse and that they need further education for the range of tasks they are asked to perform. IMPLICATIONS: The patrols are very flexible in the services provided. Without the patrols, the staff members believe that many persons would have to leave their homes to go to institutions.     

An inpatient bed for acute nursing home admissions

BACKGROUND: Some older patients are admitted directly to nursing homes without a comprehensive assessment. OBJECTIVE: To determine whether a hospital assessment bed might provide better assessment, treatment and a more appropriate placement for selected older people. Setting a single bed in an elderly care unit of a district general hospital. SUBJECTS: Older people who general practitioners thought needed nursing home care but whose social workers felt might benefit from inpatient assessment. MAIN OUTCOME MEASURES: Type of treatment needed (acute care, rehabilitation, palliation, long-term care) and placement (home, nursing home, residential home or hospital). RESULTS: of 34 patients assessed, 22 (65%) needed further clinical assessment or care and 26 (75%) left hospital for places other than nursing homes. CONCLUSIONS: Inpatient assessment is a successful way of assessing the needs of some older people who would otherwise have been admitted directly from their homes to nursing homes.     

Hospitalizations and deaths due to respiratory illnesses during influenza seasons: a comparison of community residents,senior housing residents,and nursing home residents

BACKGROUND: Although research indicates that influenza is a major cause of morbidity and mortality among older adults, few studies have tried to identify which seniors are particularly at risk of experiencing complications of influenza. The purpose of this study was to compare hospitalizations and deaths due to respiratory illnesses during influenza seasons among seniors (aged 65+) living in the community, senior residences (apartments reserved for seniors), and nursing homes. METHODS: Using administrative data, all hospital admissions and deaths due to respiratory illnesses (pneumonia and influenza, chronic lung disease, and acute respiratory diseases) were identified for all individuals aged 65 and older living in Winnipeg, Canada (approximately 88,000 individuals) during four influenza seasons (1995-1996 to 1998-1999). RESULTS: Hospitalization and death rates for respiratory illnesses increased significantly during influenza seasons, compared to fall periods (e.g., 42.7 vs 25.2 hospitalizations per 1000 population aged 80 and older). Moreover, hospitalization rates for pneumonia and influenza, chronic lung disease, and acute respiratory diseases were higher among individuals living in senior residences (42.5 per 1000 for all respiratory illnesses combined) than their counterparts living in the community (22.8 per 1000). Furthermore, deaths due to pneumonia and influenza and chronic lung disease were higher among senior housing residents (4.2 per 1000) than community residents (2.6 per 1000) and were particularly high among nursing home residents (52.1 per 1000). CONCLUSIONS: Individuals living in seniors residences are at increased risk of being hospitalized for and dying of respiratory illnesses during influenza seasons. Given that influenza vaccination is currently the best method to reduce influenza-associated illnesses among seniors, this suggests that influenza vaccination strategies should be targeted at this population.     

Profiling disability within nursing homes: a census-based approach

BACKGROUND: a significant minority of older people live in residential care. While disability is often a major contributory factor, it may not be measured or managed adequately by health and social services. At present there is little information comparing levels of disability within nursing homes and the community, and no mechanisms for monitoring changes in this disability ratio longitudinally. OBJECTIVE: to examine the prevalence of disability among older nursing home residents compared to its prevalence among older people in the community using a census-based approach. DESIGN: nationwide census over one night in 2002. SETTING: all homes and dwellings in the Republic of Ireland. Method: disability was measured using a six-item questionnaire embedded in a census form. Prevalence of disability was quantified among the general population and nursing homes residents aged 65 and over. Comparisons were made of sex, and number and type of disabilities between nursing home residents and their age-matched peers living within the community. RESULTS: the results showed a high level of disability within nursing homes with almost 90% of residents having a recorded disability compared with less than 30% of those aged 65 and over, living in the community. Nursing home residents had on average 4.5 disabilities ranging from hearing and visual problems to difficulties remembering and concentrating. CONCLUSION: there is a very high level of physical, sensory and cognitive disability among nursing home residents. Strategic health and functional questions in national censuses may be helpful in planning appropriate services for older people in residential care, as well as tracking trends in disability.     

Cruise ship care: a proposed alternative to assisted living facilities

Options for elderly patients who can no longer remain independent are limited. Most choices involve assisted living facilities, 24-hour caregivers, or nursing homes. State and federal assistance for payment for individual care is limited, and seniors usually pay for most costs out of pocket. For those patients who have the means to afford assisted living centers or nursing homes, "cruise ship care" is proposed. Traveling alongside traditional tourists, groups of seniors would live on cruise ships for extended periods of time. Cruise ships are similar to assisted living centers in the amenities provided, costs per month, and many other areas. This article begins with an examination of the needs of seniors in assisted living facilities and then explores the feasibility of cruise ship care in answering those needs. Similarities between cruise ship travel and assisted living care, as well as the monetary costs of both options, are defined. A decision tree with selections for non-independent care for seniors was created including cruise ship care as an alternative. Using a Markov model over 20 years, a representative cost-effectiveness analysis was performed that showed that cruises were priced similarly to assisted living centers and were more efficacious. Proposed ways that cruise ship companies could further accommodate the needs of seniors interested in this option are also suggested. Implementation for cruise ship care on the individual basis is also presented. Ultimately, it is wished to introduce a feasible and possibly more desirable option to seniors who can no longer remain independent.     

Assessing functional health and sociability of aged persons: the development and validation of two guttman-scales (author's transl)]

Studies to develop and validate two Guttman-scales are reported, which aim at measuring level of functional health and inclination to engage in social contacts in aged persons. A first scale analysis, based on the answers of 150 old persons, resulted in two, 12-item scales, which according to Guttman's criterion were fully satisfying. In two consecutive studies Guttman-selfratings of two other samples of old people were validated against ratings of experts, who disposed of profound knowledge of the sampled persons (a physician of a nursing home, managers of homes for the aged). A second scale analysis was performed, too. The results, especially the very significant correlations between expert ratings and selfassessments, suggest a broader application of at least the functional health scale. It is proposed to use the scales, if one aims at increasing the fit between individual needs and amount of services provided, and as instruments to control for sample characteristics, if different care programs are evaluated.     

Gerontology in rural and mountains regions aged people in the country and in mountain regions (author's transl)]

The gerontologic problems of people living in the country and in mountain regions always were neglected in comparison to those of townsmen. In the last decade an important structural change has happened, caused on the one side by the fact that more and more people leave the country for the towns, and by the problem of overaged persons in the country; on the other side this change is a consequence of improvement by modern technical acquisitions (more agricultural machines, silos), living hygiene and the tourism. The living conditions in the past and today in Switzerland are shown, referring to various publications. The ecological change also hits the aged people, financially by revenues, completion of private help organizations, rebuilding of homes for the aged persons in every village and regional nursing home, as well as household helps for those elderly people who still live in the country in their own houses. The qualitative differences between living conditions in the country and in town will in the near future be equalized--which is especially mentionned.     

上海市部分养老机构老年人体检及结核病核心知识知晓情况现况调查

目的 掌握上海市养老机构入住的老年人接受体检和社会家庭关怀情况及结核病核心信息知晓程度。方法 2017年9—12月,从上海市3个城区和4个郊区中分别按养老机构名单排列顺序依次选取3家养老机构,对养老机构入住的老年人开展调查;21家养老机构共登记在册老年人3717名,对其中符合纳入条件(年龄≥60岁、未出现意识模糊或相关重大疾病、可进行正常沟通、愿意接受调查)的438名老年人开展问卷调查;对其人口学特征、基本健康状况等进行描述性分析,并对城区和郊区养老机构老年人接受体检、家庭社会关怀情况,以及对结核病核心信息的知晓情况进行比较。结果 21家养老机构共438名老年人接受了调查,男性占36.8%(161/438),80岁及以上者占75.8%(332/438),本市户籍者占92.7%(406/438),学历为中学及以下者占90.9%(398/438),入住时长为1~5年者占56.8%(249/438),有慢性疾病史者占88.6%(388/438),有2种及以上慢性疾病的老年人占50.9%(223/438)。82.9%(363/438)的老年人入住前曾接受过胸部X线摄影检查,28.3%(124/438)的老年人入住后未进行胸部X线摄影检查;城区养老机构的老年人入住前(93.2%,179/192)及入住后(88.0%,169/192)接受X线摄影检查率均高于郊区养老机构老年人(74.8%,184/246;58.9%,145/246),差异均有统计学意义(χ ²值分别为25.82和44.92,P值均<0.001)。35.4%(155/438)的老年人被探望的频次<1次/周;城区养老机构老年人每周得到家属探望的比例(78.6%,151/192)高于郊区(53.7%,132/246),差异有统计学意义(χ ²=29.45,P<0.001)。70.3%(308/438)的老年人一年内没有离开过养老机构。接受调查的老年人对肺结核传染性及传播途径知识的知晓率分别为86.1%(309/359)和72.5%(224/309),仅29.0%(104/359)的老年人在咳嗽超过2周时会怀疑患肺结核。结论 养老机构入住老年人接受体检及社会关怀情况仍有待加强,将结核病筛查与老年人定期健康体检或慢性病随访有机结合,同时加强结核病知识的宣传教育,将有助于肺结核患者的早期发现。     

Restriction in activity associated with fear of falling among community-based seniors using home care services

BACKGROUND: Fear of falling may lead to avoidance of activities for seniors, even though they may be able to perform these activities. Specific risk factors for fear of falling that are amenable to change among various populations have been identified within the literature; however, detailed information about the risk factors for fear of falling, specifically among community-based seniors receiving home care services, is limited. OBJECTIVE: The aim of this cross-sectional study was to examine the factors associated with restriction of activity resulting from fear of falling among 2,300 seniors receiving home care services. PARTICIPANTS: All participants (n = 2,304) in this study were receiving home care services between 1999 and 2001 from a sample of 10 volunteering community-based agencies (Community Care Access Centres) representing the major geographic regions of Ontario, Canada. Community care access centres act as gatekeeping organisations assessing need and contracting out for a broad range of community-based services. MEASUREMENTS: The Minimum Data Set for Home Care, a comprehensive and standardised assessment tool used to evaluate the needs and ability levels of older adults utilising home care services, covers several key domains, such as service use, function, health and social support. Nurses trained to administer the Minimum Data Set for Home Care assessed each of the participants within their homes. RESULTS: Of the 2,304 seniors within the study, 41.2% of participants expressed they restricted their activity for fear of falling. Percentages reporting fear of falling within the literature are considerably lower than the presentfindings, and probably attributable to the frailer, home care population within the present study. In the final logistic regression model, being female, having various impairments/limitations, lack of support and being a multiple faller significantly increased risk of fear of falling, whereas individuals that used antipsychotics and individuals that had Alzheimer's disease were less likely to report restricting their activity. CONCLUSIONS: The results from this study provide information about a group void in the literature pertaining to activity restriction from fear of falling - community-based seniors receiving home care services. The comprehensive nature of the Minimum Data Set for Home Care allowed for a myriad of factors to be assessed and subsequently analysed with respect to the outcome variable. The inclusion of items on falls, fear of falling, and risk factors for both adverse outcomes means that home care professionals using this instrument will have a unique opportunity to identify and respond to problems that have an important impact on the client's quality of life.     

Problems of aged people in rural regions of the Swiss Canton St. Gall (author's transl)]

Based on the structure of the mountain population, the living conditions of the aged (in rural communities 11-17% are older than 65) are shown. By public planning and cooperation of private organizations a material security of the aged has been strived after and mostly reached in the last 15 years--with the tendency to leave the aged in his own house or at least in the environment of his native village. Homes for the aged were built--if possible in every community--on the basis of 50 beds in a home for the aged and 35 beds in a nursing home for 10.000 inhabitants (83% in nursing homes an 17% in acute hospitals with geriatric departments). The individual help for the aged: activation by offering common institutions, ingenious activity, non-public advice offices, household help is deduced and the planning for the coming decade mentionned.     

Housing policy towards a super aging society: From building specifications to special needs measures

Japan is becoming a 'super-aging society' beyond an 'aged society'. During last decade, considerable political measures on the housing for the elderly have been launched, but the turning point is coming. There are many private detached houses in Japan. In order to upgrade the quality of ordinary houses, 'guidelines of housing design devised to cope with aged society' was announced by the ministry. From April 2000, under the Long-term Care Insurance Law, house adaptation system for the frail elderly was institutionalized and the needs of it have been increasing wider and wider. Most elderly people feel anxious for the future when they need personal care that includes home help services and nursing care. Elderly residents of collective housings want to reserve the service facility in the same building. New types of dwellings have also been developed (such as senior housing, care house, group home) Recently, the old peoples homes began to consider a high value to the comfortable atmosphere as a house. Even the nursing homes are changing into houses that contain small scale homes. Group living is not an institution, but a house that must have a possibility to suit the all categories of elderly people. The scheme will become one of the mainstreams of housing for the elderly as a new type of dwelling.     

Quality of life, food choice and meal patterns - field report of a practitioner

Quality of life is defined as the result of combining personal resources, control of the environment, personal values, and actual living conditions. Balanced nutrition is an important condition for quality of life, health and well-being. During the course of life everyone develops his very individual biography of eating. This includes eating habits, food choice, and meal patterns. The process of aging is accompanied by hardly recognizable physiological, emotional, social, and environmental changes. Ignoring these changes can lead to malnutrition and nutrition-related problems and thus reduce health, diminish the quality of life, and overall well-being. Accordingly, it is necessary to synchronize the individual biography of eating, the physiological, emotional, social, and environmental changes to enable the aged to feel self-determined and self-confident. This presentation will describe successful examples from local homes for the aged/nursing homes. Examples will show that possibilities of food choice answer the need of the residents to control their environment, that residents can be integrated in the planning and preparation of food and how this corresponds with their need to show their knowledge and experience, that meals in residential facilities can be re-arranged to let the residents experience joy and pleasure, and that nutritional concepts in nursing homes can be changed so that the residents experience themselves as subjects of nutrition.     

The probability of using an aged care home over a lifetime (1999–00)

Objective: This paper aims to project the probability of using an aged care home over a lifetime for Australian men and women at various ages. Method: This paper applies life table models [1] to 1999–00 residential aged care data to estimate the probability of using an aged care home over a lifetime. Results: Women are more likely than men to enter an aged care home for permanent care over their lifetime. Based on current patterns of use of aged care homes, a woman at age 65 faces a probability as high as 0.46 of using an aged care home for permanent care before her death compared with 0.28 for a man at the same age. Conclusion: A much larger proportion of older people than has often been recognised are likely to be admitted to an aged care home at some point in their lives.     

Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter?

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%. DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.     

Model project: "Haus Lotharstrasse--residential and communication centre for seniors" (author's transl)]

"Haus Lotharstrasse, Wohn- und Begegnungszentrum für ?ltere Bürger" ("House Lotharstrasse, Residential and Communication Centre for Seniors") in Bonn had been established as a model institution of "open assistance for seniors". -The combination of 50 "protected appartments" (single and double appartments), a communication centre, accessible also for non-residents and service stations for "mobiles services" as Meals on Wheels, ambulant home-services (social service station), transport services for various purposes and consultation in individual social problems, proved to be extremely helpful in practice. Freedom and independence, combined with all necessary assistance and services when needed, promote new self-confidence and rehabilitation.     

Role of the social support network in caring for the aged

This study presents the results of an investigation of the reasons for the elderly people being cared for as residents of nursing homes or as outpatients. With regard to the reasons for being outpatients or being residents of nursing homes it can be pointed out: elderly people as outpatients can only be cared for as long as there are intact social relations. If services for outpatients are not supplemented by social relations the stay in a nursing home cannot be avoided.