PATHWAYS TO A MAINSTREAM NURSING HOME: A SURVEY OF CHINESE,GREEK AND ANGLO AUSTRALIANS

A survey of the family carers of 21 Chinese, 26 Greek and 25 Anglo Australian nursing home residents compared their aged relatives' pathways to a mainstream nursing home. The Greek aged were older and more dependent at placement while the Chinese were relatively young. Communities differed in terms of those involved in the decision making process, family reactions to the decision, reasons for selection of a home and use of services prior to placement. Community similarities included the types of event which precipitated placement, the categories of people initiating discussion of placement and the aged people's reactions to the decision.     

Changes predicting long-term care use among the oldest-old

PURPOSE: The aim of this study was to identify health-related changes occurring between 1983 and 1990 that characterize and differentiate 1996 long-term care outcomes (no services, home care, nursing home) among people aged 85 years and older. DESIGN AND METHODS: Variables capturing health-related changes between 1983 and 1990 in a cohort (N = 616) of Aging in Manitoba Longitudinal Study participants aged 85 years and older were used in a series of logistic regression models to identify factors that best predicted the use of long-term care services in 1996, controlling for age and sex. RESULTS: Factors predicting home care use relative to no services included changes in self-rated health, income adequacy, and railings outside of the house. Factors predicting nursing home use relative to home care included age and changes in general life satisfaction. Factors predicting nursing home use relative to no services included age; previous service use; length of time in the community; and changes in income adequacy, type of housing, and state of mind. IMPLICATIONS: These findings challenge assumptions about the linearity of the continuum of long-term care services, because different factors were shown to predict home care use than were shown to predict nursing home use.     

Validation of the Resident Assessment Instrument triggers in the detection of under-nutrition

OBJECTIVE: To test the validity of Resident Assessment Instrument triggers for people in Danish nursing homes and subjects receiving home care by exploring their ability to identify older people with insufficient energy and protein intake. DESIGN: Regression analysis of insufficient energy or protein intake on each of the Resident Assessment Instrument triggers alone or in combination. SUBJECTS: 38 people receiving home care and 41 living in nursing homes. METHODS: A 4 day estimated dietary record, assessment of energy and protein intake, calculation of body mass index. RESULTS: Food remaining on the plate, weight loss and any trigger present significantly influenced the energy or protein intake of the nursinghome subjects. No triggers reflected the energy or protein intake of the subjects at home. CONCLUSION: Observation of food intake seems to be the best way to detect which older Danish people living in nursing homes or receiving home care have insufficient energy or protein intake.     

AN INTERNATIONAL SURVEY ON ATTITUDES OF RENAL NURSES TOWARDS OLDER PEOPLE

Background: Previous studies have indicated that healthcare providers do not enjoy taking care of older people, because of poor attitudes towards the elderly. Aim: The purpose of this cross‐sectional study is to identify and describe the attitudes of a worldwide sample of renal nurses towards older people. Method: A convenience sample composed of renal nurses worldwide completed a socio‐demographic questionnaire and the Kogan's Attitude towards Old People Scale (KOAP). Results: We received 1,061 completed questionnaires from nurses in 12 countries. Participants were mainly female (81%), their average age being 42.69 (SD ± 8.70); 74% of nurses had older people in their families and 51% had lived with older people. The sample reported slightly positive attitudes towards the elderly [mean score (±SD) = 151.50 (±17.9)]. Attitudes were influenced by continent, country, religion, presence of older people in the family and level of nursing education (p < 0.0001). Conclusion: Our study has shown that renal nurses have slightly positive attitudes towards older people but attitudes could be improved with specific information being provided to renal nurses, to obtain better care.     

Factors Related to Primary Health Care Provision: A Cross-Sectional Study in an Elderly Rural Population

We examined the relationship between social support, lifestyle habits, and disease-related factors in two primary health care settings: the health care center and the elders’ homes. Logistic regression analysis was performed to determine the effect of independent variables on the provision of health care services. Those who received home visits were significantly older, had lower family income, and had poorer social support systems. Furthermore, elderly people with nutritional risk status, heart failure, functional dependence, or cognitive impairment were among those most likely to request in-home care visits. Our study suggests that age, nutritional risk, and functional dependence are the most important factors to predict the use of home health care services compared with general practitioner visits.     

Effects of a late-life suicide risk--assessment training on multidisciplinary healthcare providers

Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty-two participants from two Veterans Affairs Medical Centers participated in a 6.5-hour-long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre- and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late-life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.     

The effect of older people's economic resources on care home entry under the United Kingdom's long-term care financing system

OBJECTIVE: To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom. METHODS: In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization. RESULTS: Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income. DISCUSSION: UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.     

Socioeconomic differences in informal caregiving in Europe

Disclosing socioeconomic differences in informal care provision is increasingly important in aging societies as it helps to identify the segments of the population that may need targeted support and the types of national investments to support family caregivers. This study examines the association between individual-level socioeconomic status and informal care provision within the household. We also examine the role of contextual factors, income inequality, and the generosity of social spending, to identify how macro-level socioeconomic resource structures shape individuals’ provision of care to household members. We use pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4, 5, 6) and the English Longitudinal Study of Ageing (ELSA, waves 2, 3, 4, 6, 7). Poisson regression multilevel models estimate the associations between household socioeconomic status (education, income, and wealth), and country socioeconomic resources (income inequality and social spending as a percentage of GDP), and the likelihood of older adults’ informal care provision within the household. Results indicate that lower individual socioeconomic resources—education, income, and wealth—were associated with a higher incidence of older adults’ informal care provision within the household. At the macro-level, income inequality was positively associated while social spending was negatively associated with older adults’ care provision within the household. Our findings suggest that socioeconomically disadvantaged groups are more likely to provide informal care, which may reinforce socioeconomic inequalities. At the national level, more equitable resource distribution and social spending may reduce intensive family caregiving.

     

Violent crime victimization increases the risk of nursing home placement in older adults

PURPOSE: We estimate the independent contribution of crime victimization to nursing home placement in a cohort of older adults who were community dwelling at baseline. DESIGN AND METHODS: The data come from an observational cohort study of 2,321 community-residing older adults who were members of the New Haven Established Populations for Epidemiological Studies in the Elderly cohort in 1985. Participants had annual evaluations using standardized instruments. We defined the major outcome, custodial nursing home placement, as a stay of at least 30 days; mean length of nursing home stay was 413 days. We determined crime victimization by matching police records in the same catchment area as the cohort for the period 1985-1995. We determined nursing home placement through linkage to the Connecticut Long Term Care Registry. We used growth curve modeling to estimate the risk of placement in victimized and nonvictimized participants, and we used multivariable models to adjust for other factors known to predict nursing home placement. RESULTS: There were 482 members of the cohort (21%) who experienced victimization over the 10-year follow-up; 747 (32%) experienced nursing home placement. Most victimization episodes were nonviolent and noninjurious. However, violent victimization conferred an independent increased risk of nursing home placement (odds ratio = 2.1; 95% confidence interval = 1.0-4.6) that exceeded the increased risk associated with other variables traditionally thought to be predictive of placement (such as functional and cognitive impairment, and social network size). IMPLICATIONS: Violent crime victimization increases the risk of nursing home placement. Future research should be directed at determining the mechanism of this increased risk and developing interventions directed at victimized older adults that might avert nursing home placement in this uniquely vulnerable population.     

Do social networks affect the use of residential aged care among older Australians?

Background

Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants) and total social networks upon use of low-level residential care and nursing homes.

Methods

Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks.

Results

Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75). Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90). Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use.

Discussion

Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.     

Attitudes toward and use of subsequent nursing home services among a national sample of older adults

This study was designed to examine the relationship between attitudes toward nursing homes and subsequent nursing home utilization, and assess the impact of prior nursing home utilization on subsequent attitudes among a national sample of older Americans. Multivariate estimation procedures for complex survey designs were performed on the National Long-Term Care Survey data set. Although prior nursing home use did not directly affect subsequent attitudes toward nursing homes, having favorable attitudes about nursing homes increased the odds of using subsequent nursing home services by 1.5 and increased the total nursing home length of stay by 17%. Implications of this research for public policy and long-term care treatment planning are discussed.     

Families and nursing home placements: A cross-cultural study

With the aging of many populations, health careworkers and families increasingly findthemselves jointly involved in situationsinvolving decisions about nursing homeplacements. How each approaches suchsituations is affected by beliefs andassumptions about the role of family members inthe care of family members and the decisionmaking process. This paper explores theresponses of people from four cultural groupsliving in Australia (Anglo-Celtic Australian,Chinese, Greek, Lebanese) to a criticalincident scenario about a Russian family inAustralia faced with such a decision. Theresponses to this scenario were remarkablysimilar across the four cultural groups. Allsaw making such a decision as difficult, butthe reasons for the difficulty suggest someinteresting cross-cultural distinctions. Somegroups viewed care of a family member more interms of a social and role obligation whileothers addressed it as a personalresponsibility. To not care for elderlyparents in the home was accompanied by a senseof guilt among some respondents and a sense ofpublic social shame among others. Ambivalenceabout nursing homes and placing a family memberin a nursing home, culture change andcross-generational differences, and roles androle support were other important themes. Theresults are consistent with other data analysedin conjunction with the InterculturalInteraction Project. The findings from thisresearch suggests a need to examine moreclosely the beliefs and assumptions associatedwith nursing home placements and one way tohelp students and health professionals to doso.     

The association between demographic and oral health‐related quality of life factors and dental care attendance among underprivileged older people

Aim: In order to identify whether demographic and oral health‐related quality of life factors are associated with dental care attendance among an underprivileged older population, a comparison was performed between people who have and have not attended dental care. Methods: A cross‐sectional purposive sample of 344 older underprivileged people comprised the study population. The dependent variable was dental care attendance. The 14‐item version of the Oral Health Impact Profile index (OHIP‐14) was used as the independent variable, together with other social and general variables, using a structured interview. Results: The variables that were significantly associated with dental care attendance were family status (not married, the highest attendance), dwelling location (living at home, the highest attendance), caregiver (family member, the highest attendance), place of birth (Western countries, the highest attendance) and income (pension, the highest attendance). Sex, welfare support, functional ability, education, age and OHIP‐14 were not associated with dental care attendance. Conclusions: Attending dental care was not associated with oral health‐related quality of life measured by OHIP‐14. Several socioeconomic variables were strongly associated.     

Families of elderly stroke patients. Effects of home care

Elderly stroke patients and their families were studied to determine the health effects of providing home care on family caregivers, whether or not caregivers actually providing care in the home experience different effects than caregivers whose family members live in nursing homes, and factors associated with any observed deleterious effects of caregiving. One hundred forty-seven stroke patients were eligible for study. Of these, 101 were available for follow-up; 89 family caregivers were interviewed (88%). Caregivers reported both positive and negative effects of providing home care. When actual home caregivers were compared with potential caregivers (those with family members in institutions), no differences in effects were seen. The relationship between each of three health effects (general, social, and emotional) and patient and caregiver attributes was explored. No factors were found to be related to poorer perceived general health. Dependent patient functional status and additional life stress were both associated with diminished social activity and emotional ill-health. In the latter instance, insufficient social activity and help from family were additional risk factors. If policy is going to advocate home care, its consequences for family caregivers must be known.     

Informal and Formal Long-term Care for Frail Older Adults in Cairo, Egypt: Family Caregiving Decisions in a Context of Social Change

This paper explores the factors that lead family caregivers to place their frail older relatives into long-term care centers in Cairo, Egypt despite norms of family care. Semi-structured interviews were conducted with 18 “case” caregivers who placed their older relatives into long-term care and 17 “control” caregivers who provided for their older relatives at home. Cases and controls differed in their relationship to the older adult, number and proximity of supportive siblings, and perceived health status of the older adult. Caregivers who used long-term care justified their decision by stressing the need for relief from the burden of caregiving, and by conceiving long-term care as part of a broadened definition of family care. Egyptians are devising new strategies of care despite persistent norms of reciprocity among kin. As demographic, epidemiologic, and socioeconomic changes continue, families may adopt new combinations of care to support their frail older relatives. Findings underscore the need for population-based research about strategies of caring for frail older relatives in this context.

Case finding and referral model for emergency department elders: a randomized clinical trial

STUDY OBJECTIVE: Elderly emergency department patients have complex medical needs and limited social support. A transitional model of care adapted from hospitals was tested for its effectiveness in the ED in reducing subsequent service use. METHODS: A randomized clinical trial was conducted at 2 urban, academically affiliated hospitals. Participants were 650 community-residing individuals 65 years or older who were discharged home after an ED visit. Main outcomes were service use rates, defined as repeat ED visits, hospitalizations, or nursing home admissions, and health care costs at 30 and 120 days. Intervention consisted of comprehensive geriatric assessment in the ED by an advanced practice nurse and subsequent referral to a community or social agency, primary care provider, and/or geriatric clinic for unmet health, social, and medical needs. Control group participants received usual and customary ED care. RESULTS: The intervention had no effect on overall service use rates at 30 or 120 days. However, the intervention was effective in lowering nursing home admissions at 30 days (0.7% versus 3%; odds ratio 0.21; 95% confidence interval [CI] 0.05 to 0.99) and in increasing patient satisfaction with ED discharge care (3.41 versus 3.03; mean difference 0.37; 95% CI 0.13 to 0.62). The intervention was more effective for high-risk than low-risk elders. CONCLUSION: An ED-based transitional model of care reduced subsequent nursing home admissions but did not decrease overall service use for older ED patients. Further studies are needed to determine the best models of care for this setting and for at-risk patients.     

Casino gambling among urban elders: just another social activity?

OBJECTIVES: This study explored older adults' attitudes about a range of activities and determined characteristics associated with casino participation. Activity theory was used as conceptual framework to examine casino gambling as a newer social activity and to identify characteristics related to gambling behavior among elders. METHODS: The sample consisted of 1,410 randomly selected participants, aged 60 and older, who reside in the city of Detroit. Through the use of a cross-sectional analyses, selected variables tested with casino visits included health, demographics, social activities, senior optimism, opinions about casinos, transportation, and social support network. RESULTS: Bivariate associations revealed that sociodemographic variables such as income, age, education, marriage, and transportation were significantly associated with casino participation. Additional factors associated with casino visitation included positive attitudes about casinos, social support network, and enjoying a variety of other "active" activities. DISCUSSION: The results of this study supported the theoretical perspective underlying the basis of this project. Although not a favorite activity, gambling is among several types of social activities in which older adults do participate. Results suggest further investigation of how casino activities relate to mental health and other leisure activities.     

Clinicians' predictions of nursing home placement for hospitalized patients.

Identifying patients who will need long-term care may improve the efficiency and effectiveness of acute hospital care. This prospective study evaluated clinicians' ability to identify patients requiring nursing home care. The study had two principal objectives. The first objective was to measure whether registered nurses, physicians, and social workers made similar estimates of the probability of nursing home placement early in an acute care hospitalization. The second objective was to identify the clinical characteristics of patients for whom the clinicians incorrectly predicted that they would return home. The study subjects were 342 patients older than age 55 who were admitted to the medicine, surgery, and neurology services of two university-affiliated Veterans Affairs hospitals. Fifteen percent were discharged to nursing homes. The nurses, physicians, and social workers had high agreement in their estimates of the probability of nursing home placement for each patient. However, each of the provider groups assigned low probability estimates to more than 20% of the patients discharged to nursing homes. Examination of the characteristics of patients assigned low probability estimates revealed that mental impairment and functional disability were higher in those patients who ultimately were discharged to nursing homes than in those patients who returned to their homes. These findings suggest that better assessment and interpretation of patient characteristics early in the hospital stay may improve discharge planning. Some clinicians appear to underestimate mental and functional impairment as risk factors for long-term care needs.     

Similarities and differences in attitudes toward long-term care between Japanese Americans and Caucasian Americans

The purpose of this study was to compare attitudes toward the use of long-term care between older Japanese Americans (n = 1,244) and older Caucasian Americans (n = 1,354). When presented with a hypothetical situation in which they have dementia, 39% of older Japanese Americans and 42% of older Caucasians intended to be cared for at home, whereas 53% versus 38%, respectively, intended to use nursing home care (P <.001). If the hypothetical situation was hip fracture, 81% of older Japanese Americans and 72% of older Caucasians intended to be cared for at home, with 13% of both groups intending to use nursing home care (P = NS). The subjects' perceptions of what their families, friends, ministers, and communities would want them to choose differed, with more uncertainty among Caucasians (P <.001). For provision of home care, Japanese Americans were more likely to rely on loved ones than Caucasians, who were more likely to rely on paid providers. Multivariate logistic regression showed ethnicity to be independently related to intention to use nursing home care in the dementia scenario, controlling for demographic variables. Being married lowered the odds of intending to use nursing homes in any situation. We conclude that Caucasian Americans intend to use paid home health care at higher rates than Japanese Americans if they become disabled by dementia. Japanese Americans demonstrated more certainty about the influences of others on their opinions, suggesting a more stable cultural norm in this population, and intended to use more nursing home care in the event of permanent debility (dementia).