'Misplacement' of elderly people in the caring organisation: reasons and alternatives

The degree of misplacement in the care organisation was studied in a repeated cross-sectional study (788 persons in 1993 and 1538 in 1988, 65 years and older) in Sundsvall, an industrial city in the middle of Sweden. The overall misplacements were 23% both in 1988 and 1993. Misplacements were most frequent in the homes for the aged (about 50%). At the nursing homes, misplacement decreased from 27 to 12% between 1988 and 1993, while it has increased in home care from 8 to 27%. Almost half of the misplacements in home care needed nursing home or psychogeriatric care. The main conclusion is that the care organisation is not working optimally. The number of misplacements reflects an exhausted care situation. The concept of misplacement is probably valuable, but its usefulness must be evaluated in further studies.     

Personal and environmental relationships among the elderly living in residential settings

There is strong empirical evidence to support the influence of environmental and social factors in health and behavior among the institutionalized elderly. In order to assess personal and environmental relationships, 32 residential centers for the elderly and 1403 of their inhabitants were assessed using the Sistema de Evaluación de Residencias de Ancianos (SERA). Our principal findings were as follows: (1) relationships between individual variables (e.g. objective and subjective health, depression) and subjective variables (e.g. satisfaction); (2) the predictive power of the environment characteristics (e.g. policy choice) on the subjects functioning (e.g. level of activity); (3) residential satisfaction is the product of several personal variables (e.g. objective and perceived health), as well as of social environmental factors (e.g. physical comfort); and (4) very weak relationships were found between social climate dimensions and other environmental factors.     

Was beeinflusst die Lebenszufriedenheit im hohen Alter?

Background

Most older adults wish to stay in their own homes even after the onset of care dependency, which is enabled by different care arrangements. General life satisfaction can serve as a criterion for assessing the functionality of these arrangements.

Methods

The study is based on a standardized survey (face-to-face interviews; n=712) performed in 2009/2010. The population consisted of persons aged ≥70 years, with a need for care, living in one of three selected Swiss German-speaking cantons. The dataset is a representative sample of the population.

Results

The following results were found with regard to the surveyed target group of persons aged ≥70 years, living at home and receiving formal and/or informal care: the need for care of persons ≥80 is not greater than that of persons aged 70–79 years and is not decisive for general life satisfaction. Strength of social network, presence (or absence) of pain, and satisfaction with care are more important. The odds of being satisfied with life are greater with increasing age. The social network of persons ≥80 is weaker than that of persons aged 70–79 years but contributes nonetheless to satisfaction with life.     

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.     

Risk factors in eighty-plus year-olds living at home: an investigation of a Danish community

A series of risk factors involving the health of the elderly were investigated among persons aged eighty years and older living at home in the community of Holbaek, Denmark. The investigation included a total of 459 participants, 84 percent of this age group. After a two-year period of observation, it was found that 75 percent were still living at home, less than 1 percent were hospitalized, 10 percent had moved to nursing homes, and 14 percent had died. A total of 62 percent had lived at home during the entire period without hospitalization. By means of comparing conditions of health in 1977 and subsequently in 1979, it is possible to point out a series of predictors which are statistically significant but of limited clinical value. The article concludes that it is scarcely possible to achieve more in the prophylaxis of acute breakdown in the life of the old people with the present Danish health policy. Two possibilities were suggested: twenty-four-hour care services, or strengthening of the informal social network.     

Quality of medical information on admission to a nursing home

In this paper one aspect of social relation in health and social service is investigated by means of documentation analysis: the quality of medical information on admission to a nursing home. In 6% of all cases (n = 120) the nursing home received detailed data on the diagnosis and therapy, the status praesens and on the clinical symptoms, on the social and psychological situation of the aged person in need of care and his/her clinical parameters. With 6% the basic data (name, date of birth, diagnosis) were incomplete. With 66.7% the data were available on the day of admission. There was no dependence on age, sex and stage of care of the person in need of care. The data were less extensive if the person in need of care was referred to from an out-patient department and inquiries could not be made with him/her or his/her relatives/acquaintances. An improvement of this situation is possible if the cooperation between hitherto attending doctor, the care institution of the municipal district for aged people and the nursing home is coordinated better.     

Functional disability of older persons in long-term care facilities in Korea

The aim of this study was to examine functional disability of older persons in long-term care facilities and to identify factors associated with their levels of functioning. The first national survey of older residents in nursing and residential care homes in Korea was conducted in 1999. Of the 1105 respondents who completed the interview 73% in residential care homes and 88% in nursing homes reported limitations in functioning. The percentage of persons with three or more limitations in activities of daily living (ADL) was 63% among nursing home residents and 36% among those at residential care homes. Overall, persons of older age, female, widowed, with less family support, and bearing out-of-pocket costs of medical care tended to show higher levels of disability. Presence of arthritis, hypertension, and stroke was found to be significantly associated with increased likelihood of disability. Multivariate analysis revealed variability in the associations by type of facility. Characteristics such as older age, women, and stroke were significantly associated with a higher likelihood of disability for those in both residential and nursing homes. Arthritis, fracture, exercise, and contact with family members, however, were found to be independently associated with disability among those in residential care homes only. Recent government proposals to improve care delivered to long-term care residents need to take into account their differing levels of functional disability and its associated care needs.     

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。     

Analysis of comprehensive geriatric assessment of elderly residents in a social welfare home for the aged compared with those in a residential care home in an urban area in Japan

Background:   The purpose of the present study was to clarify the influence of the socioeconomic factors during the middle age on the results of comprehensive geriatric assessments in later stage of life.
Methods:   A cross-sectional, questionnaire-based study was conducted of elderly residents in a welfare home for the aged in Osaka and those in a residential care home in Kyoto. Results of questionnaires pertaining to activities of daily living (ADL), quality of life (QOL) and a 15-item Geriatric Depression Scale as well as medical and social histories of the two groups were compared by unpaired T -test and χ² test.
Results:   Elderly residents in the welfare home were significantly younger and more were both male and unmarried or divorced than among those in the residential care home. Scores in ADLs and QOLs were significantly lower and the prevalence of depression was significantly higher in residents in the welfare home than in the residential care home.
Conclusion:   The ADLs, mental mood and subjective QOLs of residents in the welfare home were significantly lower than those of residents in the residential care home. The reason for these differences is suggested to be due to both the differences in the lifestyles of the residents in their middle age and the difference in the quality and quantity of care the residents are receiving. Local social welfare government should pay more attention to lower ADLs and QOLs of residents in welfare homes and increase efforts to improve the quality and quantity of care for them.     

The critical life event "admission to a retirement and nursing home" and the problem of self help

By showing us the admission of seniors to a home for aged people the authors have given a topical example for the explanation that social self-help plays an important role for mastering this problematic situation. The for-life capability of the individual to manage the appearance of living-problems very consciously, the authors remark, represents the new quality of aged peoples self-help in socialism. They refer to the comprehensive possibilities for aged people to develop their personal active potencies and self confidence in a home for aged people. Individual unfolding that depends on the sociable conditions is mainly discussed in two parts of interrogation: What form and idea of aged people does the society have? How do the seniors think about the specific sociable function of homes for aged people? The direct importance of the individual conditions of self-help is emphasized by giving notes which refers to the age, sex, social status and state of health of the aged people in the homes for aged people of today.     

Psychiatric disease and social isolation in elderly nursing home residents: a comparative study

As part of a population-based morbidity survey, a sample of over-65-year-old residents of geriatric nursing homes and old people's homes (N = 153) in the city of Mannheim, F.R.G. (Popn. 308,000) was investigated with regard to mental and physical impairment, as well as to the frequency and quality of their family and social contacts. Corresponding data from the investigation of a community sample (N = 350) served as a basis for a direct comparison of old people in residential care and those living in the community. The findings point to a large relative excess both of mental impairments--especially organic brain syndromes--and of physical disabilities among the nursing-home residents. Those in old people's homes, in marked contrast, do not differ in these respects from persons of the same age living in the community. The home residents have on average far fewer social contacts, and derive less help and support from their social relationships, than do their contemporaries who live in private households. From this point of view, there appears to be little difference between those in nursing homes and those in old people's homes. The observed disparities between the home and community samples remained significant following statistical correction of the data for differences in the sample distributions by age and by marital status. The implications of these findings for further research and for geriatric service-planning are discussed.     

Attitudes of Older Egyptians towards Nursing Care at Home: A Qualitative Study

The aim of this study was to identify the attitudes of older Egyptians towards receiving nursing care at home and to identify the characteristics that allow differentiating between various types of these attitudes. The number of older persons in Egypt requiring nursing care is increasing. Care was traditionally provided by the family, but the social network is changing in bigger cities. Beside geriatric homes, older Egyptians can refer to private helpers and a small number of home care services. Structured guideline interviews were performed with 33 Egyptians above 60 years of age. Participants were chosen by purposeful sampling. Twelve of them received home care. Interviews were analyzed with qualitative content analysis according to Mayring. Participants could be classified under three main categories of care seeking types: (1) insufficient income, (2) sufficient income and family dependent decision about care, (3) sufficient income and independent decision about care. Variations under these categories were due to differences in the social network and the perceived self-help abilities. Examples for the influence of factors which explained variations were not identified in every category to the same extent. Some types of care seeking that exist in reality may be missing in this study. Findings suggest the hypothesis that care seeking of older Egyptians is related to their social status. Those with insufficient income seem to reject home care whereas independent personalities with sufficient income may be the main winners of this offer.     

深圳市民对AIDS防制措施态度的调查

目的　了解深圳市民对当前艾滋病 (AIDS)形势和政府防制措施的态度及其影响因素。方法　采用多阶段整群抽样和配额抽样相结合的方法 ,对深圳市 13 2 0名居民进行了入户问卷调查。结果　同意政府为防制AIDS投入大量经费的“态度”评分最高 ;向静脉吸毒者提供针具或替代药物的评分最低。 3 4 6%的人不知道或不赞同中国的AIDS形势已很严峻 ;75 %的市民表示关注深圳市的AIDS情况 ;86 3 %的人愿意学习AIDS知识 ;80 5 %的人同意推广使用安全套。年龄、文化程度、职业和婚姻状况对“态度”水平有显著影响。结论　政府的防制及宣传工作都有民众基础 ;要加强AIDS形势教育 ;向静脉吸毒者提供针具或替代药物的实施要慎重 ;党政机关和事业单位人员的态度值得关注     

Home environmental problems and physical function in Taiwanese older adults

Environmental hazards play an important role in the disablement process. The purpose of this study was to investigate the relationship between home environmental problems and personal physical function. Data were based on a two-stage nationwide survey and evaluation on the needs of long-term care in Taiwan. A total of 10,596 individuals aged 65 and over were included in this study. These participants were identified with physical or cognitive problems at the screening interview and further evaluated at the second interview on health condition, functional status, needs of long-term care, and home environmental problems. Six items of environmental hazards were assessed at the participants’ homes with direct observation. The prevalence rates of home environmental problems were similar among older adults with different levels of physical function. No grab bars (79.6–85.1%) and no protections against slip (81.9–92.8%) in the bathroom were two commonly present hazards in older adults’ homes. Older adults with a higher income (Odds ratio = OR = 0.75), without income information (OR = 0.78) or living with other persons (OR = 0.74) were less likely to experience environmental problems at home. Results from this study revealed that home environment condition was associated with factors other than personal disabling conditions for the elderly. Modifying home environment, especially the bathroom, should be attached with great importance for physically disabled older adults.     

Successful aging in the oldest old: Who can be characterized as successfully aged?

BACKGROUND: Successful aging is a worldwide aim, but it is less clear which indicators characterize elderly persons as successfully aged. We explored the meaning of successful aging from 2 perspectives. METHODS: Analysis of data from the first cross-sectional part of the longitudinal Leiden 85-plus Study, conducted in Leiden, the Netherlands. All inhabitants of Leiden aged 85 years were eligible. Data were obtained from 599 participants (response rate, 87%). Successful aging from a public health perspective was defined as a state of being. All participants were classified as successful or not successful based on optimal scores for physical, social, and psychocognitive functioning and on feelings of well-being, using validated quantitative instruments. Qualitative indepth interviews on the perspectives of elderly persons were held with a representative group of 27 participants. RESULTS: Although 45% (267/599) of the participants had optimal scores for well-being, only 13% (79/599) had optimal scores for overall functioning. In total, 10% (58/599) of the participants satisfied all the criteria and could be classified as successfully aged. The qualitative interviews showed that most elderly persons viewed success as a process of adaptation rather than a state of being. They recognized the various domains of successful aging, but valued well-being and social functioning more than physical and psychocognitive functioning. CONCLUSIONS: If successful aging is defined as an optimal state of overall functioning and well-being, only a happy few meet the criteria. However, elderly persons view successful aging as a process of adaptation. Using this perspective, many more persons could be considered to be successfully aged.     

Health care costs of older persons with cognitive impairments

The 1981-1982 National Long-Term Care Channeling Demonstration Project data revealed that the mean annual cost per capita for home and institutional care for cognitively impaired persons was +18,500. The equivalent figure for cognitively intact persons was +16,650. Cognitively impaired persons used nursing homes at twice the rate of cognitively intact persons. Use differences for other health services were slight. A pre- and post-nursing home admission analysis indicated that for the cognitively impaired the annual cost of community care was +11,700, whereas the cost of nursing home care was +22,300.     

Review: use of health care services among persons living with HIV infection: state of the science and future directions

Health care services for persons living with HIV have broadened from short-term, crisis-oriented, and palliative care to include preventive, acute, and long-term services because of advances in HIV treatment and earlier detection. This integrated literature review on utilization of HIV-related health care services provides information on barriers to access, disparities in treatments, and factors contributing to wasteful use of services. Early research focused on describing and quantifying use of in-hospital care. As HIV transformed into a chronic disease, research on utilization expanded into outpatient settings. Predisposing factors such as race, gender, and injection drug use, and enabling factors (i.e., insurance, social support systems, housing) were strong predictors of utilization patterns. Clinical factors, such as immune status, symptoms, and depression, as well as contextual factors (i.e., characteristics of clinicians, urban/rural residence) determined the amounts of services obtained. Additional research is recommended on the utilization of nursing and preventive services and care in rehabilitation settings, home health, and nursing homes. Understanding the patterns and predictors of resource use can facilitate health professionals' efforts in improving the health care delivery system for individuals with HIV infection.     

Factors influencing residents' satisfaction in residential aged care

PURPOSE: The aim of this study was to identify the important factors influencing residents' satisfaction in residential aged care and to provide a better understanding of their interrelationships. DESIGN AND METHODS: A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency levels, and staff satisfaction. A stratified random sampling approach was utilized to select facilities. All residents satisfying the selection criteria (i.e., understand English, be sufficient cognitive competence, have a sufficient energy level to participate in the survey, and live in the facility for more than 4 weeks) and all care staff were invited to participate. A total of 996 residents and 895 staff from 62 facilities (36 hostels and 26 nursing homes) provided the required data. Structural equation modeling was used to examine the interrelationships among three sets of contributing factors, related to the facility, staff and residents, and resident satisfaction components, separately for nursing home and hostel residents. RESULTS: Overall fits of both nursing home and hostel models were satisfactory. This study has revealed that staff satisfaction plays a crucial and central role in determining resident satisfaction in nursing homes, whereas it has less impact in hostels. The provision of more care hours has only a small, yet positive, impact on resident satisfaction. Larger facility size has a negative impact on resident involvement. Older residents were found to be more satisfied with staff care. IMPLICATIONS: The results provide a comprehensive understanding of what influences resident satisfaction. By accounting for important factors identified by residents, a resident-focused care model can be developed and implemented, leading to better service for aged care residents.     

Präventive Hausbesuche im Alter: Entwicklung und Pilottestung eines multidimensionalen Abklärungsinstruments

Preventive home visits with multidimensional geriatric assessment have been shown to delay or prevent the onset of disability and reduce nursing home admissions in older people. The purpose of the present study was to develop and test a multidimensional instrument for in-home preventive assessments in older persons. In developing the instrument, we conducted a systematic literature review of risk factors for functional status decline and of appropriate instruments for measuring these risk factors. Based on an Expert Panel using a modified Delphi process [1] the risk factor domains for functional status decline were chosen, [2] the instruments for evaluating each of the included risk factor domains were selected, and [3] the individual instruments were combined into one comprehensive assessment instrument. A German language version of the original English version of the instrument was developed based on translation, backtranslation, and cultural adaptation. The feasibility of use of the new instrument was evaluated in a field test in 150 people aged 75 years and older in Hamburg, Ulm, Germany, and Bern, Switzerland. The instrument was well accepted by the older persons. The prevalence of risk factors for functional status decline in these populations (e.g., physical inactivity, urinary incontinence, vision impairment) was high. There was also a high prevalence of underuse of preventive care measures (e.g., no pneumococcal vaccination in over 95 percent of persons). These preliminary results support the possible usefulness of this instrument for conducting preventive home visits or for epidemiological purposes (e.g., prevention surveillance). In a next phase, the test-retest reliability of the instrument, and the feasibility and reliability of self-administration as compared to interviewer administration will be described in a separate paper.     

Study of constipation in a geriatric hospital, day hospital, old people's home and at home

A study of constipation and related factors was carried out in 439 geriatric hospital patients, 183 people living in two old people's homes, and 78 patients visiting a geriatric day hospital. In addition, a cross-sectional survey of constipation and related factors was undertaken in 138 people older than 74 years and 74 people aged 41 to 50 years living at home. Constipation and the use of laxatives were most frequent in the geriatric hospital (79% and 76% respectively), followed by the old people's homes (59% and 60%), the day hospital (29% and 31%), elderly living at home (38% and 20%) and middle-aged living at home (12% and 5%). The results suggest an increased risk of constipation for the persons walking less than 0.5 km daily [relative risk (RR) = 1.7], walking with help (RR = 3.4), chairbound (RR = 6.9) and bedbound (RR = 15.9). The relative risk of constipation increased for the persons living in the old people's homes (RR = 1.7) and the geriatric hospital (RR = 2.2), and also with advancing age (between 75 and 84 years, RR = 2.9; over 84 years, RR = 4.9). The prevalence of constipation was directly correlated to fecal and urinary incontinence.