From Alarm Systems to Smart Houses

The percentage of senior citizens in the Netherlands will rise in coming years. The expected percentage for the year 2010 of persons over age 65 in the total population is 15%. More persons over age 65 than ever before will continue to live in their own environment. Emergency response systems (ERS) can support independent living. The most common type of organization distributing ERS is a small, partly subsidized local alarm organization run by a social welfare office for the elderly. Government subsidy has been reduced in recent years which has motivated small organizations to join together into larger regional organizations in order to get a more solid financial base. On the other hand new semicommercial and cornmercial organizations have come into being. These developments are part of the growing im ortance of home care, leading to more medical applications of ad. User satisfaction with ERS is high. Portable triggers can enhance the_effectiveness of the system. However, many users do not wear the portable trigger when feeling well. Future technical developments will result in multifunctionality of ERS-devices. In the long term the hardware of today will be integrated in a multimedia home terminal replacing the telephone. The portable trigger will remain the only specific hardware at home for ERS.     

Demografischer Wandel und Krankheitshäufigkeiten

Demographic change and its impact on the German healthcare system is a subject of great debate. The purpose of this paper is to make projections on disease rates based on the 11th coordinated demographic prediction and population-based data which take into consideration demographic developments. The German population will decrease by approximately 16% until 2050, while at the same time the number of persons aged over 65 years will increase by 38% and the number of individuals aged over 80 years will increase by 156%. Baby boomers cause a vertical wave in the population pyramid. The population pyramid itself will lead to an overproportional increase in the number of elderly persons. Assuming that disease probability stays the same, the incidence of diseases due to advanced age will rise dramatically. Especially diseases, such as community-acquired pneumonia, age-related macula degeneration, dementia, fracture of the femur neck, and myocardial infarction, will by then occur more often. By 2050, some of the most frequent diseases will be hypertension and arthrosis. Thus, the continuous cutting of resources seems rather short minded. It is highly recommended to reconsider the long-run effects before setting a health policy course. A proper social discourse about primary care and prioritization appears to be urgently needed.     

Positioning for capitation in long-term care: a profile of vertical integration strategies in health and social service organizations

During the next decade, the population over age 65 is expected to increase by 11% while the population over age 85 is expected to increase by 42%. These projections suggest that many organizations which currently provide services to the aged will be required to design a range of new products and services for this diverse population. Vertically integrated services provide a viable opportunity to competitively position an organization to respond to the diverse needs of an aged market. Since vertical integration will be essential in negotiating capitate contracts for the aged in the future, this study examined the extent of vertical integration in 116 health and social service organizations in an urban market with an expanding geriatric population.     

The effect of the will of the bedridden elderly to be self-reliant on their life prognoses in Japan

The purpose of this study was to establish the relationship between the will of bedridden elderly people to be self-reliant and their life prognosis, and to clarify the factors related to the will to be self-reliant of such persons. The cohort consisted of 274 bedridden elderly persons aged 65 years and over who lived at home and were observed continually over ten years. Data were obtained from observation records done by four public health nurses who visited the subjects at least once a year and assessed their state of health. The variables studied were demographic variables, activities of daily living, the cause of being bedridden, the strength of the will to be self-reliant and the date of having become bedridden. Cox’s proportional hazard model, the Kaplan-Meier method and discriminant analysis were used for statistical analysis. Of the 274 subjects, 107 subjects (39.1%) were male and 167 (60.9%) female, with a mean age of 82 years. The subjects who lived with their families accounted for 96.7%. The mortality hazard ratio for subjects with a weak will to be self-reliant to those with a strong will was 1.64, which was statistically significant. Discriminant analysis demonstrated that the will to be self-reliant showed a significant relationship with age, level of activities of daily living and refraining from expressing one’s own feelings in consideration of the family’s feelings. Bedridden elderly persons with a strong will to be self-reliant had a significandy better life prognosis than those with a weak one. A strong will to be self-reliant among the elderly is related to age, level of activities of daily living, and refraining from expressing one’s own feelings in consideration of the family’s feelings. This study clearly points out the need for home care service personnel to work in cooperation with families to emphasize encouragement to build the will to be self-reliant for the elderly in Japan.     

Alcohol in the older population part 1: grandma has a drinking problem?

Previously thought of as the elderly, the older population is most frequently defined as those age 60 and older; in short, "we older persons" are the baby boomers-although many of us do not want to consider ourselves older. We members of the boomer population, born between 1946 and 1964, generally consider ourselves vital, active, proactive, productive, and thriving. We often think the category "older"-those who are 65 years and older-is reserved for our parents, a misperception that misses a significant percentage of persons entering their older years. We do not stop to think that by 2010, baby boomers will increase the population of older adults to 40 million and begin to depend on Medicare. Twenty years later, in 2030, the 65-and-over population will hit 70 million; we "older persons" will be 1 out of every 5 Americans.     

Exclusion of elderly persons from health-risk behavior clinical trials

BACKGROUND: It has been found that the elderly population is underrepresented in clinical trials aimed at disease treatment. It is unknown to what extent this group is also excluded from clinical trials aimed at reducing health-risk behaviors. METHOD: We systematically reviewed clinical trials targeting the leading health-risk behaviors, as identified by Healthy People 2010: tobacco use, overweight/obesity, physical inactivity, substance abuse, and irresponsible sexual behavior. Using MEDLINE, we identified clinical trials published in the five most cited medical journals between January 1990 and May 2004. RESULTS: The majority (53%) of the 198 health-risk behavior clinical trials excluded persons over the age of 65; the exclusion percentage increased to 72% for those over the age of 75. The exclusion of elderly persons in these five medical journals did not decline over the 14 years studied. This age exclusion pattern was not explained by the intervention's intrusiveness or whether illness was an exclusion criterion. The trials that included those over the age of 65 were more likely to report a significant finding in the predicted direction. CONCLUSIONS: Although elderly persons are most at risk for diseases linked to lifestyle behavior, such as heart disease, they were excluded from the majority of health-risk behavior clinical trials in five major medical journals.     

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.     

Socioeconomic factors and burn rates in persons hospitalized for burns in Massachusetts

To assess the usefulness of routinely collected socioeconomic variables from the U.S. census in predicting burn incidence rates, burn rates and 25 socioeconomic variables were analyzed at the level of census tracts for the Boston Standard Metropolitan Statistical Area. The burn rates were based on data collected during the National Burn Demonstration Project and consisted of patients who sustained burns between July 1, 1978, and June 30, 1979, and who required inhospital care. Analysis of the data revealed strong associations between burn rates and six of the variables. The six variables were the percentage of families below the poverty level with a householder under age 65 years, the percentage of persons over 5 years of age whose residence in 1975 was a different dwelling but in the same county, the percentage of persons in the civilian labor force who were unemployed at the time of census enumeration, the average age of occupied dwelling units, the percentage of occupied housing units occupied on a rental basis, and the percentage of persons age 25 years or older who acquired some college education but did not complete college. Interpretation of the findings is not straightforward but seems to suggest that the previously observed association between poor socioeconomic status and increased burn risk for individuals can be quantified at the census tract population level.     

Differences in health care provision between 11 ENT partnership practices in 2 health insurance catchment areas

Medical insurance organizations possess a large amount of production data from individual health care providers and from institutions. These data give insight into the type and amount of health care delivered. The number of admissions, patient days, inpatient and outpatient procedures and three specific procedures, per 100 referred patients and per 1000 insured persons, from 1986 were compared for 11 partnerships of ENT specialists located in the regions of two medical insurance organizations. The raw data were corrected for percentage of persons aged 65 years and older, the percentage of women, the referral practice of the general practitioners in the treated patient population and the number of specialists in each partnership. The differences between the partnerships with the largest and those with the smallest number of items of service amount to a factor 2.9 (admissions per 1000 insured persons) to 6.7 (septum corrections per 1000 insured persons). After introduction of the independent variables, substantial differences still exist, the lowest factor being 1.8 (hearing improvement operations per 1000 insured persons) and the highest 5.6 (outpatient procedures per 1000 insured persons). There is hardly any difference between the groups regarding a procedure with a supposedly clear indication and two procedures with a less defined indication. Further study of the causes of these differences on the individual patient level is necessary.     

Mortality and morbidity related to injuries from falls in British Columbia

Falls are a major health problem for persons aged 65 years and over. This study examined differences in patterns of fall-related injuries and deaths between age groups, sexes, and among Health Regions of BC. For those under the age of 65 years, fall-related injuries are highest among males, whereas for those 65 and over, falls among females exceed those among males by 2:1. For persons aged 65 and over, 84% of hospital days for unintentional injuries involve falls, with transportation and "other" unintentional injuries contributing 16%. While older women are hospitalized more often for fall-related injuries, more older men die from fall-related injuries. Hospitalization rates due to injuries from falls are highest in the Northern Regions of BC. Policy implications of the findings are discussed.     

Malnutrition in care home residents with dementia

Objectives: To investigate the malnutrition prevalence in Dutch care home residents with dementia over the years. Secondly, to examine the relationship of malnutrition and dementia and the role of care dependency and co-morbidity within this relationship. Design: This study is a secondary analysis of data of the annual independent Dutch National Prevalence Measurement of Care Problems of Maastricht University. The design involves a cross-sectional, multicenter point prevalence measurement. Setting: Care homes. Participants: 75399 residents older than 65 years (4523 resident with dementia) participated over 5 years (2006–2010). Sixty organizations measured 4 times, 31 organizations 3 times, 68 organizations 2 times, 511 organizations 1 time. Measurements: A standardized questionnaire was used to register amongst others data of weight, height, nutritional intake, undesired weight loss, comorbidity, dementia, and care dependency. Results: The study was able to show that there is a significant decline in malnutrition prevalence in the group of non-demented residents over the years (Non-demented group p <0.001). The prevalence of malnutrition in the demented group showed no significant reduction over the years. GEE analysis showed that malnutrition and dementia are related and that care dependency and age are important influencing factors in this relation. Conclusion: The results show that compared to the non-demented residents, the prevalence of malnutrition does not decline in demented care home residents over the years. Moreover, the findings of this study stress that malnutrition and dementia are related, while care dependency and age are confounding factors in this relationship.     

Trends and patterns in place of death for Medicare enrollees

Two changes in the Medicare program in 1983 may have affected where aged persons die--the change from retrospective hospital reimbursement to the prospective payment system and passage of the Medicare hospice benefit. Patterns and trends in where people die--hospitals, other institutions such as nursing homes, decedents' homes, and other places--for persons 65 years of age or over from 1980 through 1986 are examined. The proportion of deaths in hospitals declined somewhat after implementation of prospective payment. The hospice benefit may have caused the shift among cancer patients away from hospital deaths toward deaths at home.     

State-specific influenza vaccination coverage among adults--United States, 2006-07 influenza season

Adult groups included in the 2008 Advisory Committee on Immunization Practices (ACIP) recommendation for annual influenza vaccination include all persons aged >/=50 years, women who will be pregnant during the influenza season, persons aged 18-49 years with high-risk conditions, and other persons at increased risk for complications from influenza. Health-care personnel and household contacts and caregivers of persons at high risk also should receive annual influenza vaccination, as should adults who want to reduce their risk for becoming ill with influenza or for transmitting it to others. Healthy People 2010 influenza vaccination coverage targets are 90% among all persons aged >/=65 years and 60% among persons aged 18-64 years who have one or more high-risk conditions. Data from the 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys indicate that influenza vaccination coverage among adults for the 2006-07 season increased significantly compared with the 2005-06 season, reaching 35.1% among persons aged 18-49 years with high-risk conditions, 42.0% among all persons aged 50-64 years, and 72.1% among all persons aged >/=65 years. However, vaccination coverage remained well below Healthy People 2010 targets. Increasing influenza vaccination coverage among adults in the United States will require more cooperation among health-care providers, professional organizations, vaccine manufacturers, and public health departments to raise public awareness about influenza vaccination and to ensure continued distribution and administration of available vaccine throughout the vaccination season.     

Homebound status in a community-dwelling elderly population in Japan

The present study investigated the association between sociodemoraphic profiles, health condition and functional disabilities of subjects with a homebound status in a rural community setting. The subjects were residents aged 65 years or over in a mountain village of Japan. A comprehensive questionnaire was used to obtain their data. Among the 1,002 residents, the information of 866 residents (85%), who voluntarily completed the entire survey, was obtained for this study. All the subjects were native Japanese. Of the 866 subjects investigated, 301 (34.8%) were homebound as defined by the parameters of this study. Univariate analysis revealed age, female gender, functional impairment (vision, hearing and memory), all the ADL impairments, and the use of a portable toilet were associated with homebound status. Multivariate analysis revealed that older age, female gender, visual and two ADL impairments (moving inside the home and bathing) and use of a portable toilet remained significantly related to homebound status. Homebound elderly people have more functional limitation and disability related factor than their nonhomebound counterparts. Functional impairment, particularly in the mobility domain and sensory disturbances, was associated with homebound status. These data indicate the importance of assessment in the provision of home care for elderly people.     

Food habits and anthropometric measurements in a group of independent and institutionalized elderly people in Spain

Because of an increase in the number of elderly and the problems of nutrition associated with them, we considered it of interest to study the eating habits of 352 elderly persons (134 males and 218 females) 65 to 95 years of age in an urban area in the north of Spain (Oviedo). The purpose of this study was specifically to describe the differences in the eating habits of elderly institutionalized persons and those resident at home and to detect the nutritional status of 161 subjects living in institutions and 191 living at home. The weight, height, body mass index (BMI), and triceps skinfold (PTP) of each were recorded. To determine the eating habits, a questionnaire measuring the frequency of food consumption was distributed to the subjects. The mean age of the institutionalized elderly was greater than those living independently. The mean values of BMI indicated overweight in all cases, with values around those of obesity in independent females (BMI = 29.97). The value of PTP was found to be within normal limits, but a greater percentage of institutionalized subjects showed PTP values of less than P10 (males, 10.2%; females, 11%). Food habits showed that the consumption of fish and margarine/oil was greater in institutionalized subjects of both sexes. Independent males consumed more vegetables; females consumed more milk and greens. Milk, vegetables, fruit, and fish were the food groups with consumption frequencies less than those recommended. A greater percentage of noncompliance was seen among the institutionalized elderly.     

Recovery from disability in an older population. Results of long-term follow-up in Upper-Normandy (France)

BACKGROUND: The recovery of people initially disabled was addressed using the National Institute of Health and Medical Research Upper-Normandy survey, conducted on a representative sample of the older population from 1978 to 1999. METHODS: The survey was based on 1082 older people aged 65 and over. A follow-up was organized to register mortality and disability at point 3, 6, 10 and 20 years. Among the persons initially disabled were taken into account those who were able to go outside their home without help during the 20-year follow-up. Each case of recovery was validated. RESULTS: Among the 1046 subjects for whom data could be analyzed, 218 presented mobility disability necessitating help to go outside their home. Recovery from disability was observed in 23 subjects (10.5%; CI: 6.5-14.5). Among the 195 subjects (89.5%) without any recovery, 107 (49%) had died before 4 years, 44 (20%) had died between 4 and 6 years, and 44 (20%) survived with disability more than 6 years. The rate of recovery was 18.6% before age 80, and 4.1% for people aged 80 and over. It was 1.3% for home-confined or bed- or chair-confined people and 15.4% for the others. Before age 80 the recovery rate was significantly higher in women. No recovery was observed for people with mental deterioration. Cerebrovascular diseases were significantly associated with a low rate of recovery (5%). CONCLUSIONS: Recovery from disability should be taken into account for the health prospects of the elderly population. It concerns about one person out of five before the age of 80. Increased rate of recovery after the age of 80 should be one of the objectives for the health system in the future.     

Incidence of falling injuries leading to medical treatment in the elderly

The incidence of falling injuries leading to medical treatment was described by sex, age, marital status, education, amount of daily motion, self-perceived health, mechanism of fall and severity of injury. Material was collected regarding persons aged 65 years or over seeking medical treatment due to a fall during a period of one year. Altogether 3.8% of the elderly population (men: 2.5%; women: 4.4%) sought medical treatment due to a fall at least once during this year. When repeated falls were taken into account, the total incidence rate was 5.5 per 100 persons per year. The cumulative incidence rate (percentage of persons seeking medical treatment due to a fall) of women was higher than that of the men and in both sexes it increased with age. It was also higher for unmarried, widowed or divorced persons than for married ones, and higher in less educated persons than in better educated ones. It was also higher in persons with a low amount of daily motion or poor self-perceived health than in persons with a moderate or high amount of daily motion or good health status. The multivariate analyses based on log-linear models showed two-term interactions. A low amount of daily motion, poor self-perceived health and high age were independently related to the occurrence of a fall leading to medical treatment in both sexes.     

Reforming health care for the elderly--the example of Vorarlberg.

Vorarlberg--Austria's most western province with a population of about 325,000--has always implemented forms of social policy in which the principles of subsidiarity and solidarity play an important role. This is reflected in the structure of the organizations traditionally providing social services as well as in the more recent programmes the government has developed for social policy. This paper discusses two cases in point: the private associations for home care (Krankenpflegerverb?nde)--which now exist in 65 Vorarlberg communities and cover 85% of the population in the province--offering nursing services at home to members or to persons who are willing to join the organization when they need care, and the new organizational model, called Gesunder Lebensraum Vorarlberg (GLV), which is successfully operating in a few pilot communities. GLV has spawned umbrella organizations, run by volunteers, and offering a variety of social services relevant to the elderly, for example visiting services or neighbourhood help in case of emergencies. The volunteers get organizational help from a profit-making firm financed by the government. The Vorarlberg models can be interpreted as a step towards demedicalization and deinstitutionalization of health care for the elderly. Nevertheless, they also show the problems that arise when professionals and volunteers must cooperate. The models may lead to savings for the governments involved, although details are still subject to future empirical investigations.     

The 24-h distribution of falls and person-hours of physical activity in the home are strongly associated among community-dwelling older persons

OBJECTIVES: Most research on falls among older persons focuses on health-related factors that affect the ability to maintain balance. The objective of the study is to determine the association between physical activity and occurrence of falls among community-dwelling older persons. METHODS: The distribution of falls and person-hours of physical activity in the home over 24 h was compared. The falls data (n=501) were extracted from a pooled dataset of three follow-up studies conducted between 1994 and 2005 (n=3587). The 1995 Dutch National Time-Budget Survey provided hour-by-hour information on activities performed by older individuals (n=459) in the home; this sample was representative for the Netherlands. The association between the 24-h distribution of falls and physical activity and the risk of falling (the ratio between the distribution of falls and physical activity) were determined. Participants were community-dwelling older persons aged 65 years and older. RESULTS: More physical activity was positively associated with more falls (Spearman correlation=.89, p<.000). The risk of falling at night (1 a.m.-6 a.m.) was almost eight times higher compared to 7 a.m.-12 p.m. CONCLUSIONS: Physical activity is strongly associated with the number of falls in the home, measured over 24 h. Older persons may be at increased risk of falling if they are encouraged to become more physically active, or if they often get out of bed at night. Thus in addition to health-related factors, changes in level of physical activity should also be taken into account when estimating a person's risk of falling.