Recommendations on end-of-life care for people with dementia

Objective  

To establish, in collaboration with national Alzheimer Societies in Europe, practical and consensual recommendations for the end-of-life care of people with dementia. The aim of these recommendations is to provide a basis for understanding and action with regard to end-of-life care not only for family caregivers but also for professionals, policy makers and anyone with an interest in palliative care.     

老年痴呆患者健康状况分析

目的了解老年痴呆患者健康状况，分析老年痴呆可能的危险因素及痴呆对老年人健康状况的影响。方法回顾性分析经简易精神状态检测评分的104例老年痴呆患者和99例无痴呆的老年对照者的健康状况。从病史询问、体格检查、辅助检查人手，采用卡方检验方法对两组患者各观察变量进行统计学处理，分析老年痴呆可能的危险因素。结果老年痴呆患者中女性、高龄、低教育水平、卒中病史、手术史、肿瘤、肺部感染、重症骨关节病、低钙血症及高胆固醇血症的发生率更高（P〈0．05），其余两组比较差异无统计学意义（P〉0．05）。结论老年痴呆患者的危险因素是多因素的，同时老年痴呆恶化了患者的健康状况。     

Patient‐centred care training needs of health care assistants who provide care for people with dementia

It is well documented that Health care assistants (HCAs) provide the most hands‐on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person‐centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end‐of‐life, identifies the skills required for their work and examines the education provided against these skills. Semi‐structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person‐centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de‐escalation skills, both verbal and non‐verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem.     

Measuring the quality of inpatient health care

A validated case mix and severity adjusted performance measurement system and methodology are presented. Using this methodology in a user-friendly interactive interface, those who are interested in the performance of a hospital or providers within a hospital can easily identify areas for quality improvement.     

Obesity and receipt of personal care assistance for people with mobility impairments

OBJECTIVE: The purpose of this study was to evaluate the extent to which level of obesity was associated with hours of personal care among people with mobility impairments. RESEARCH METHODS AND PROCEDURES: The analytic sample consisted of 9496 respondents to the Adult Disability Follow-Back Survey (NHIS-D Phase II) who had mobility difficulty and difficulty with at least one activity of daily living or instrumental activity of daily living. Logistic regression analyses determined the relationship between level of obesity and receipt of any paid or unpaid help, controlling for potential confounders. In addition, differences in hours of help by level of obesity were evaluated using multiple regression. RESULTS: In the crude analysis, obese respondents were significantly less likely to receive any paid help than normal weight respondents (average odds ratio 0.75) and received significantly fewer hours of both paid and unpaid help. The difference in prevalence of receipt of any unpaid and any paid help by level of obesity was explained by adjustment for age and other demographic characteristics. Adjusted hours of paid and unpaid help were equivalent for those with and without obesity. DISCUSSION: Obese people with mobility impairments received less help with personal care than those of normal weight, although these findings are explained by demographics. Nevertheless, these findings raise public health concerns given the growing obesity epidemic in the United States and lack of available resources to support younger persons with disabilities.     

Accessibility of health clubs for people with mobility disabilities and visual impairments

OBJECTIVE: We sought to examine the accessibility of health clubs to persons with mobility disabilities and visual impairments. METHODS: We assessed 35 health clubs and fitness facilities as part of a national field trial of a new instrument, Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE), designed to assess accessibility of fitness facilities in the following domains: (1) built environment, (2) equipment, (3) swimming pools, (4) information, (5) facility policies, and (6) professional behavior. RESULTS: All facilities had a low to moderate level of accessibility. Some of the deficiencies concerned specific Americans with Disabilities Act guidelines pertaining to the built environment, whereas other deficiency areas were related to aspects of the facilities' equipment, information, policies, and professional staff. CONCLUSIONS: Persons with mobility disabilities and visual impairments have difficulty accessing various areas of fitness facilities and health clubs. AIMFREE is an important tool for increasing awareness of these accessibility barriers for people with disabilities.     

老年期痴呆患者经济负担研究

目的:研究上海市闵行区敬老院老年期痴呆患者的经济负担及相关的影响因素.方法:通过横断面调查,收集全区27家敬老院老年期痴呆患者每月缴纳费用和相关的影响因素,运用多元线性回归分析费用的影响因素.结果:多元线性回归分析表明,性别、年龄、职业、每月收入等人口学因素,敬老院性质和入住时间等社会学因素,以及痴呆严重程度和患有其他慢性疾病等疾病因素,是影响老年期痴呆患者费用的主要因素.结论:老年期痴呆的患病率和经济负担不断增长,政府部门在配置卫生资源时应充分考虑痴呆的疾病和经济负担,同时提高痴呆患者的康复和照料水平,改善痴呆老人的卫生保健现状.     

Work absenteeism of the nursing personnel of Valencia hospitals]

A survey was carried out on a sample of 973 nurses from hospitals in the Valencian Region. The objective was to study work absenteeism due to health reasons depending on socio-demographic factors, work organization and self perception of health status. Information was collected by means of a self-administered questionnaire. Duration and frequency of absenteeism was analysed over the previous twelve months. A 34.4% of female nurses and 35.4% of male nurses reported at least one episode, with an average length of 21 and 26 days respectively. There is a relation between absenteeism and self-perception of health status. We did not find man/woman differences with regards to absenteeism.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.     

Bringing care to the people: Lillian Wald's legacy to public health nursing.

Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service.     

Eliminating health and health care disparities among the growing population of people with disabilities

Fifty-four million people in the United States are now living with disabilities. That number will grow substantially in the next thirty years, as the "baby-boom" generation ages and many of today's children and young adults mature and experience complications related to overweight and obesity. This reality poses a major challenge to the health care and policy communities. People with disabilities confront disadvantages from social and environmental determinants of health, including lower educational levels, lower incomes, and higher unemployment, than people without disabilities. Those with disabilities are also much more likely to report being in fair or poor health; to use tobacco; to forgo physical activity; and to be overweight or obese. People with disabilities also experience health care disparities, such as lower rates of screening and more difficulty accessing services, compared to people without disabilities. Eliminating these multifaceted disadvantages among people with disabilities should be a critical national priority.     

Organizing health care for people with seizures and epilepsy

The day-to-day responsibilities of managing seizures and epilepsy fall most heavily on patients and their families. Unfortunately, health care services in the United States are not organized to identify, diagnose, and treat people with seizures effectively nor are they delivered in such a way that patients and their families can engage in a positive, collaborative relationship with health care providers. This article describes a model of chronic illness care as applied to seizures and epilepsy, that is, how care should be structured to help people with seizures live as well as possible.     

Attitude of medical personnel to the health care reform

A total of 953 managers and doctors, specializing in various spheres at therapeutic-and-prevention facilities, were polled on the basis of questionnaires for the purpose of assessing the healthcare personnel attitude towards the changes occurring in society and inside their branch. The thus obtained results are presented in the article.     

Bioactive properties of milk proteins with particular focus on anticariogenesis

Beyond nutrition, there is an increasing amount of data and information to demonstrate a bioactive role for dairy components in adults including a role in prevention of dental caries. Specifically, the casein fraction and hydrolysates thereof have been the focus of researchers investigating cariogenicity prevention. Tooth enamel is a polymeric substance consisting of crystalline calcium phosphate embedded in a protein matrix. Dental caries develop by acidic demineralization (calcium and phosphorus solubilization) of tooth enamel. Demineralization occurs directly (acidic food consumption) or indirectly (by fermentation products of dental plaque odontopathogenic bacteria growing on residual food particles between teeth or adhering to the plaque). Research efforts with milk derived bioactive peptides have focused on inhibition of cariogenic, plaque-forming bacteria, inhibition of tooth enamel demineralization, and subsequent enamel remineralization. Caseinophosphopeptides (CPP) and glycomacropeptide (GMP) have been patented for use in common personal hygiene products to prevent dental caries. Research has shown CPP and GMP to be growth inhibitory to the cariogenic bacteria Streptococcus mutans and other species. Additionally, CPP forms nanoclusters with amorphous calcium phosphate (AMP) at the tooth surface to provide a reservoir of calcium and phosphate ions to maintain a state of super saturation with respect to tooth enamel. This would buffer plaque pH, and also provide ions for tooth enamel remineralization. Glycosidic structures attached to GMP are important to numerous bioactive properties of the peptide including anticariogenicity. Like CPP, GMP has shown inhibitory activity to enamel demineralization and promotes tooth enamel remineralization.