Abuse and neglect of elderly persons by family members. A special communication

Abuse and neglect of elderly persons, particularly by adult family members, is a serious social and health phenomenon that cannot be ignored. Physical therapists who deal with elderly persons must prepare themselves to recognize signs of abuse and neglect and to become familiar with existing intervention agencies and outlets for prevention. Awareness that the problem exists and improved detection and intervention procedures are needed to prevent abuse and neglect of elderly persons from becoming more widespread.     

Alternate forms reliability of the assessment of motor and process skills

The purpose of this study is to examine the alternate forms reliability of the AMPS (Assessment of Motor and Process Skills) (Fisher, 1997a) where alternate forms means different pairs of AMPS tasks. The participants for this study were persons selected from the AMPS database who had performed four AMPS tasks. The participants varied in age, gender, diagnosis, and level of assistance needed to live in the community. The AMPS was administered by trained and calibrated occupational therapists according to standardized procedures. The data for the 91 participants were subjected to 12 many-faceted Rasch analyses to generate ADL motor and ADL process ability measures for each task and each set of paired tasks. Repeated measures ANOVAs revealed no time effect across the four AMPS tasks. Pearson product moment correlations between Tasks 1 and 2 combined and Tasks 3 and 4 combined were r = .91 and r = .86 for the ADL motor and ADL process scales, respectively. Calculation of the standardized difference (z) revealed that no more than 8% of the participants had ADL motor or ADL process ability measures that differed significantly between observations once we accounted for real differences in a persons performance; 80% of the paired ADL motor and ADL process ability measures remained stable within +/- 0.5 logits when the participants performed two tasks. The AMPS ADL motor and ADL process scales can be used reliably in clinical practice and for research purposes.     

Comparison of Activities of Daily Living Ability of Older Adults Who Are Homebound and Nonhomebound

ABSTRACT

The objective of this study was to compare the activities of daily living (ADL) ability of older adults who were chronically homebound to older adults who were nonhomebound.

The participants were 40 older adults 60 years of age or older, 20 homebound and 20 nonhomebound. The two groups did not differ in mean age, gender distribution, ethnicity, marital status, living situation, or type of housing. The older adults who were homebound had significantly more conditions than those who were nonhomebound.

T tests revealed statically significant differences in the mean Assessment of Motor and Process Skills ADL motor and ADL process ability measures of older adults in the homebound and nonhomebound groups, with the latter group demonstrating higher ADL ability measures. Based on a power analysis indicating a need for 10 persons in each group, the nonhomebound group was subsequently divided into two subgroups, those who needed assistance to perform ADL from paid staff and/or family members and those who performed ADL independently. The results of two analyses of variance revealed that participants who were chronically homebound and those who were nonhomebound and had assistance had significantly lower ADL motor ability and ADL process ability than those who were nonhomebound and independent. The homebound group and the nonhomebound group with assistance did not differ significantly in ADL motor or ADL ability.

The findings support the need for occupational therapists to provide services for older adults who have ADL limitations regardless of their homebound status.     

Occupational therapy practice patterns with older Swedish persons at home

This paper explores and describes occupational therapy practice patterns during two periods for 89 elderly persons living at home. Occupational therapists working in one social welfare district in Stockholm, Sweden documented and reported every occupational therapy intervention provided. The results revealed that the elderly persons who received occupational therapy services during an extended period had an age span of 30 years, with a mean age over 80 years. They had several medical problems and were living in different types of settings. Occupational therapists provided a wide range of interventions, most frequently categorised as treatment, especially related to leisure activities. Irrespective of level of care, the median of interventions per person increased or was the same over time, and 72% of the elderly persons remained at the same level of care. Enabling occupation for elderly disabled person living in their home involves constantly adjusting to the current situation since the clients' capacities, goals and environment change over time. Therefore, occupational therapists need to have a client-centred approach working in home health community services.     

Effects of Intervention with To-balance Exercise on the Elderly Requiring Assistance and Lower Levels of Care

[Purpose] To examine the effects of intervention combining individualized and group rhythm (To-balance) exercises on the mental and physical functions of the elderly requiring low level care. [Subjects] A total of 29 elderly persons requiring level 2 assistance to level 2 who were and using outpatient care services participated in this study. [Methods] The participants were randomly allocated to 2 groups: To-balance, and Sitting. The former group performed individualized and To-balance group exercises, while the latter group performed individualized exercise, as well as group exercise while sitting on a chair. The effects were evaluated through somatometric, physical fitness, and mental function measurements before and 3, 6, and 9 months after the initiation of the intervention. [Results] The lower-limb muscle strength and mental function significantly improved in both groups. Particularly, in the To-balance group, early improvement in balance and gait ability were observed. [Conclusion] The To-balance exercise may be useful for quickly improving the elderly’s static balance ability.Key words: Elderly persons, Rhythm exercises, Balance ability     

Validity of using the Assessment of Motor and Process Skills to estimate overall home safety in persons with psychiatric conditions.

OBJECTIVE: Occupational therapists often base estimates of home safety on their behavioral observations of a client performing functional activities during a hospitalization. To examine this practice, this study investigated the predictive validity of the Assessment of Motor and Process Skills (AMPS) to the overall home safety of persons with psychiatric conditions associated with cognitive impairments. METHOD: Ability in activities of daily living (ADL) of 20 participants was evaluated with the AMPS before discharge from an inpatient psychiatric unit. Within approximately 2 weeks of their discharge, the participants' home safety was evaluated within their home settings using the Safety Assessment of Function and the Environment for Rehabilitation. To form a basis for comparison, a second administration of the AMPS was administered concurrently with the home safety evaluation. RESULTS: Moderate positive relationships were found between ADL motor and ADL process ability and home safety in both the clinic and the home; however, analyses of the sensitivity, specificity, and overall predictive values revealed that home ADL process ability was the best predictor of home safety for participants who were categorized as less safe in the study. CONCLUSION: Findings suggest that clinic ADL evaluations using the AMPS give a reasonable estimate of home safety for participants categorized as having more home safety risk. For participants categorized as having less home safety risk, clinic ADL evaluation using the AMPS produced significantly less accurate estimates than ADL evaluations conducted in the home. These results indicate that home safety estimates may be most accurate if they are based on home rather than clinic ADL process ability measures.     

Transitional care for seriously mentally ill persons: a pilot study

This article reports the results of a pilot study of a nurse-based in-home transitional care intervention for seriously mentally ill persons. The goals of the intervention were to address the lack of continuity of care in existing programs and to meet the immediate postdischarge needs of severely mentally ill persons. This article focuses primarily on the applicability and feasibility of the intervention for this population, given the challenges of engaging seriously mentally ill patients in a community-based protocol and the complexity of their illnesses. Factors that are important to community adjustment postdischarge were identified: caregiver concerns and health status impeding illness management, lack of structure/involvement in daily activities, structural and functional factors affecting adherence, and presence of symptoms after discharge. Use of an advanced practice nurse to provide transitional care can offer an alternative to patients who might otherwise be left poorly treated or untreated in the community setting.     

A comparison of the individualized education plan and the individualized family service plan.

The individualized education plan (IEP) and the individualized family service plan (IFSP) are mandated for children with special needs. Occupational therapists participate in the development of both the IEP and the IFSP. This paper summarizes the similarities and the differences in the mandated components. The components addressed are (a) information about the child's status, (b) information about the family, (c) outcomes for the child and family, (d) intervention services, (e) other services, (f) dates and duration of services, (g) selection of a case manager, and (h) transition plans.     

过渡期护理模式对COPD病人家属疾病不确定感和应对方式的影响

[目的]探讨过渡期护理干预对慢性阻塞性肺疾病（COPD）病人家属疾病不确定感和应对方式的影响.[方法]将81名COPD病人家属随机分为干预组和对照组,干预组病人以过渡期护理模式（TCM）为依据实行护理干预,对照组予常规护理.病人住院时和出院后8周采用疾病不确定感家属量表和简易应对方式量表对病人家属进行评估.[结果]干预后两组COPD病人家属疾病不确定感明显降低,干预组应对方式各维度得分均优于对照组（P＜0.05）.[结论]运用TCM为COPD病人家属提供过渡期护理,有利于降低家属的疾病不确定感,提高其应对能力.     

Long-term care of the aged: ethical dilemmas and solutions

This article identifies the need to rethink beliefs and assumptions about the bioethics of long-term care of elderly people. An unconventional way of conceptualizing autonomy is explored that may help occupational therapists support and maintain the independence of older frail and dependent persons. In addition, the partnership model of bioethics is introduced-that is, an ethical framework that makes partners of family members in health care decisions affecting the older adult.     

Functional outcomes and daily life activities of African-American elders after hospitalization.

OBJECTIVE: African-American elders were recruited from a transitional unit after hospitalization and tracked for 6 months in the community after discharge to (a) examine functional outcomes on the unit and in the community and (b) identify patterns of participation in daily life activities. The International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) framework provided the structure to examine the connections among body systems, functional outcomes, and social participation for this population that has been underrepresented in past research. METHOD: A mixed design combined qualitative and quantitative methods, including qualitative interviews to document personal adaptive experience, a standardized functional assessment to identify functional outcomes, and a structured format to record activity participation. RESULTS: Findings revealed that 11 of the 17 participants improved their functional outcomes after discharge. Three patterns of activity participation identified were self-care, self-care and household management, and mixed activities. Contextual influences were diverse family support arrangements. CONCLUSION: Complex relationships were identified among body systems, functional outcomes, and daily life activities that were influenced by individual values and support arrangements.     

Implementing transitional care in skilled nursing facilities: Evaluation of a learning collaborative

Proctor's Framework for Implementation Research describes the role of implementation strategies and outcomes in the pathway from evidence-based interventions to service and client outcomes. This report describes the evaluation of a learning collaborative to implement a transitional care intervention in skilled nursing facilities (SNF). The collaborative protocol included implementation strategies to promote uptake of a transitional care intervention in SNFs. Using RE-AIM to evaluate outcomes, the main findings were intervention reach to 550 SNF patients, adoption in three of four SNFs that expressed interest in participation, and high fidelity to the implementation strategies. Fidelity to the transitional care intervention was moderate to high; SNF staff provided the five key components of the transitional care intervention for 64–93% of eligible patients. The evaluation was completed during the COVID-19 pandemic, which suggests the protocol was valued by staff and feasible to use amid serious internal and external challenges.     

Involving family members in physiotherapy for older people transitioning from hospital to the community: a qualitative analysis

Abstract

Purpose: To generate an understanding of the opinions of key people associated with a program for older people transitioning from hospital back to the community and explore their thoughts around training family members to help provide physiotherapy. Method: A qualitative study using focus groups and semi-structured interviews was conducted. Participants included patients admitted to a transitional care program, their family members, physiotherapists working in transitional care and members of a consumer group from the health service where the transitional care program was based. Data were transcribed verbatim and a thematic analysis was conducted. Results: Four patients, four family members, four consumer group members and eight physiotherapists participated in this study. Three themes emerged: family members providing physiotherapy may improve outcomes for patients; training family members to provide physiotherapy should include key elements and be individualised; and involving family members in physiotherapy may impact positively and negatively on people and relationships. Conclusions: Older people transitioning from hospital to the community are at risk of functional decline and may receive very little physiotherapy. Training family members to assist with physiotherapy was perceived as a way to improve patient outcomes and relationships between patients and their family, although there were concerns raised about caregiver stress. Evaluation of the feasibility and effectiveness of this approach is warranted.

• Implications for Rehabilitation

• Older people transitioning from hospital to the community are at risk of functional decline and often receive very little physiotherapy.

• Training family members to assist with simple physiotherapy programs may increase the amount of physiotherapy patients transitioning from hospital to the community can receive and improve functional outcomes for patients.

• Stakeholders perceive that individualising a program to patient and family member needs is important.

• Involving family members in physiotherapy may not increase caregiver stress and may improve relationship dynamics between patients and family members.

     

老年精神障碍人群社区延续照护需求调查及社会干预对策

目的：通过对老年精神障碍疾病出院患者追踪调查,提出社区长期延续照护及社会干预对策。方法采用入户调查法,以2010-2012年525例老年精神障碍疾病出院患者为研究对象,采用老年抑郁量表（ GDS）和日常生活活动能力量表（ ADL）对该人群社区和家庭长期照护及医疗护理服务供需情况进行调查。结果525例出院老年精神障碍患者经GDS量表测量,得分1～10分者86例,视为无郁症,占40％;11～20分者79例,显示轻度抑郁,占36．74％;21～30分者50例,显示重度抑郁,占23.25％。 ADL得分＜35分者422例,提示个人自理能力存在不同程度障碍者,占80．38％;40～100分者103例,提示部分或者完全能够自理,占19．62％。525例老年精神障碍疾患者群社区延续照护,主要依靠家庭,由家庭成员照护占68．95％,由保姆或者钟点工照顾者占11．43％,由养老机构和医疗机构专业护理人员进行照护占19．62％。社区老年人长期照护需求和医疗护理服务供给相比有很大差距。结论老年精神障碍疾患者群的长期照护和社会支持问题是老年学领域亟待解决的民生问题,应依据实际情况给予社会性干预。     

Recruitment of a rural, southern, predominantly African-American population into a diabetes self-management trial

We are conducting a community-based cluster-randomized trial in rural Alabama, testing a peer-support intervention designed to improve diabetes self-care behaviors. We describe recruitment and data collection approaches used, focusing on strategies that created community partnerships and facilitated recruitment in underserved, rural, largely minority communities. Key recruitment and data collection strategies included early community engagement; pilot testing of procedures; inclusion of community members as study team members, recruiters, and data collectors; data collection at community venues to minimize participant travel requirements; and provision of a multi-disciplinary diabetes education program to both intervention and control participants. A total of 424 participants were recruited and enrolled (400 targeted). Of the 759 referrals received, 78.9% (n=599) successfully completed telephone screening. Of these, 78.8% (n=472) were eligible and scheduled for a local enrollment day, and 81.4% (n=384) attended and enrolled in the study. In addition, community members who walked in and expressed interest were screened, and 40 eligible and willing individuals were consented and enrolled. We exceeded recruitment goals in underserved, rural communities in Alabama. This success was due in large part to community partnerships that facilitated community involvement on several levels: engaging the community early in study proposal and design; hiring community members to fill various capacities as research team members, recruiters, and data collectors; conducting data collection within communities; and collecting additional contact information to maintain communication. Providing diabetes education to all participants, including intervention and control, helped ensure that everyone stood to benefit and likely enhanced overall participation.     

Discharging older adults with a severe and chronic mental illness in the community

In recent years, a deinstitutionalization movement has been occurring in Canadian psychiatric institutions. Occupational therapists, experts in evaluating occupational performance, are key contributors to the selection of appropriate community housing environments. This study describes the global functioning, performance in activities of daily living, social behavior, cognitive status, and quality of life of 33 older adults with a severe and chronic mental illness, who were transferred from a psychiatric hospital to community facilities between 1995 and 1998. Evaluations were repeated five times, twice before discharge and three times after the transfer. Participants demonstrated stability in their global, social and ADL functioning over time. In general, participants required occasional intervention for management of social behaviors, moderate assistance in activities of daily living, and were highly satisfied with their community accommodation. The transfer to community settings did not lead to a significant deterioration in the participants' levels of global functioning and quality of life.     

The ratio of impaired elderly in the community to those in nursing homes in two rural Iowa counties

The Iowa 65+ Rural Health Study gathered health status information on all elderly persons living in two rural Iowa counties. In this report these data are used to determine the ratio of persons with activities of daily living (ADL) dependencies living in the community to those in institutions. Results indicated that the "community/institutional dependency ratio" is about 1 to 1 for these counties, which is about half the ratio representing conventional wisdom. Possible explanations for this difference are discussed. In addition, it was found that the level of ADL dependency (need) can serve alone as an almost certain predictor of institutionalization for some elderly. For others, ADL dependency (need) is only one factor. The likely variability of the community/institutional dependency ratio across different geographic areas has implications for government funding of home health care, for long-term care insurance, and for eliminating excess demand. These implications are discussed.     

Pediatric occupational therapy in the home

This article discusses the challenges and implications for pediatric practice in the home. Pediatric occupational therapists are moving the treatment setting from the clinic to the home. Working within the home environment requires occupational therapists to adapt their roles, functions, and treatment styles. Intervention frequently involves practical and relevant treatment, using activities and objects from the child's world. Thus, functional goals may be more realistically achieved in the child's living environment. Involvement with family members also offers opportunities to develop collaborative relationships with parents and, therefore, to integrate the intervention program into the child's home life.     

居家长期照护老年人的压疮发生及风险因素调查与分析

目的了解居家长期照护老年人发生压疮情况及发生压疮风险因素。方法采用分层整群抽样法对909例老年人进行一般人口学资料调查及采用日常生活活动能力量表、工具性日常生活活动能力量表、Norton量表等对其进行测评,分析各相关因素对压疮发生的影响。结果居家长期照护老年人压疮发生率为25.8%;压疮的好发部位为骶尾部、髋部和足跟部;卧床分级、工具性日常生活活动能力和Norton量表压疮发生危险因素是压疮发生的重要影响因素。结论居家长期护理老年人压疮发生率较高,在社区和居家护理中需采取相对应的预防和干预策略。