Improving attitude towards elderly people: Evaluation of an intervention programme for caregivers

There is yet no specific Government policy on care of the elderly in Nigeria despite increase in its awareness as well as the number of people reaching old age. This study was carried out to assess the attitude of caregivers in seven out of the eleven wards in Ilorin metropolis. The caregivers consisted of daughters (44.4%), sons (18.3%), family-relation (24.6%), employees (1.4%), neighbors (4.5%) and community members (6.8%). The data collection toll was a structured questionnaire consisting of three parts designed to determine the socio-demographic characteristics, general and specific attitude to the care of the elderly. Effect of Health Education on attitude of caregivers concerning the care of the elderly was also evaluated. Based on the scoring system, the attitude of the caregivers was found to be fairly positive and after the Health Education intervention, a significant improvement in the attitude of caregivers was recorded. The Mean (SD) score increased significantly from 78.4 +/- (14.6) pre-intervention to 96.8 +/-(15.2), post-intervention, p-value < 0.05. Religious teaching (35.9%), traditional/customary obligation (28.7%) and personal feeling (21.1%) were the most influencing factors of attitude of caregivers towards the care of the elderly. The influence of educational status of caregivers on where the elderly should be taken care of was found to be non statistically significant (p > 0.05). Gender had overall positive effect on attitudinal measurement. The deduction from this study is that care of the elderly is still being valued despite lack of specific government policy and support. The negative attitude of caregivers to institutional care may be difficult to change through health education intervention because care of the elderly at home is still being greatly valued in this country as it is seen as a responsibility of children and other family members. Institutional care is also considered as an abomination and irresponsibility by some caregivers Keywords: attitude, caregivers, elderly, intervention and health education.     

Development of a nursing care problems coping scale for male caregivers for people with dementia living at home

Objective: The number of male caregivers has increased, but male caregiversface several problems that reduce their quality of life and psychological condition. Thisstudy focused on the coping problems of men who care for people with dementia at home. Itaimed to develop a coping scale for male caregivers so that they can continue caring forpeople with dementia at home and improve their own quality of life. The study also aimedto verify the reliability and validity of the scale.Patients/Material and Methods: The subjects were 759 men who care for peoplewith dementia at home. The Care Problems Coping Scale consists of 21 questions based onelements of questions extracted from a pilot study. Additionally, subjects completed threeself-administered questionnaires: the Japanese version of the Zarit Caregiver BurdenScale, the Depressive Symptoms and the Self-esteem Emotional Scale, and RosenbergSelf-Esteem Scale.Results: There were 274 valid responses (36.1% response rate). Regarding theanswer distribution, each average value of the 21 items ranged from 1.56 to 2.68. Themedian answer distribution of the 21 items was 39 (SD = 6.6). Five items had a ceilingeffect, and two items had a floor effect. The scale stability was about 50%, andCronbach’s α was 0.49. There were significant correlations between the Care ProblemsCoping Scale and total scores of the Japanese version of the Zarit Caregiver Burden Scale,the Depressive Symptoms and Self-esteem Emotional Scale, and the Rosenberg Self-EsteemScale.Conclusion: The answers provided on the Care Problems Coping Scalequestionnaire indicated that male caregivers experience care problems. In terms ofvalidity, there were significant correlations between the external questionnaires and 19of the 21 items in this scale. This scale can therefore be used to measure problems withcoping for male caregivers who care for people with dementia at home.     

优化资源配置，开展临终家庭护理

近期来自英国国家审计办公室（National Audit Office,NAO）的一份报告显示：在英国,大多数患者希望在自己的家中去世,即使医院临终护理的费用可以用于家庭护理,但每年依然有成千的临终患者被毫无意义地辗转到医院进行护理。     

老年公寓老年人死亡原因分析

目的:调查分析入住老年公寓的老年人死亡的主要原因,促进社会化养老的发展。方法:对2008年1月至2011年12月入住我院老年公寓老年人用自制一般情况调查表、《日常生活能力量表》(ADL)进行调查,对死亡前的表现及导致死亡的主要原因进行统计分析。结果:死亡组:平均年龄(79.97±6.79)岁,较总体平均年龄无明显差异;ADL评分明显增高,为(45.00±10.32)分。导致死亡的主要原因是:多脏器功能衰竭(19例)、心力衰竭(9例)、癌症(4例)、猝死(3例)。慢性衰竭患者濒死的主要表现是:四肢皮肤湿冷、腕处脉搏上移、额纹舒展、潮式呼吸等。结论:入住我院老年公寓的老年人患病种类多,主要死亡原因是各种疾病导致的脏器(特别是心脏)功能衰竭,应加强养老机构的医疗服务(特别是抢救)能力。     

滨州市农村居家老人的健康状况

目的 了解滨州市农村居家老人的健康状况,进一步探索影响老人健康状况的相关因素,为政府相关部门制定农村居家老人的健康促进政策提供参考依据。方法 采用自制的一般情况调查问卷及SF-36健康调查简表为研究工具,对滨州市农村地区465名老年人进行问卷调查。结果 滨州市农村居家老年人健康状况不是很理想,生理功能(PF)、生理职能(RP)、肌体疼痛(BP)、总体健康(GH)、社会功能(SF)、情感职能(RE)6个维度均低于常模得分,P<0.05;而活力(VT)和心理卫生(MH) 2个维度高于常模,P<0.05。滨州市农村居家老年人的健康状况在8个维度与性别、年龄、婚姻状况、居住方式、月收入等有关,P<0.05。结论 滨州市农村地区老年人的整体健康状况不是很理想,政府相关部门应针对本地区老年人的实际状况给予合理的健康促进。     

Carers’ concern for older people falling at home: an integrative review

Falls, the leading cause of injury and death among older people, can have a significant psychosocial impact on carers. Carers play a crucial role in caring for older persons at home and in fall prevention. This review, which included 15 studies, aimed to identify carers’ concern about older people falling and its impact. We identified that most carers had concerns about repeated falls in older people, unknown consequences of falls and care recipients’ non-adherence to fall prevention advice. These concerns, in turn, affect carers’ physical and psychological health, lifestyle, caregiving burden and use of fall prevention strategies. This paper highlights the importance of recognising carers’ fall concern so as to identify carers’ needs and awareness of fall prevention in older people living at home. Greater insight into carers’ fall concern could facilitate the implementation of new strategies to manage older people’s fall risk as well as improve carers’ well-being.     

Aids and adaptations for the elderly at home: underprovided, underused, and undermaintained

A random sample of 140 elderly people aged over 75 was selected from the age-sex register of an urban general practice to assess the provision and use of aids and adaptations in their homes. Many of the aids that the elderly had were faulty, including half of the walking aids and 15% of hearing aids, reading spectacles, and dentures, and up to half of the aids were not used. Yet despite this underuse there were many disabled elderly people who required aids for the bath and toilet. When screening of elderly people is carried out in general practice assessment of aids and adaptations should be included to see that they are provided where needed, are used, and are adequately maintained.     

老年人的预防性家访——随机对照试验不能判断其有效性

在预防保健工作中 ,“缺少证据并非没有证据”这条古老的格言甚为重要。Ｅｌｋａｎ等所作的汇总分析 (见本期 2 2 1页 )、Ｓｔｕｃｋ及Ｈａａｓｔｒｅｇｔ等所作的系统性回顾 ,与他们自己及其他研究人员所作的随机对照试验出现明显矛盾 ,这一结果并不奇怪1 3 。在死亡率、机构设置和功能的特定测量方面并不能肯定老年人预防性家访的有效性 ,但最重要的是不能因此而终止此项服务。ＶａｎＨａａｓｔｒｅｇｔ论文发表后 ,在读者来信中已发现了汇总分析和系统性回顾的某些局限性3 。尽管这些随机对照试验的研究方法对于评估医疗介入的有效性是最…     

Gender disparities in the receipt of home care for elderly people with disability in the United States

Context  Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources. Objective  To address gender differences in receipt of informal and formal home care. Design, Setting, and Participants  Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older. Main Outcome Measure  Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors. Results  Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19.7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4). Conclusion  Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.      

The hospitalisation of death: should more people die at home?

With the increase in the proportion of hospital deaths there is increasing debate about appropriateness of place of death. Death should be a family affair but is increasingly hidden from public view. In contrast to those who die at home, most of those who die in hospital die alone with no relatives or friends with them. Husbands and wives are less likely to have the opportunity to say 'goodbye' to their dying spouses. As people become less familiar with death they may increasingly assume that the terminally ill are better cared for in hospital. However, this need not be the case. Most people want to die at home, most do not for social rather than medical reasons. It is not the illness itself which leads to hospital admission in many cases but its duration and nature--and the type of burden it places on relatives. Although home care should be encouraged where possible, no amount of exhortation to the family or to the dying person of the advantages of home care can disguise the fact that demand for domiciliary services is greater than is now being provided. The paper is based on one read to a London Medical Group Symposium.     

Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis

Context  The effects of home visitation programs to prevent functional decline in elderly persons have been inconsistent, and the value of these programs is controversial. Objective  To evaluate the effect of preventive home visits on functional status, nursing home admission, and mortality. Data Sources  Studies published in English, French, German, Italian, or Spanish reporting randomized trials of the effects of preventive in-home visits in older people (mean age >70 years) living in the community were identified through searches of MEDLINE, PSYCHINFO, and EMBASE (January 1985–November 2001). We also searched the Cochrane Controlled Trials Register, checked reference lists of earlier reviews and book chapters, searched conference proceedings and specialty journals, and contacted experts. Study Selection  We screened 1349 abstracts and excluded those that did not test in-home interventions or in which the mean age of the study population was younger than 70 years. After further exclusions, 17 articles describing 18 trials were analyzed. Data Extraction  Two reviewers independently screened abstracts. Discrepancies were resolved by consensus with a third reviewer. For each included trial, we extracted data on the study population and the characteristics of the intervention. Two of us extracted information on 3 end points: nursing home admissions, mortality, and functional status. One of us assessed trial quality, including an examination of the method of randomization, blinding of caregivers and research staff ascertaining outcomes, and proportion of patients included in analyses of the 3 end points. Data Synthesis  The 18 trials included 13 447 individuals aged 65 years and older. The effect on nursing home admissions depended on the number of visits performed during follow-up. The pooled relative risk (RR) was 0.66 (95% confidence interval [CI], 0.48-0.92) for trials in the upper tertile (>9 visits) but was 1.05 (95% CI, 0.85-1.30) in the lower tertile (0-4 visits). Functional decline was reduced in trials that used multidimensional assessment with follow-up (RR, 0.76; 95% CI, 0.64-0.91) but not in other trials (RR, 1.01; 95% CI, 0.92-1.11). Functional decline was reduced (RR, 0.78; 95% CI, 0.64-0.95) in trials with a control group mortality rate in the lower tertile (3.4%-5.8%) but not (RR, 0.98; 95% CI, 0.84-1.13) in those with a control-group mortality rate in the upper tertile (8.3%-10.7%). A beneficial effect on mortality was evident in younger study populations (RR, 0.76; 95% CI, 0.65-0.88 for ages 72.7-77.5 years) but not in older study populations (RR, 1.09; 95% CI, 0.92-1.28 for ages 80.2-81.6 years). Conclusion  Preventive home visitation programs appear to be effective, provided the interventions are based on multidimensional geriatric assessment and include multiple follow-up home visits and target persons at lower risk for death. Benefits on survival were seen in young-old rather than old-old populations.      

预防老年人跌倒——我们需要将干预措施瞄准那些最有可能获益的人群

1960年，Sheldon将有关跌倒的文献描述为“罕见”。而现在已发表了大量的文献涉及这一主题，以至于难辨真伪，在制定政策和临床实践时难以找出有用的信息。我们知道，生活在社区中的65岁以上的老年人群中，每年有超过30％的人会发生跌倒，许多人跌倒不止一次，而且跌倒的危险性随着年龄的增长而增加。     

正念减压疗法对癌症患者照顾者干预效果的meta分析

目的 评价正念减压疗法(mindfulness-based stress reduction,MBSR)在癌症患者照顾者中的应用效果.方法 收集建库至2020年6月30日公开发表的随机对照研究,系统检索Cochrane Library、Pubmed、Embase、中国生物医学文献数据库、中国知网、万方数据库及中国维普全文数据库,按照纳入与排除标准筛选文献,对其进行质量评估和数据提取后,用RevMan5.3软件进行meta分析.结果 共纳入5篇文献,197例患者.与对照组相比,MBSR可显著提高癌症患者照顾者的正念水平,差异有统计学意义(MD=6.70,95％CI:1.45～11.95,P=0.01);而在焦虑(MD)=-0.68,95％CI:-2.55～1.19,P=0.47)、抑郁(MD)=-1.30,95％CI:-3.12～0.51,P=0.16)及照顾者负担(MD=1.77,95％CI:-3.90～7.45,P=0.54)方面,差异均无统计学意义.结论 MBSR可改善癌症患者照顾者的正念水平,但对降低癌症患者照顾者的焦虑、抑郁水平及照顾者负担作用不明显,未来仍需开展更多研究以验证MBSR在癌症患者照顾者中的应用效果.     

养老院老年人身体活动能力与跌倒的相关性研究

目的:研究老年人多方面身体活动能力与跌倒的相关性,为评估老年人的跌倒风险提供一定的理论依据.方法:对171名65岁以上老年人通过握力、闭眼单脚站立、起立-行走计时测试(TUGT)和6 min行走试验(6MWD)对各方面身体活动能力进行测定,对老年人近一年来跌倒情况、体力活动水平情况进行问卷调查.结果:被调查人群老年人跌倒的发生率为31.0％,在跌倒与未跌倒人群中,未发现二者之间存在年龄、身高、体质量的统计学差异.跌倒人群闭眼单脚站立时间和6MWD低于未跌倒人群,TUGT高于未跌倒人群,均有统计学差异(P＜0.05),但两者之间握力无显著差异.女性低体力活动水平与跌倒发生有关.Logistic回归分析结果显示,闭眼单脚站立时间、TUGT、6MWD和体力活动水平与老年人跌倒发生有关.结论:老年人身体平衡能力下降、肌肉耐力和行走能力减退可能会导致老年人跌倒发生率增加,临床上可以采用TUGT、6MWD和闭眼单脚站立来评估老年人的跌倒风险.