Dependency levels of elderly people in institutional care in Canterbury

All elderly persons in long term or social relief institutional care in the Canterbury area were assessed using a rating scale which assessed self care, continence, orientation and social integration. There was no difference in dependency in residents in homes provided by religious and welfare organisations compared with residents in homes provided by the private sector. Organisations providing a comprehensive service with flats, residential and hospital sections had lower dependency residents in the residential care section than institutions that provide home care alone. Public hospital long stay patients were significantly more dependent than private sector long stay patients. Of all subjects in residential homes and long term hospitals in Canterbury 49.3% were essentially independent in the dimensions assessed. This study adds further data concerning patterns of dependency of elderly subjects in institutional care.     

Functional disability in residents of Auckland rest homes

OBJECT: to measure the extent of disability in residents of Auckland rest homes and to document any differences between religious and welfare homes and commercial homes. METHODS: analysis of a 36 item questionnaire on 2087 residents in 32 religious and welfare homes and 3126 residents in 191 commercial homes (98.7% response rate). RESULTS: residents in commercial homes were significantly more disabled than those in religious and welfare homes: 24% compared with 12% were incontinent, 62% and 31% confused, and 78% and 49% respectively needed assistance with mobility and selfcare. Of special concern were 7% and 3% who were doubly incontinent, 7% and 2% confused to the point of disturbing other residents, and 4% and 2% who met the criteria for hospital care. CONCLUSIONS: a significant number of residents were disabled and required help in important aspects of simple self care. Informed advice, variety, and choice in type of care are mandatory before entering a rest home. Homes must employ trained staff who can identify and minimise problems so as to ensure optimal quality of life for residents.     

A profile of the 7500 people in aged-care institutions in Auckland

A study was carried out in 1988 to describe the residents and patients of aged-care institutions in Auckland against which future measures, including planned changes in licensing and funding, could be made. Information was collected for each patient in every hospital (public and private) and each resident in all old people's homes in the Auckland region between January and June 1988. Of the 7516 people surveyed (99.4% response rate), 70% were residents in old people's homes, 25% were patients in private hospitals and 6% were cared for in the public hospital sector. Of the people surveyed, 71% were women. The average age of women, 82 years, was 6.5 years older than that of men. Three-quarters of all women and 44% of men in care were widowed. Women had a higher rate of admission to institutions than did men with almost one in two women and one in four men in the age group 85 years and over being in long term care. Rates of institutionalisation for Maoris and Pacific Islanders were the same as for Europeans. The majority of elderly people received regular contact and concern from family members. This study has demonstrated that Auckland has a higher proportion of the elderly population (7.6% of the population 65 years and over) in long term care compared with other areas of New Zealand.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Measuring care and dependency of elderly people in residential homes: an unreliable exercise.

OBJECTIVES: to determine the correlation between a scale measuring the amount of care required by people in rest homes and two scales, the Booth scale and the composite scale which measure dependency. To examine the scales for retest reliability. SUBJECTS: one hundred and twenty-five people aged 47 to 98 years, median age 84 years, living in seven rest homes in Dunedin. METHOD: subjects were assessed using the care, Booth and composite scales and the assessment repeated after four weeks. RESULTS: the care scale test-retest reliability based on rank order correlates was 0.86. For the physical care items retest reliability was high but supervision and the management of behavioural problems showed poor retest reliability. Correlation between the care scale and the two dependency scales was only moderate (composite scale 0.64, Booth scale 0.55). Behavioural problems and the time for supervision were assessed on the care scale only and it was these components which accounted for most of the poor correlation between the care and dependency scales. CONCLUSION: the time required for the management of behavioural problems and supervision for some people in rest homes was considerable. Measurement of this was difficult and made assessment of individual residents in homes unreliable.     

Young disabled residents in old people's homes.

A survey of the status of residents in aged care facilities in the Auckland region conducted in 1988 indicated that almost 9% (645) of the 7516 people studied were under 65 years of age. Rates were markedly higher for people of Maori descent than for those of European descent in this age group. For nonMaori, the rate for men was higher than that for women, but for Maori the opposite was the case. The majority of these young residents (94%) were being cared for in commercial old people's homes. One half were cared for in just 29 of the 223 homes in the region. While most (59%) were admitted after the age of 50, 15% were admitted before they were 40 and must expect to liver their lives out in institutions primarily housing elderly residents. Almost half of those in old people's homes had been admitted from a psychiatric hospital. The authors are concerned that so many young people appear to be in old people's homes because of a lack of alternative accommodation which is more suited to their care.     

Utilisation of private hospital beds in Auckland for long term geriatric care

A cross-sectional survey at 25 February 1985 was conducted to determine the utilisation of beds in Auckland's private hospitals. Fifty-three licensed private hospitals accepted patients under the geriatric hospital special assistance scheme (GHSAS). Eighty point eight percent of all patients were receiving public subsidies additional to the universal Department of Health benefit. Ninety-five percent of patients were aged 65 years or more and receiving long term care; of these nearly all had been assessed by a geriatrician and 81.5% were subsidised by the GHSAS. The actual proportion of elderly receiving long term hospital care in Auckland, at 23.3/1000 aged 65 years and over, corresponded closely to newly proposed national guidelines; a previously unrecognised use of private beds for psychogeriatric patients was demonstrated.     

Changes in behavioural characteristics of elderly populations of local authority homes and long-stay hospital wards, 1976-7.

Behavioural characteristics of the elderly populations of seven local authority residential homes and three long-stay hospital wards were assessed in 1976 and 1977 with the Crichton Royal behavioural rating scale. In 1977 the levels of behavioural problems had increased in the residential homes, but declined in the hospital wards. Differences between the homes had decreased as the overall level of problems increased. The findings suggested that the additional burden of caring for increasing numbers of severely disabled elderly people was affecting the balance of institutional care, and a radical reappraisal of present patterns of care may be necessary to meet their future needs.     

Vitamin B12 concentrations in the elderly: a regional study

A prospective study of 100 subjects over 70 years of age residing in rest homes or geriatric wards within the Auckland region showed that 23% of the population sampled had a serum vitamin B12 concentration below the reference range. Less than half (48%) of the group with a reduced serum vitamin B12 concentration had other haematological findings on initial screening suggestive of megaloblastosis. Comparative data from hospital and community based laboratories demonstrated that 20% and 29% respectively of samples from individuals aged greater than 70 years referred for serum vitamin B12 analysis had a B12 concentration below the reference range. Reduced serum vitamin B12 abnormalities in elderly individuals should not be ignored and some guidelines for investigations with which to establish a diagnosis are presented.     

Clinical medication review by a pharmacist of elderly people living in care homes: pharmacist interventions

Objectives To describe the rate and nature of pharmacist interventions following clinical medication review of elderly people living in care homes. Setting Care home residents aged 65+ years, prescribed at least one repeat medication, living in nursing, residential and mixed care homes for older people in Leeds, UK. Method Analysis of data from care home residents receiving clinical medication review in the intervention arm of a randomised controlled trial. Intervention outcomes for each medicine were evaluated for each resident. Key findings Three‐hundred and thirty‐one residents were randomised to receive a clinical medication review and 315 (95%) were reviewed by the study pharmacist; 256 (77%) residents had at least one recommendation made to the general practitioner. For the 2280 medicines prescribed, there were 672 medicine‐related interventions: medicines for cardiovascular system (167 (25%)), nutrition and blood (121 (18%)), central nervous system (113 (17%)) and gastrointestinal conditions (86 (13%)) accounted for 487 (73%) of medicine‐related interventions. There were 75 non‐medicine‐related interventions. The most common interventions were ‘technical’ (225 (30%)), ‘test to monitor medicine’ (161 (22%)), ‘stop drug’ (100 (13%)), ‘test to monitor conditions' (75 (10%)), ‘start drug’ (76 (10%)), ‘alter dose’ (40 (5%)) and ‘switch drug’ (37 (5%)). Recommendations to stop a medicine were most common for CNS drugs (32 (32%)). The most common medicine to be recommended to be started was calcium and vitamin D (45 (59%)). Following a recommendation to test to monitor a medicine, 23 (14%) medicines required a change. Conclusions This study has demonstrated that clinical medication review by a pharmacist can identify medicine problems in approximately 80% of care home residents, requiring intervention in 1 in 4 of their prescribed medications.     

Chronic pain and the use of health services.

The range and extent of health consulting by people who have chronic pain attending a specialist clinic was assessed. Forty-two subjects attending Auckland Hospital pain clinic completed a questionnaire about their use of conventional and complementary health services for their pain in the previous 12 months. The general practitioner was the most frequently consulted health professional, visited, on average, 12.9 times per annum; compared with the expected rate of 4.2 consultations per annum. Medical specialists and health professionals had been consulted more frequently than complementary specialists. Twenty-five percent of the sample had been admitted to hospital for investigations relating to their pain in the previous year. On average, these patients spent $1333.63 per annum of their personal funds on health care. The cost of health care for chronic pain is significant both for the individual and the state and highlights the need for intensive pain management programmes.     

Trauma in Auckland: an overview

Data are presented on all 569 subjects who, as a result of trauma, either died or were admitted to hospital in Auckland over a four week period. Median age was 23 with an overall 3:2 male:female ratio. Median injury severity score (ISS) was five with 9% of subjects having an ISS of 16 or more (major trauma). Blunt trauma accounted for 84% of all injuries. Life threatening injuries were most commonly to the head, thorax and abdomen while the largest number of less severe injuries were to the extremities. Eight subjects died before admission to hospital and a further six in hospital. Definitive care was given to 98% of patients at Middlemore and Auckland hospitals (including the onsite Princess Mary paediatric facility) but 26% had presented first to other hospitals and 43% of all patients were transferred from one hospital to another. The 561 patients used 6380 hospital days (including 314 intensive care days) and the following services--operating room 63%, orthopaedic ward 45%, plastic surgical ward 17%, paediatric ward 15%, neurosurgical ward 10%, general surgical ward 5%, intensive care 5% and CT scanner 4%. Only one hospital death was judged potentially preventable. This study reveals areas where trauma care could be improved, demonstrates the large amount of hospital resources required to treat trauma and particularly highlights the urgent need for studies into strategies for trauma prevention in New Zealand.     

Satisfactions and dissatisfactions with public and private hospitals

A fully national sample of 1255 people were questioned about their degree of satisfaction with hospital care in New Zealand. Questions covered both public and private hospitals and concerned actual experience of care as well as general attitudes to that care. Almost half the sample (49%) rated public hospital care as "excellent" or "very good", and a similar proportion (48%) assigned those grades to private hospitals. Only 7% of the sample rated public hospital care as "poor" or "very poor" and only 1% rated private hospitals in this way. Major reasons for satisfaction with public hospital care were the high standard of nursing care (41% of sample), the high qualifications of staff (34%) and the availability of appropriate equipment for emergencies (17%). The most common complaints were that hospitals are short-staffed/overworked (15%) and there are long waiting lists (14%). Reasons for satisfaction with private hospital care were no waiting (26%), good standard of care (20%) and good hotel facilities (14%). In general, both public and private hospitals were highly regarded. Dissatisfaction with public hospitals was most evident amongst younger, working people and amongst those in the north and central regions. Dunedin respondents were more satisfied with their hospital care than those in other parts of the country.     

Trends in cardiovascular risk factors in Auckland, 1982 to 1987

This paper examines trends in Auckland over a five year period (1982-87) in the major cardiovascular risk factors: serum total cholesterol, blood pressure and cigarette smoking; trends in body mass index are also presented. The data came from two independent random samples of European people aged 40-64 years chosen from the central Auckland electoral rolls in 1982 (915 men and 476 women) and 1986-88 (503 men and 359 women); response rates were over 80% in both surveys. In the five year period self reported smoking declined by 22% in men and 10% in women; the decline was particularly marked in upper socioeconomic men and women aged 55-64 years. There were no consistent changes in either blood pressure or body mass index levels. Serum cholesterol levels, after adjustment for the change in laboratory methods, declined by approximately 1% in both men and women. Cardiovascular risk factor levels remain high in Auckland; comprehensive population based prevention programmes, such as Heartbeat (New Zealand), are urgently required in New Zealand.     

Medical evaluation of sexual assault findings in the Auckland region

A five year retrospective study of medical findings in sexual assault is presented. Data from examinations of 109 children and 81 adults were analysed. Results indicate that those at highest risk of sexual assault are Maori girls and young women, who were just over a quarter of the cases seen, although only 8.7% of the Auckland city population. Pacific Island children also appear to be at increased risk (19% of child victims but only 10.9% of Auckland population). Over a third of the women raped were intoxicated with alcohol. It seems likely that drinking is an important factor in sexual assault. Children are usually abused by acquaintances or family (only 15% were stranger rape) and often in their own home. Over a third of adults were also assaulted in their own homes. Sexual assault victims are predominantly girls and young women. Only 7.3% were older than 30 years, although 37.7% of the Auckland female population is in this age group. Well over half the women raped were physically restrained and three quarters of them had signs of trauma on examination. A weapon was involved in nearly a quarter of the women. Medical findings will not often prove the assault, and only a minority of cases examined (28%) proceeded to court hearings.     

Cognitive impairment and its relationship to gait rehabilitation in the elderly

In a prospective study of 116 elderly people admitted to a geriatric rehabilitation ward, mini-mental state score on admission was used to classify nonaphasic subjects into three groups: cognitively normal (24-30), mildly impaired (17-23) and severely impaired (less than 17). Forty-three percent of the subjects were normal, 34% had mild and 23% had severe cognitive impairment. Using walking speed as the index of gait rehabilitation, subjects with normal cognition had significantly greater gait improvement than those with cognitive impairment. Age and urinary incontinence did not contribute to predicting gait improvement in regression modelling. Cognitive impairment also predicted discharge placement to long term hospital care and to a higher level of care than the subject received prior to admission. Thus cognitive impairment on admission to a geriatric rehabilitation ward predicts poor rehabilitation outcome with respect to gait and discharge residence.