A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people

OBJECTIVES: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use. DESIGN: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care. PARTICIPANTS: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control). MAIN OUTCOME MEASURES: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use. RESULTS: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65-1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75-2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility. CONCLUSIONS: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.     

Acute respiratory infections in day care

A 16-year, longitudinal study of acute respiratory infections was conducted in a day care center. The incidence of infections peaked in the second six months of life (10 per child per year) and declined thereafter. Fewer than 10% of infections involved the lower respiratory tract. The isolation of respiratory viruses was associated closely with illnesses, and viruses appeared to be the most important causes of respiratory infections. Haemophilus influenzae type b was isolated infrequently and caused no invasive disease. Nontypable H. influenzae and Streptococcus pneumoniae were isolated frequently but were not associated epidemiologically with illnesses. Group A streptococci were isolated with moderate frequency but were not a major problem. Although the data presented are an inadequate basis for firm conclusions, they suggest that the incidence of acute respiratory infections during the first year of life is higher among children in day care centers than among those cared for at home but that the incidence in later years is perhaps lower for children who enter day care as infants and remain in day care through the preschool years.     

A study of the long-term effectiveness of an outpatient pulmonary rehabilitation program]

Pulmonary rehabilitation is one of the most important components of comprehensive care for patients with significant disability due to chronic respiratory failure. Because pulmonary rehabilitation has not been popular in Japan, the long-term effectiveness of pulmonary rehabilitation has rarely been reported. We therefore examined the long-term effectiveness of an outpatient pulmonary rehabilitation program for patients with chronic respiratory failure. Our program was composed of a once-a-week introduction program for 2 months and a support program that was continued every 4 weeks as long as possible. Thirty stable patients with chronic respiratory failure were enrolled in the program; 21 patients (COPD: 15, lung complications of tuberculosis: 6) completed the 9-week introduction program and the ensuing 6-month support program. Good compliance with the home training regimen was maintained during the period. The introduction program significantly alleviated dyspnea (Fletcher's grade: 3.3 to 3.0, p < 0.01) and improved the data for activity (Spector's score: 5.3 to 5.8, p < 0.01) and 6-minute walking distance (319 to 384 m, p < 0.01). These benefits were sustained during the 6-month support program. We concluded that outpatient pulmonary rehabilitation can alleviate dyspnea and improve the activity and exercise tolerance of patients with chronic respiratory failure, and that the effectiveness of training can be well maintained with a minimal support program.     

Chronic respiratory care and rehabilitation in France

The development of chronic respiratory care in France faces the same problems of ageing population, technological advancement and budgeting difficulties as other industrially developed countries. We describe the intermediate and home-care systems for treatment of chronic respiratory diseases.     

Outcomes of a geriatric rehabilitation program in a long-term care facility.

This study investigated outcomes of geriatric rehabilitation and predictors of success among 81 consecutive admissions to a 40-bed rehabilitation unit in a long-term care facility. Predictors measured at admission included sociodemographic variables, functional status (both current and prior to illness), social contact, and self-motivation. In all, 62 patients (77%) successfully completed the rehabilitation program; 76% of the successes were discharged home. Failure to discharge successfully rehabilitated subjects was mainly due to placement problems and patient and family preference. Both of the success groups showed significant improvement in functional status (Barthel Index), while failures had poorer initial functional status, and showed no improvement on average. At six-month follow-up, functional status (measured by the Sickness Impact Profile) was similar in the two success groups. No predictors other than functional status were associated with rehabilitation success. Among the successes, better functional status at six months was predicted by aspects of self-motivation.     

A pilot study of a mobile spirometry service in primary care.

This evaluation of an inexpensive mobile spirometry service demonstrates how patients with respiratory problems can be diagnosed and referred to appropriate services, with major potential benefits to the patient and the health service.     

Adenovirus infections and respiratory illnesses in children in group day care

Adenovirus infections and respiratory illnesses among 123 children attending a research day care center were analyzed from data collected prospectively from 1967 through 1981. During the 15-year study period, 298 adenovirus isolates were recovered from respiratory secretions of the study children, and five different serotypes were identified, with types 1, 2, and 5 accounting for 92% of the typed isolates. Annual incidence of each serotype varied greatly, with types 2 and 5 predominating before 1975 and type 1 thereafter. Exposure to adenovirus in the day care center correlated with acquisition of infection. Through two years of age, children were exposed to 3.4 +/- 0.9 (mean +/- SD) different serotypes and became infected by 2.1 +/- 0.8 different types. Most infections occurred before the child's second birthday, and incidence was highest from six to 12 months of age (1.4 primary infections/child-year). Mild and febrile illness accompanied 75% of primary isolations. Otitis media occurred in 37% of illnesses over all ages and in greater than 50% of illnesses among infants.     

A new fiberoptical respiratory rate monitor for the neonatal intensive care unit

A new technique for respiratory rate measurement in the neonatal intensive care unit, fiberoptic respirometry (FORE), was tested using a specially designed nasal adapter. The aim was to investigate the system's accuracy and compare it to the transthoracic impedance (TTI) method and manual counting (MC). Further, the relationship between accuracy and degree of body movement was investigated. Seventeen neonates of median gestational age 35 weeks were included in the study. Video recordings (synchronized with data recordings) were used for classification of body movement. Breaths per minute data were obtained for 23-32-min periods per child, and a subset of these included MC performed by experienced nurses. A Bland-Altman analysis showed low accuracy of both FORE and TTI. A >20% deviation from MC was found in 22.7% and 23.8% of observations for the two methods, respectively. Both methods had accuracy problems during body movement. FORE tended to underestimate respiratory rate due to probe displacement, while TTI overestimated due to motion artefacts. The accuracy was also strongly subject-dependent. The neonates were undisturbed by the FORE device. In some cases, though, it was difficult to keep the adapter positioned in the airway. Further development should, therefore, focus on FORE adapter improvements to maintain probe position over time.