Paediatric access care in Europe: results of the Paediatric Access Care (PAC) project

Part two of the Paediatric Access Care (PAC) project, a research project of EDTNA/ERCA, investigated PAC in HD and PD patients including the policy for the creation and maintenance of access, and the registration of access related complications that occurred during the registration year of 2004. Data were collected from 39 centres of 13 European countries and included 379 paediatric patients. Fatal complications, resulting in terminating the use of the access, were noted in 59 HD and 22 PD patients. Paediatric access care varied considerably between European centres and in many areas consensus or best practice evidence is still lacking. There is a need for recommendations for the paediatric renal nurse, handling access care in the paediatric renal population.     

Chewing problems and mortality in older adults in home care: results from the Aged in Home Care study

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe.
DESIGN: Retrospective cohort study.
SETTING: Eleven European countries.
PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age±standard deviation 82.2±7.2) in home care.
MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period.
RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05–1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03–2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12–2.34).
CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.     

Australian Innovations in Home-based Care: a Comparison of Community Aged Care Packages,Community Options Projects and Hostel Care

Objective: To compare Australian client dependency levels in Community Aged Care Packages, Community Options projects and hostels, and to explore the interplay between client dependency, carer availability and levels of service use in community care services. Method: The data analysed were derived from the first national Community Aged Care Packages Survey conducted by the then Department of Health and Family Services in 1996. Results: Community Aged Care Package clients in Australia were found to be less dependent than both Community Options clients and hostel residents. For both sets of community care clients, service use increased with dependency levels. The presence of co-resident carers was associated with lower levels of service use for given levels of dependency. Conclusions: Community Aged Care Packages, while intended to provide an alternative to admission to a hostel at the personal care level, were found to be serving a somewhat less dependent sector of the frail and disabled aged population. Most recipients had an informal carer in addition to being in receipt of formal services. The evidence suggests that, among the clients of both Community Options and Community Aged Care Packages, available resources were targeted on those in greater need.     

Variations in quality of Home Care between sites across Europe, as measured by Home Care Quality Indicators

BACKGROUND AND AIMS: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for monitoring quality of care. Research questions were, "Do HCQI scores vary between home care organizations in different countries?" and "Are one or more country-specific sites consistently scoring better on most or all HCQIs"? METHODS: a cross-sectional observational study of 65+ randomly selected clients of home care organizations in urban areas in 11 European countries who had been receiving home care for at least two weeks. Data were collected with the MDS-HC. The scoring of 16 prevalent quality indicators for home care, adjusted for population differences, was calculated with baseline data. RESULTS: Population size at baseline was 4,007 clients. Among home care clients in Europe, "rehabilitation potential in Activities of Daily Living and no therapies" (average 75.9%) and "inadequate pain control" were the most common quality problems. The prevalence between populations studied in various countries varied substantially. No country-specific site consistently scored worst or best. CONCLUSIONS: HCQIs derived from the MDS-HC detect variance in quality scores between home care in the 11 partner countries. The highest prevalence of unwanted outcomes were most often found in the Czech Republic, Italy and Germany. Although further research is necessary, we believe that HCQIs may be of great value for quality improvement in home care.     

Home care services in Israel-implications of the expansion of home care following implementation of the Community Long-Term Care Insurance Law

In 1986 the Israeli Parliament enacted the Community Long-Term Care Insurance (CLTCI) Law, in response to concern over the growing need for long-term care. The principal aims of this study were to examine the extent to which the law has improved the appropriateness of care, reduced unmet needs, and lessened the burden on families of disabled elderly living in the community; and to assess the degree to which the expansion of formal services has supplemented, or substituted for, informal assistance. The findings show that expansion of formal services under the law has significantly increased the number of elderly receiving care, as well as the quantity of care they receive. This study also indicates that the formal services added under the law supplement, but do not substitute for, informal care: This has had a positive effect both on the elderly and on their families.