Assistive devices and community-based services among 85-year-old community-dwelling elderly in The Netherlands: Ownership,use,and need for intervention

Objective.?To assess the home-situation of the oldest old regarding the ownership, use, and need for intervention of assistive devices and community-based services.

Methods.?A research nurse and an occupational therapist, who evaluated the current situation regarding ownership and use of assistive devices, visited a representative group of 147 Dutch community-dwelling 85-year-olds in their own homes. Furthermore, the occupational therapist assessed whether an intervention was indicated. Assistance in purchasing devices, information, and instruction were provided when necessary.

Results.?94% of the subjects owned one or more assistive devices, with a mean of 4.5 (SD 2.7) assistive devices. Most frequently owned were grab rails. Of the total number of 591 assistive devices, 74 (13%) were not in use. In 66 of the 147 (45%) subjects at least one intervention was indicated. A total number of 23 subjects received information and instruction on mobility-related issues, while 17 subjects received information and instruction on personal care-related issues. Moreover, for 19 subjects an application procedure was started for a total of 25 assistive devices and five community-based services in the mobility category while for 19 subjects an application procedure was started for a total of 31 devices and four services in the personal care category.

Conclusions.?Based on detailed information from occupational therapists, the home situation of community-dwelling elderly regarding the presence and use of assistive devices and community-based services is not optimal.     

Unmet health needs and associated factors among 1727 rural community-dwelling older adults: A cross-sectional study

AimTo investigate the needed, unneeded and unmet health care services among rural community-dwelling older adults in China and examine the influencing factors, aiming to facilitate the global development of the home care system for a healthier world.MethodsThis cross-sectional study investigated rural areas in three provinces in Western China. A total of 1727 rural community-dwelling older adults were enrolled. The needed, unneeded and unmet health care services were assessed by the Supply and Demand of Health Care Services (SD-HCS) questionnaire for older adults.ResultsRespect (73%, 1265/1727) was the most needed. The other top 9 needed mainly belonged to the divisions of health monitoring and information regarding chronic diseases. Re-employment or part-time jobs (71%, 1230/1727) was the most unneeded. All five protection and safety items were the most unmet but needed. Religion was the main influencing factor of those health care services that were less unmet but needed.ConclusionsRespect was basic for older adults, and chronic disease management was in great demand among rural community-dwelling older adults. Due to low willingness and the crisis workforce, a more flexible retirement policy is needed in rural China. It is urgent to improve the emergency care system in rural areas. Last but not least, more research is needed to explore the association between religion and health.     

北京市社区失能老年人的照护需求及其影响因素

目的 探讨北京市社区失能老年人的照护需求及其影响因素。方法 采用多阶段随机抽样法,对北京市4个区8个社区的1158名老年人进行问卷调查,采用老年人生活活动能力量表筛选失能老年人,使用自行编制的社区失能老年人照护需求调查问卷对其照护服务需求内容进行调查,分析照护需求的影响因素。结果 调查对象中共有220名失能老年人,失能率为19%,其中轻度失能90名（40.9%）,中度失能68 名（30.9%）,重度失能62名（28.2%）。失能老年人存在多方面的照护需求,排序前3位的身体照护服务需求是：上下楼梯、洗澡和室内行走;排序前3位的日常生活照护需求是：家务助理、代购和陪同;排序前3位的居家护理服务需求是：吸氧、口腔护理和鼻饲喂养;其他服务需求的前3位是：紧急救护、康复治疗和小饭桌。多元线性回归分析结果显示,年龄、慢性病的种类、自评健康状况、失能 程度、慢性疼痛、跌倒经历是失能老年人照护需求的影响因素。结论 北京市60岁及以上失能老年人照护需求迫切,其中身体照护需求最高,影响该人群照护需求的因素呈多元化。     

Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program

OBJECTIVE: To assess the short-term effect of an exercise-based rehabilitation intervention on balance, mobility, falls and injuries. DESIGN: This randomized, controlled trial with repeated measures was performed at an outpatient rehabilitation center. Elderly, ambulatory, community-dwelling volunteers underwent 6 wks of supervised stretching, balance, endurance, coordination, and strengthening exercises. Controls attended seminars. Data were recorded for time and quality performance on a functional obstacle course and for self-reported falls and injuries. RESULTS: From baseline through 6-mo follow-up, participants in the exercise group (n = 122) significantly outperformed those in the control group (n = 83). The exercise group's functional obstacle course quality improved 2.3% postintervention and 1.57% at follow-up compared with 0.3% for the control group for each time period (P = 0.001). Functional obstacle course completion time improved 7.69% at postintervention and 8.35% at follow-up for the exercise group compared with 4.0% and 3.4% for the control group. Of baseline fallers in the intervention group, 87% (compared with 34.5% for the controls) reported no falls in the subsequent 6 mos. Of those reporting injuries in the 6 mos preintervention, 89.7% in the intervention group (compared with 55.6% for controls) reported no injury at 6 mos postintervention. CONCLUSIONS: Our intervention can improve functional performance and protect against falls and fall-related injuries.     

养老机构失能老人护理服务需求调查研究

目的了解养老机构失能老人护理服务需求,为制定科学合理的养老政策提供依据。方法采用自行设计的"养老机构失能老人养老服务评估及需求调查问卷"对湖州市的8家养老机构中符合纳入标准的72名失能老人进行调查,根据Barthel指数总分进行失能等级评估。结果养老机构内失能老人高龄化,80岁以上失能老人占52.8%;失能老人健康状况不佳,50%以上的老人有肢体活动障碍并伴有不同程度的慢性疾病;养老机构老人失能情况较严重,重度失能的老人占38.9%,中度失能老人占15.3%;老人的社会生活环境存在较大的问题,23.6%失能老人没有物质和情感支持,30.5%失能老人反映出入无障碍设施有问题;失能老人的护理服务需求依次是日常生活照料、医疗保健服务、聊天和文化娱乐。失能等级是影响服务需要的主要因素,年龄、健康状况、失能持续时间、文化程度也会影响其服务需求。结论养老机构失能老人护理服务需求较多,机构应改善老人的社会生活环境,满足失能老人的多样化需求。     

The influence of isokinetic peak torque and muscular power on the functional performance of active and inactive community-dwelling elderly: a cross-sectional study

ObjectiveTo verify the importance of the isokinetic muscular torque and power of knee extensors and flexors on the functional performance of active and inactive elderly women.MethodsA cross-sectional observational study was conducted with 116 community-dwelling women (≥60 years old) without severe cognitive and/or motor dysfunction. Isokinetic muscle function was measured by peak torque and muscle power at 60°/s (5 repetitions) and 180°/s (15 repetitions), respectively. Mobility was evaluated by means of the Timed Up and Go test (TUG) and the Habitual Gait Speed (HGS) test. Balance was evaluated via the alternate step and semitandem tests. Lower limb strength was assessed using the Sit-to-stand test. Univariate and multivariate logistic regression analysis was used to determine association between independent and dependent variables (α = 0.05).ResultActive elderly women had better muscle function and functional performance than inactive elderly women for almost all variables. Peak torque and muscular power of knee extensor muscles explained the dynamic balance, mobility, and lower limb strength among inactive elderly women (OR: 0.89–0.95; p < 0.05). Muscular power of knee flexors influenced tasks that required mobility and lower limb strength among active elderly (OR: 0.82–0.87; p < 0.05).ConclusionsThe muscular power of knee flexors was shown to be more important for the functional performance of active elderly women. The muscular power of knee extensors had a stronger influence on the performance of the inactive elderly women.     

5次坐立试验用于预测老年人跌倒危险的有效性

目的:探讨5次坐立试验(FTSST)在预测老年人跌倒危险方面的有效性。方法:137位老年人受试者参与本研究并分为跌倒组和非跌倒组。对受试者进行FTSTS和利用功能性蹲屈测试训练仪来测量下肢肌力。结果:41位受试者在过去一年内发生过跌倒。跌倒组和非跌倒组的受试者在年龄、FTSST时间和下肢肌力之间的比较有显著差异(P<0.001)。Spearman相关分析结果显示FTSST时间与肌力、年龄和跌倒史之间显著相关(P<0.001)。Logistic回归分析因变量和跌倒史关系,FTSST时间是预测跌倒危险最主要的变量(OR:1.406)。ROC曲线分析显示FTSST最佳临界值为9.75s,其敏感性为78%,特异性为70.8%,ROC曲线下面积为0.81。结论:FTSST作为一个简便、快捷的功能性测试工具可以有效预测老年人跌倒危险,FTSST鉴别力优于下肢肌力。     

Risk factors at pretreatment predicting treatment-induced nausea and vomiting in Australian cancer patients: a prospective, longitudinal, observational study

Purpose  

Despite significant advances in antiemetic management, almost 50% of cancer patients still experience nausea and vomiting during treatment. The goal of antiemetic therapy is complete prevention of treatment-induced nausea and/or vomiting (TINV); however, realisation of this goal remains elusive, thus supplementary strategies identifying patients at high risk must be employed in the interim. Consequently, we examined TINV incidence and its risk factors, including patient, clinical and pretreatment quality of life (QOL)/psychological factors.     

Palliative care consultation in The Netherlands: a nationwide evaluation study

Palliative care in The Netherlands is mainly provided by generalist professionals who are part of the regular health care system. In order to provide good quality palliative care, they need options for training and consultation. Therefore, Palliative Care Consultation (PCC) teams were established, which inform, support, and advise professional caregivers involved with patients in palliative care without taking over responsibility. This study is the first nationwide study on PCC teams. Investigated was the nature and effect of consultations by registration and evaluation of consultations given by 19 PCC teams during a one-year period. Sixty-one percent of the requesting caregivers were primary care professionals and the problems discussed covered the entire field of palliative care, although physical problems played a dominant role. Although the patient was often not seen by the consultant, the consultant appeared to be able to identify more problems than initially discussed by the requesting professional. The types of problems discussed were hardly related to patient characteristics but more related to the discipline of the professional caregiver. According to the requesting professionals, consultation was helpful and contributed to improving the quality of palliative care.     

Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis

BACKGROUND AND PURPOSE: Inconsistent research findings make it unclear whether therapeutic exercise improves gait speed in community-dwelling elderly people. Using meta-analytical procedures, we examined the effect of therapeutic exercise on changing gait speed in community-dwelling older adults and the effect of type, intensity, and dose of therapeutic exercise on gait speed. METHOD: Studies were retrieved using a comprehensive database search. Two independent reviewers determined study eligibility based on inclusion criteria, rated study quality, and extracted information on study methods, design, intervention, and results. Data were combined to obtain an overall effect size, its 95% confidence interval, and a measure of significance. In addition, analyses to characterize the clinical relevance of the findings were performed. RESULTS: One hundred seventeen studies were evaluated, with 24 studies (n=1,302 subjects) meeting the inclusion criteria for habitual gait speed and 18 studies (n=752 subjects) meeting the inclusion criteria for fast gait speed. Therapeutic exercise--or, more specifically, strength training and combination training (aerobic plus other exercise)--had significant effects (r=.145, P=.017; r=.176, P=.002, respectively) on habitual gait speed. High-intensity (effort expended by subjects) exercise and high-dosage (frequency and duration of exercise sessions) intervention also had a significant effect (r=.184, P=.001; r=.190, P=.001, respectively) on gait speed, whereas there was no effect for moderate- and low-intensity exercise or for low-dosage exercise. No exercise intervention affected fast gait speed in this analysis. DISCUSSION AND CONCLUSION: The results provide support for the belief that therapeutic exercise can improve gait speed in community-dwelling elderly people and that intensity and dosage are important contributing factors. The relatively weak correlation found between therapeutic exercise and gait speed merits further study.     

Trends in short-term and 1-year mortality in very elderly intensive care patients in the Netherlands: a retrospective study from 2008 to 2014

Purpose

To describe the trends in short-term and long-term mortality in very elderly intensive care unit (ICU) patients between 2008 and 2014.

Methods

A retrospective cohort study was conducted using data from the National Intensive Care Evaluation Foundation from 31 Dutch ICUs. Generalized linear mixed-effects models were used to determine the change in adjusted short-term mortality (ICU/hospital deaths) and long-term mortality (3, 6, and 12 months after ICU admission) over the period 2008–2014 in very elderly patients and in patients less than 80 years old admitted to the ICU.

Results

A total of 216,196 patients admitted to 31 ICUs in the period from 2008 to 2014 were included in the study, including 28,284 (13.1%) very elderly patients (80 years or older). Follow-up data for determination of 3-, 6-, and 12-month mortality were available for, respectively, 210,005 (97.1%), 202,551 (93.7%), and 176,847 (81.8%) ICU admissions. The crude ICU and in-hospital mortality decreased, respectively, from 17.6% to 13.0% and from 30.7% to 21.0%. The annual risk-adjusted ICU and in-hospital mortality of very elderly patients (adjusted for APACHE III score, comorbidities, and admission type) decreased significantly during the study period [adjusted odds ratio 0.97 (0.95–0.99) and 0.92 (0.91–0.93), respectively]. Additionally, the annual risk-adjusted 3-, 6-, and 12-month mortality decreased significantly from 2008 to 2014 [adjusted odds ratio 0.96 (0.95–0.97), 0.96 (0.94–0.97), and 0.97 (0.95–0.98), respectively]. A similar significant annual decrease in risk-adjusted short-term and long-term mortality was observed in patients aged less than 80 years.

Conclusions

Both short-term and long-term risk-adjusted mortality decreased significantly during the study period in both very elderly ICU patients and patients aged less than 80 years in the Netherlands. This study clearly shows that in our setting very elderly patients benefit almost as much as their younger counterparts from improvement in quality of care over time.

     

国家级贫困县老年人护理需求及其影响因素分析

目的 了解国家级贫困县老年人的护理需求及其影响因素,以期提高他们的生活质量,达到健康老龄化.方法 在2个某国家级贫困县中随机抽取8个村的623名老年人,采用访谈法和自制的护理需求问卷,对其护理需求及其影响因素进行调查.结果 本组老年人护理需求较高,得分情况为:疾病预防(3.40±0.56)分,健康促进(3.30±0.70)分,疾病护理(3.56±0.52)分;影响其护理需求的主要因素是否患病、文化程度、婚姻状况、性别、平均月收入.结论 应针对贫困地区老年人护理需求较高的现状及其影响因素采取有效措施,从社会-家庭-个人等层面满足其护理需求.