Predictors of elders' and family caregivers' use of formal home services

The purposes of this study were to examine the characteristics of care recipients, caregivers, and their relationship to predict the use of formal services in the home by functionally impaired elders, and to explore the effect of informal care on formal service use in the home. A secondary analysis of data from the informal caregiver questionnaire and the community survey of the 1989 National Long-Term Care Survey was performed using logistic regression analysis. Results showed that the utilization of formal services was less frequent as the hours of informal care increased. Care recipient characteristics that emerged as important predictors included residence in elder housing, recent hospitalization, gender, limitations in activities of daily living, recipient of Medicaid, age, quantity of informal care, and number of household members. Important caregiver characteristics included difficulty getting around outside, rearrangement of work hours, and bowel and bladder care performed by female caregivers. The findings from this study support the consideration of both care recipient and caregiver characteristics when predicting the utilization of formal service use in the home. Data also support the development of interventions to promote the caregiving process. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21:533–543, 1998     

Impact of community care in enabling older people with complex needs to remain at home

Aim.  This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home.
Background.  Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community.
Design.  A qualitative approach using semi-structured interviews was used to collect data from older people ( n  = 17) and carers ( n  = 14).
Method.  Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners.
Results.  Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed.
Conclusions.  The provision of high-quality community care for older people is a globally significant challenge and one that requires creative solutions, both at a local and strategic level.
Relevance to clinical practice.  Nurses and other health and social care professionals need to understand the significance of 'home' for older people and take steps to ensure that additional and appropriate resources are targeted towards community care.     

Informal and formal caregivers' involvement in nursing home care activities: impact of integrated care

AIMS: This paper reports a study to investigate the relationships between informal and formal care, changing relationships over time, impact of integrated care, and theoretical and methodological lessons that can be drawn from research on this topic. BACKGROUND: The ratio of informal to formal care provided in nursing homes varies. In many countries the predominance of traditional, formal care is being challenged by the emergence of integrated care models in which formal and informal caregivers co-operate and co-ordinate their activities to deliver tailor-made care. This move towards integrated care is likely to result in changes in the degree and nature of involvement of formal and informal caregivers in care activities. However, very little research has investigated this. Previous research is restricted to one point in time, as opposed to focussing on the changing relationships between formal and informal caregivers over time. METHODS: The quasi-experimental design encompassed a traditional care comparison setting and an experimental setting with an integrated care intervention. At three measurement points, one before the intervention in May/June 2000 and two at 6 and 14 months after the intervention, informal and formal caregivers recorded their care activities. Informal care relationships were determined by calculating contribution rates and informal/formal care ratios for 14 activities. RESULTS: Integrated care did not bring about the expected major changes. There was a limited amount of substitution of formal care with informal care. There were limited changes in the extent of dual specialization, in which informal and formal caregivers perform separate activities. There was little supplementation of formal care with informal care. Furthermore, relationships changed over time, resulting in a complex pattern of linkages at the level of separate activities. CONCLUSIONS: Informal caregivers contribute to many activities. The impact of integrated care on the degree and nature of involvement, however, was moderate. A possible explanation is the contextual situation for nursing home care. These findings point to the need for further research into the (changing) relationship between formal and informal carers in residential care activities and the evolution of this relationship over time.     

慢性心力衰竭患者居家护理中的家属护理要求分析

目的观察分析慢性心力衰竭家属的护理要求及相应的护理对策。方法选取该院2013年1月至2014年6月收治的50例慢性心力衰竭患者作为研究对象,通过问卷调查以及面对面交流的方法对患者家属的健康教育需求进行总结分析,并探讨有效的护理对策。结果慢性心力衰竭患者照顾者的健康需求在运动、饮食指导、药物依从性以及心理护理方面存在一定的缺陷,而其主要的护理需求集中在治疗效果以及药物的注意事项方面,经过积极的护理干预后,患者家属对护理的满意度达到100%。结论慢性心力衰竭患者家属的护理需求主要集中在患者的治疗效果以及药物的依从性方面,需要给予针对性的护理干预。     

Technology-dependent children and their families: a review

Background. Advances in medical technology and nursing care have enabled children who rely on long‐term medical and technical support to reunite with their families and community. The impact of discharging these children into the community involves a number of unprecedented social implications that warrant policy consideration. To begin with, an effort must be made to understand the phenomenon of caring for technology‐dependent children living at home. Aim. The aim of this paper is to provide a comprehensive literature review on caring for technology‐dependent children living at home. Methods. The review was conducted via keyword searches using various electronic databases. These included CINAHL, MEDLINE, Social Science Index, Sociological Abstracts, Australian Family and Society Abstracts, and the Australian Bureau of Statistics. The articles and books found were examined for commonality and difference, significant themes were extracted, and the strength of the research methods and subsequent evidence were critiqued. Findings. In this paper, themes relating to home care for technology‐dependent children and their families are elucidated and summarized. These are: chronic illness and children; the impact of paediatric home care on children; the uniqueness of technology‐dependent children and their families; and parents’ experience of paediatric home care. Discussion. Contentious issues, relevant to the social life of these children and their families, are raised and are discussed with the intention of extending awareness and provoking further debate among key stakeholders. These issues include: the changed meaning of home; family dynamics; social isolation; saving costs for whom?; shifts in responsibility; and parent–professional relationships. Conclusion. More research is needed in the arena of paediatric home care, to facilitate relevant policy formation and implementation.     

家庭关怀度和家庭因素与初产妇妊娠压力的相关性研究

目的探讨家庭及家庭因素对初产妇妊娠压力的影响,为寻找减轻初产妇心理压力途径和孕期心理保健指导提供参考依据。方法采用妊娠压力量表、家庭关怀度指数问卷、家庭相关因素调查问卷对272名初产妇进行问卷调查,结果初产妇妊娠总体压力均值为轻度压力,“为确保母子健康和安全而引发的压力感”最高;初产妇中家庭功能良好占86．76％,家庭关怀指数、成长度、情感度与孕妇总体压力水平呈负相关;婆媳关系、怀孕的计划性与孕期压力呈正相关一结论孕期良好的家庭功能、融洽的婆媳关系和怀孕的计划性,可以缓解孕期的压力。     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

Expectations and experiences of older people and their carers in relation to emergency department arrival and care: A qualitative study in Australia

Although older people frequently present to the emergency department (ED), little is known about their experiences in this setting, despite increasing attendance rates reported in this population internationally. This study explores the experiences of older people and their carers leading to and during ED care in a metropolitan university hospital in Sydney, Australia. The study forms part of a larger prospective exploratory study on this topic. Individual in‐depth interviews were conducted with 10 people over 65 years of age who had a chronic illness and their carers one month after they presented to the ED. Interviews were transcribed verbatim and analyzed using general interpretive methods. The results revealed that the participants presented to the ED as a result of escalating symptoms and on their general practitioner's advice. Participants felt uninformed about ED procedures, therefore, families/carers felt the need to advocate for information and basic services. Participants were grateful for the care received and mindful of the busy environment. To meet the expectations of older people, nurses need to provide timely information and advise carers how they can assist.     

Elders' needs and experiences of receiving formal and informal care for their activities of daily living

Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.     

Urinary incontinence in older adults receiving home care diagnosis and strategies

Introduction:  Urinary incontinence (UI) is a major health problem mostly affecting older people. With the shift toward healthcare delivery in the home setting, it is necessary for home healthcare workers to know how to manage UI in the elderly. Little is known about the care for patients receiving home care suffering from UI. The aim of this study was to assess the prevalence of UI in older adults receiving home care and to gain insight into caring for patients with UI.
Method:  A cross-sectional survey using data from the Dutch National Prevalence Measurement of Health Care Problems was conducted.
Results:  Of the 2866 patients, 46% were suffering from UI. In 49% of these patients the type of UI was diagnosed. Patients with a diagnosis suffered more from their UI and were offered more strategies when compared with patients without a diagnosis. Most patients used pads. Relatively few patients were offered bladder training or pelvic floor muscle exercises (PFME).
Discussion:  Urinary incontinence is a highly prevalent condition in older patients receiving home care. In half of the patients with UI no diagnosis regarding the type of incontinence was made. However, to treat or manage UI it is essential to assess the type of UI, as UI is treatable even in older people. As this study had a cross-sectional design, only strategies being offered at a fixed point in time are documented.
Conclusion:  Despite studies reporting the success of behavioural interventions for adults suffering from UI, most patients use pads. With the aging of the population and the increasing number of older adults suffering from UI, home care agencies need to acquire the knowledge and skills to address UI.     

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.     

Pillars for the care of older persons in the Caribbean

Pillars for the Care of Older Persons in the Caribbean: A Comprehensive Community-Based Framework (Pillars) is a hybrid of multiple public health frameworks developed through community-based participatory research processes. Health and social service professionals, governmental organizations, elderly persons, and others from across the English-speaking Caribbean countries developed the Pillars framework to address the growing elderly population and with an aim to increase the number of healthy and active years of life. The Pillars framework consists of four interrelated pillars organized across multiple sectors of society: primary care with care management; integrated services coordination; population-based health promotion and disease prevention; and planning and accountability. Pillars is enabled by an envisioned integrated system of information technology that will increase community-based services delivery, interprofessional communication and coordination, and will aggregate data with all identifiers removed for surveillance, planning, forecasting, policy making, evaluation, and research.     

The relationship between patient characteristics and carer psychological status in home palliative cancer care

Goals Despite being both providers and intended recipients of care, informal carers in cancer palliative care report high levels of distress and unmet needs. In order to develop supportive care strategies, this analysis aimed to identify which patient characteristics contribute to carer psychological distress and which coping strategies carers employ.Patients and methods Informal carers attending two home palliative care services gave cross-sectional data regarding patient characteristics and their own psychological status using standardised measures. Multivariate analyses were performed for each dependent carer psychological measure, with patient characteristics as independent variables (adjusted for carer age and gender).Main results Forty-three carers participated. Greater patient distress was associated with carer anxiety (b value: magnitude of the effect) (b=0.31, p=0.07), and both patient psychological status (b=0.37, p=0.02) and pain (b=0.29, p=0.09) were associated with carer psychological morbidity. Carer burden was associated with patient psychological distress (b=0.35, p=0.03) and pain (b=0.29, p=0.08). Carer avoidance/emotion-focused cognitive coping strategies were associated with patient physical function (b=0.34, p=0.04), and cognitive problem-focused coping was associated with patient symptoms (b=0.28, p=0.06) and physical function (b=0.29, p=0.05).Conclusions Adequate provision of patient psychological interventions and effective pain education and control are needed in order to improve carers' psychological health. Patient characteristics are associated with apparently opposing forms of carers' coping (i.e. both avoidance and engagement), demonstrating the importance of interventions addressing a range of coping responses. Further research is needed to understand why carers employ problem-focused coping in response to symptoms but not to pain. Evidence-based interventions for informal carers are urgently needed but must be delivered in the context of optimal patient pain and symptom control.