[Aging of the Polish population and its effect on the health care system in Poland]

The aim of the paper is presentation of the issue of increase in number of older population and the influence of this phenomenon on functioning of health service in Poland. The material comprised statistical data concerning age structure of the Polish population and demographic prognoses for the next decades, elaborated by the Main Statistical Office (GUS). The percentage of children and adolescents will decrease according to prognosis from 28% in 2000 to about 21% in 2030. The population of adults at the age from 20 to 44 years, will diminish by about 3 million and its percentage will decrease to about 29%. Population at the age of 45-65 will reach this level. The highest rise in number and percentage will concern the population over 65 years of age. The extension of the length of life in Poland will be maintained. The life expectancy for women will be 84.3 years, and 78.0 years for men in 2050. Due to this fact in 2030 every fourth women in our society will reach 65 years of age. On the basis of these prognoses it is indispensable to plan restructuring of hospitals in order to increase the number of geriatric, nursing and day-care wards. The increase in number of the elderly citizens will impose changes in structure of employment in order to secure appropriate medical and nursing staff adequately trained for treatment and care of this age group.

[Drug supply to nursing homes for the aged]

BACKGROUND

The Federal Government of Germany intends to revise the relevant legislation for pharmacies to improve supply of medicines for inhabitants of nursing homes. According to this initiative pharmacies would sign agreements with nursing homes determining the supply order, service and quality of supply. Today, such a contract is prohibited on the basis of current legislation. The local inspectorates for pharmacies in North Rhine-Westphalia checked on the current supply and initiated an investigation.

METHOD

The local inspectorates for pharmacies performed structured interviews with senior managements of 35 nursing homes in four cities of North Rhine-Westphalia focussing on service and quality of supply of drugs by pharmacies.

RESULTS

80 % of nursing homes were content with the regular service provided by retail pharmacies today. Additional information and consultation by pharmacists for managements, inhabitants and nurses about drug use is only provided in special cases, e. g. after detailed requests.

CONCLUSIONS

To improve drug safety in nursing homes, it makes sense and it is necessary to revise the legislation for pharmacies and to make contracts possible in which the extent of service provided is laid down. Information, consultation and inspection of drug storage should be an essential part of future contracts.

Palliative care and nursing homes: where next?

Specialist palliative care providers are seeking to transfer the principles of palliative care to more general care settings in order to meet the needs of people with diseases other than cancer. To prepare nursing home staff to provide palliative care increasing numbers of educational initiatives are now being offered. This paper explores some of the assumptions that underpin these initiatives. Recommendations are made that recognize the expertise already held within nursing homes and propose a collaborative approach to promote the appropriate integration of palliative care with nursing home practice.

[Myth of independence: caring for house and residential facilities with care for the elderly]

The innovations in the field of housing and care for elderly people often emphasize the concept of independence. Older people in these days are expected to competently and smoothly manage their own lives in a housing and care environment, that encourages self-help and selfsufficiency. Architects, care managers and politicians often are optimistic on the translation of independence into every-day practice of housing and care arrangements. By means of participating observations and interviews we explored how this translation is realised in an innovative project of 'lifetime' housing. Our results point out that strong and unexpected social factors develop in the use of space and caregiving that hinder personal fullfillment of autonomy. These problems were especially seen when every-day dependency failed to be noticed because of a too strongly emphasized autonomy.

Use of in-patient hospital beds by people living in residential care

BACKGROUND

There is concern that people living in residential care in Australia make significant and often inappropriate use of acute in-patient hospital services. To date, no factual information has been collected in Australia and its absence may allow myths and negative stereotypes to proliferate.

OBJECTIVE

To determine how and why people living in residential care in Australia use in-patient hospital beds. To determine the outcome of hospitalisation and functional status at 3 months following discharge.

METHODS

Prospective study of 184 consecutive admissions to hospital following Emergency Department (ED) attendance involving people aged over 65 years and living in residential care in southern Adelaide, South Australia. Information was obtained from the facilities' transfer letters, and where these were inadequate or absent, telephone interviews were held with residential care staff.

RESULTS

153 people accounted for the 184 admissions. They had a mean age of 84 years and 69% were female. 61% came from hostels and 35% from nursing homes. They had a wide range of clinical problems and twice as many were admitted to medical than to surgical units. Their mean length of hospital stay was 7.9 days, 2.3 days higher than for non-same-day patients and was higher for hostel than for nursing home residents. All but two admissions were considered unavoidable though the provision of specialised care within residential care could have prevented a further 19 (10%) admissions. 96% of admissions resulted in survival to leave hospital and in 74%, people returned directly to their place of origin. At 3 months follow-up, a further 20% of the group had died while 5% were in hospital. In all, 14% of the original group were in a different long-term care facility while 56% were living at their former residence.

CONCLUSIONS

People living in residential care are often hospitalised because of acute illness. In the vast majority of cases hospitalisation is both appropriate and unavoidable. Most did not require prolonged hospitalisation and were discharged alive, usually to their original residence. However, within 3 months many had died or had functionally declined. Strategies that prevent health breakdown in the residential care setting need to be developed and trialed.

Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden

BACKGROUND

In 1992, local municipalities in Sweden took over full responsibility for the long-term care of elderly. This has led to an increased care burden for the various assisted accommodation services run by the municipalities.

OBJECTIVE

Since ageing and chronic diseases are risk factors for protein-energy malnutrition, we evaluated the nutritional status of all individuals in assisted accommodation, i.e., service flats (SF), old people's homes (OPH), group living for the demented (GLD), and nursing homes (NH), in three Swedish municipalities.

METHODS

Of 994 eligible subjects, 872 were examined; the average age was 84.5+/-8 years, and 69% were female. The Mini Nutritional Assessment (MNA) scale (0-30 points) was used, consisting of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment.

RESULTS

MNA <17, i.e., malnutrition, was noted in 36% of the study population. Divided according to accommodation type, the MNA scores were <17 in 21% of individuals in SF, 33% of those in OPH, 38% of those in GLD, and 71% of those in NH. The corresponding values for MNA scores 17-23.5 (risk for malnutrition) were 49, 51, 57, and 29%, respectively. Average body mass index (BMI) values were 24.2+/-5 (SF), 23.6+/-5 (OPH), 23.9+/-4 (GLD), and 22.3+/-4 (NH). BMI values < or =20 were found in 18% of those in SF, in 25% of those in OPH, in 19% of those in GLD, and in 33% of those in NH. Both MNA and BMI correlated with upper arm and calf circumference, with r values ranging from 0.4 to 0.7 (p<0.001). MNA and BMI correlated significantly (r = 0.52, p<0.001). Age correlated with MNA and BMI with r values of 0.1 (p<0.01) and 0.14 (p < 0.001), respectively. Subjects with significant help requirements during meals ate fewer whole meals per day than those who could feed themselves.

CONCLUSIONS

Based on the MNA, one third of the study subjects living in assisted accommodation, and more than half of those living in NH, appeared to be malnourished. Further studies are necessary to assess to what extent these nutritional disturbances are reversible.

What nursing home residents value in their doctors

Patient satisfaction is influenced by multiple factors, and different populations are expected to define satisfaction in terms of their novel perspectives. Despite growing interest in patient satisfaction, an extensive literature search reveals no studies of nursing home residents' satisfaction with respect to medical care. In an initial qualitative study using transcripts of interviews conducted as part of a state quality control mandate, categories are identified that make up this population's construct of satisfaction and dissatisfaction. These categories serve as building blocks for designing future studies investigating these issues and allowing for comparison of nursing home residents' ideas of satisfaction and dissatisfaction to other older patients, including those in an outpatient geriatric setting.

[Resident Assessment Instrument (RAI): a review of international research on the psychometric qualities and effects of implementation in nursing homes]

This article is a review of the available literature on psychometric qualities and effects of implementation of the Resident Assessment Instrument (RAI) on quality of care and health of nursing homes residents. The RAI was developed in the USA to assess the needs of nursing home residents. It consists of a comprehensive assessment of the resident (the Minimum Data Set) and 18 protocols (Resident Assessment Protocols) for further analysis of major problem areas. RAI is implemented in nursing homes in the United States, Canada, Japan and several European countries. The interrater reliability was adequate for clinical use in several studies. The validity is good for the appraisal of ADL- and cognitive functions, but moderate for mood and behaviour. In Japan and the United States positive effects were found after implementation of the RAI, especially on the care process. Implementation of RAI has shown to have positive effects on the physical and cognitive function of the resident, but there were negative effects on a number of psychosocial domains. Fourteen Dutch nursing homes have recently implemented the RAI. Studies concerning reliability, validity and effects on quality of care and quality of life are underway.

Rapid growth of rehabilitation services in traditional community-based nursing homes

OBJECTIVE

To describe the changes in rehabilitation therapy services in nursing homes based in the community during a period of rapid escalation of Medicare payments to nursing homes.

SETTING

All Medicaid-certified nursing homes in Ohio.

SUBJECTS

The 52,705 residents newly admitted to nursing homes in 1994 and 1995.

DESIGN

Retrospective trend analysis of administrative data.

MAIN OUTCOME MEASURES

For newly admitted residents receiving 90 or more minutes of rehabilitation therapy per week, the trends in percentage and in the amount and type of therapy received were determined for eight quarters.

RESULTS

Of all newly admitted residents, 50.5% received 90 or more minutes of therapy. When they received such therapy it averaged 412 minutes per week (SD = 259). Those residents who received rehabilitation services increased by 2.2% each quarter (p<.001), and the amount of therapy they received increased by 6.4 minutes each quarter (p<.0001). All three types of rehabilitation therapy-physical, occupational, and speech-increased (p<.015) over the study period.

CONCLUSIONS

The traditional nursing home is an important site for the provision of rehabilitation therapy services. Rehabilitation specialists should be aware of these trends as they plan for the future of rehabilitation. The effectiveness of this increased provision of therapy service in terms of measurable outcomes needs to be evaluated.

[Future organizational structures for old age homes and nursing homes]

New organizational concepts are of significant importance for homes for the elderly. Restructuring of the homes is necessary because of some fundamental weaknesses in the contemporary elderly care system as well as the shift of the level of aspiration which is expected by the formation of the so-called "new elderly". Main topics in the restructuring process are consumer orientation, core organizational competences, and core processes. The challenge for the management is not to copy "ideal" models but to develop and to implement new structures which fit into the special context of the homes.