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Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care. Healthcare (Basel) 2020; 8:healthcare8030296. [PMID: 32854303 PMCID: PMC7551165 DOI: 10.3390/healthcare8030296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5–9.7], IC-LO 1.4 [0.3–6.6], IC-LA 1.4 [0.3–6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.
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Ness TM, Söderberg S, Hellzèn O. ‘The same care providers over time who make individual adjustments and have competence’ Older South Sami People in Sweden's expectations of home nursing care. Scand J Caring Sci 2019; 34:181-189. [DOI: 10.1111/scs.12719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Tove M. Ness
- Faculty of Nursing and Health Sciences Nord University Namsos Norway
| | - Siv Söderberg
- Department of Nursing Mid‐Sweden University Östersund Sweden
| | - Ove Hellzèn
- Department of Nursing Mid‐Sweden University Sundsvall Sweden
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Lambotte D, De Donder L, Van Regenmortel S, Fret B, Dury S, Smetcoren AS, Dierckx E, De Witte N, Verté D, Kardol MJM. Frailty differences in older adults' use of informal and formal care. Arch Gerontol Geriatr 2018; 79:69-77. [PMID: 30125830 DOI: 10.1016/j.archger.2018.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study examines different combinations of informal and formal care use of older adults and investigates whether these combinations differ in terms of need for care (physical and psychological frailty) and enabling factors for informal and formal care use (social and environmental frailty). METHODS Using cross-sectional data from the Belgian Ageing Studies (survey, N = 38,066 community-dwelling older adults), Latent Class Analysis (LCA) is used to identify combinations of informal and formal care use. Bivariate analyses are used to explore the relationship between the different combinations of care use and frailty. RESULTS Latent Class Analysis (LCA) identified 8 different types of care use, which vary in combinations of informal and formal caregivers. Older adults who are more likely to combine care from family and care from all types of formal caregivers are more physically, psychologically and environmentally frail than expected. Older adults who are more likely to receive care only from nuclear family, or only from formal caregivers are more socially frail than expected. CONCLUSIONS Older adults with a higher need for care are more likely to receive care from different types of informal and formal caregivers. High environmental frailty and low social frailty are related with the use of care from different types of informal and formal caregivers. This study confirms that informal care can act as substitute for formal care. However, this substitute relationship becomes a complementary relationship in frail older adults. Policymakers should take into account that frailty in older adults affects the use of informal and formal care.
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Affiliation(s)
- Deborah Lambotte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Liesbeth De Donder
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Sofie Van Regenmortel
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Bram Fret
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Sarah Dury
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - An-Sofie Smetcoren
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Eva Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Nico De Witte
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium; Faculty of Education, Health and Social Work, College University Ghent, Geraard de Duivelstraat 5, 9000, Gent, Belgium.
| | - Dominique Verté
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Martinus J M Kardol
- Academic Chair Active Ageing, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
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Ju YJ, Lee HJ, Kim W, Lee SA, Han KT, Park EC. Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study. Int J Nurs Stud 2017; 75:93-100. [DOI: 10.1016/j.ijnurstu.2017.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
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Laudisio A, Marzetti E, Franceschi F, Bernabei R, Zuccalà G. Disability is associated with emergency room visits in the elderly: a population-based study. Aging Clin Exp Res 2015; 27:663-71. [PMID: 25680781 DOI: 10.1007/s40520-015-0324-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing. AIMS The aim of the present study was to assess whether among older subjects functional disability is associated with increased ER visits and hospitalization rates. METHODS We assessed the association of functional ability with 1-year ER visits and hospitalization rates in all 342 subjects aged 75+ living in Tuscania (Italy) in 2004. Functional ability was estimated using the Katz' activities of daily living (ADLs), and the Lawton and Brody scale for the instrumental activities of daily living (IADLs). Functional disability was defined as the dependence for two or more ADLs or IADLs. RESULTS According to Cox regression, disability in ADLs was associated with increased risk of ER visits (RR 2.12; 95 % CI 1.11-4.08; P = .023) but not of hospital admission (RR 1.50; 95 % CI .80-2.80; P = .208). Also, in Poisson regression, ADLs disability predicted the number of ER visits (IRR 2.56; 95 % CI 1.48-4.40; P = .001). DISCUSSION Disability is associated with increased risk of ER visits, but not of subsequent hospitalization in community-dwelling elderly, independent of clinical conditions. Dedicated studies are needed to evaluate the impact of social interventions for disabled elderly on ER access rates. CONCLUSIONS Emergency Departments should implement innovative triage procedures to identify older patients with disability who gain access to ER, to recognize and classify any unmet social needs.
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Affiliation(s)
- Alice Laudisio
- Department of Gerontology, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
| | - Emanuele Marzetti
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | | | - Roberto Bernabei
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | - Giuseppe Zuccalà
- Emergency Department, Catholic University of Medicine, Rome, Italy
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Esbensen BA, Hvitved I, Andersen HE, Petersen CM. Growing older in the context of needing geriatric assessment: a qualitative study. Scand J Caring Sci 2015; 30:489-98. [PMID: 26331276 DOI: 10.1111/scs.12267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 06/24/2015] [Indexed: 12/01/2022]
Abstract
AIM The number of older adults will increase worldwide in the next 30 years, with many expected to develop chronic diseases and consequently require additional medical assessments and adequate care. The aim of this study was to describe how a group of older adults who need geriatric assessment experience growing older. METHODOLOGY A qualitative study was performed. The empirical data consisted of qualitative in-depth interviews with eight older persons referred to geriatric assessment (median age 76, range 65-86). The interviews were analysed based on Giorgi's descriptive phenomenological methodology. RESULTS The results led to an overall essence and five themes. The five themes were identified: (i) considerations to avoid weakness, (ii) compensation for the inability to perform certain activities, (iii) aides - a symbol of freedom or limitation, (iv) lifestyle considered being particularly significant and (v) considerations about the end of life as a component of growing older. The essence was defined as: illness essential for the experience of growing older and pointed to the experience of growing older that highlighted that experiencing illnesses and limitations served as reminders of their advancing age. CONCLUSION Growing older while in need of comprehensive geriatric assessment led to participants feeling they were no longer able to do the same things, they used to do. Consequently, compensation became an essential part of adaption to the altered situation. Aides that helped to overcome limitations in every daily life had the status of either creating freedom or being limiting in things they wished to do. Considerations about lifestyle were focused on housing and change of dwelling. This also led to thoughts about the future and end of life. Additional research regarding accommodations in older age is warranted to offer the best solutions for older people.
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Affiliation(s)
- Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, VRR, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ida Hvitved
- HR - Quality, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Elkjaer Andersen
- Department of Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Møller Petersen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, VRR, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: A prospective observational cohort study☆☆This paper was submitted as an entry for the European Academy of Nursing Science's Rosemary Crow award, sponsored by the International Journal of Nursing Studies. The award is open to current doctoral students or recent graduates of the academy's programme. Int J Nurs Stud 2015; 52:980-7. [DOI: 10.1016/j.ijnurstu.2015.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 01/06/2023]
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Lee TW, Yim E, Cho E, Chung J. Cognitive function, behavioral problems, and physical function in long-term care insurance beneficiaries with dementia in South Korea: comparison of home care and institutional care services. J Am Geriatr Soc 2014; 62:1467-75. [PMID: 25041583 DOI: 10.1111/jgs.12944] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine, in beneficiaries with long-term care (LTC) insurance (LTCI) with dementia in Korea, changes in cognitive function, behavioral symptoms, and physical function over time in relation to LTCI service type and to determine the 2-year effects of service type on those health outcomes. DESIGN Secondary analyses of the existing LTCI data set from 2008 to 2010. SETTING South Korea. PARTICIPANTS LTCI beneficiaries with dementia aged 65 and older (N=31,319). Participants were divided according to the service type that they were receiving home care (HC), institutional care (IC), and combined care (CC). MEASUREMENTS A LTC approval checklist was used to determine the level of LTCI coverage of each participant and to assess cognitive function, behavioral symptoms, and physical function. Linear mixed models and multiple regression models were used. RESULTS There were significant differences in cognitive function, behavioral symptoms, and physical function at baseline between individuals receiving the three service types (P<.001) and overall improvements in those outcomes over 2 years in the three groups (P<.001). After limiting the sample to those who had received LTCI services for the full 2 years (2008-2010) and adjusting for baseline characteristics, individuals receiving HC were more likely to have better cognitive and physical function than those receiving IC or CC but were likely to have more behavioral symptoms 2 years after the LTCI enrollment (P<.001). CONCLUSION LTCI service type (HC, IC, CC) predicted cognitive function, behavioral symptoms, and physical function at 2-year follow-up in beneficiaries with dementia. Further research is necessary to examine the effect of LTC services on health outcomes in a longer observational cohort.
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Affiliation(s)
- Tae Wha Lee
- Department of Nursing Environments and Systems, College of Nursing, Seoul, South Korea; Nursing Policy Research Institute, Yonsei University, Seoul, South Korea
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Rubio E, Comín M, Montón G, Martínez T, Magallón R. [Health and social services used by the rural elderly]. Rev Esp Geriatr Gerontol 2014; 49:217-22. [PMID: 25005158 DOI: 10.1016/j.regg.2014.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the use of health and social services, and to analyze the influence of functional capacity for Instrumental Activities of Daily Living (IADL) and other factors in their use. METHOD Cross-sectional study in a non-institutionalized population older than 64 years old in a basic rural health area of Zaragoza. DEPENDENT VARIABLES use of different health and social services. Main independent variable: functional capacity for IADL according to the Lawton-Brody. Confounding variables: sociodemographic, physical exercise, comorbidity, self-perceived health, walking aids, social resources and economic resources (OARS-MAFQ). The relationship between the use of services and functional capacity for IADL was assessed using crude OR (ORC) and adjusted (adjusted OR) with CI95% by means of multivariate logistic regression models. RESULTS The use of social and health services increased with age and worse functional capacity for IADL. The increased use of health services was related with bad stage of health, limited social and economic resources, physical inactivity and female. The increased use of home help services was related with limited social resources, low education level and male. Regular physical activity and using walking aids were associated with greater participation in recreational activities. CONCLUSIONS The probability of using social and health services increased in older people with impaired functional capacity for IADL. The specific use of them changed according to differences in health, demographic and contextual features.
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Affiliation(s)
| | - Magdalena Comín
- Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza
| | | | | | - Rosa Magallón
- Red de Investigación en Atención Primaria (redIAPP) (Carlos III 06/018), Instituto Aragonés de Ciencias de la Salud
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Hedman AMR, Fonad E, Sandmark H. Older people living at home: associations between falls and health complaints in men and women. J Clin Nurs 2013; 22:2945-52. [DOI: 10.1111/jocn.12279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Edit Fonad
- Department of Neurobiology; Karolinska Institutet; Care Sciences and Society; Stockholm Sweden
| | - Hélène Sandmark
- School of Health; Mälardalen University; Care and Social Welfare, Public Health Sciences; Västerås Sweden
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Karlsson S, Edberg AK, Jakobsson U, Hallberg IR. Care satisfaction among older people receiving public care and service at home or in special accommodation. J Clin Nurs 2013; 22:318-30. [DOI: 10.1111/jocn.12115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Staffan Karlsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund
| | - Anna-Karin Edberg
- The Vårdal Institute; The Swedish Institute for Health Sciences; Lund University; Lund
| | - Ulf Jakobsson
- Center for Primary Health Care Research; Lund University; Skåne University Hospital; Malmö Sweden
| | - Ingalill R Hallberg
- The Vårdal Institute; The Swedish Institute for Health Sciences; Lund University; Lund
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Factors favoring a degradation or an improvement in activities of daily living (ADL) performance among nursing home (NH) residents: A survival analysis. Arch Gerontol Geriatr 2013; 56:250-7. [DOI: 10.1016/j.archger.2012.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022]
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Yamada Y, Siersma V, Avlund K, Vass M. Formal home help services and institutionalization. Arch Gerontol Geriatr 2012; 54:e52-6. [DOI: 10.1016/j.archger.2011.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
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Hoi LV, Thang P, Lindholm L. Elderly care in daily living in rural Vietnam: need and its socioeconomic determinants. BMC Geriatr 2011; 11:81. [PMID: 22136507 PMCID: PMC3239225 DOI: 10.1186/1471-2318-11-81] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 12/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of older people is increasing rapidly in Vietnam. The majority of the elderly live in rural areas. Their health status is generally improving but this is less pronounced among the most vulnerable groups. The movement of young people for employment and the impact of other socioeconomic changes leave more elderly on their own and with less family support. This study aims to assess the daily care needs and their socioeconomic determinants among older people in a rural setting. METHODS In 2007, people aged 60 years and older, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance System (DSS). They were interviewed using structured questionnaires to assess needed support in activities of daily living (ADLs). Individuals were interviewed about the presence of chronic illnesses that had been diagnosed by a physician. Participant socioeconomic characteristics were extracted from the FilaBavi repeat census. The repeat census used a repeat of the same survey methods and questions as the original FilaBavi DSS. Distributions of study participants by socioeconomic group, supports needed, levels of support received, types of caregivers, and the ADL index were described. Multivariate analyses were performed to identify socioeconomic determinants of the ADL index. RESULTS The majority of older people do not need of support for each specific ADL item. Dependence in instrumental or intellectual ADLs was more common than for basic ADLs. People who need total help were less common than those who need some help in most ADLs. Over three-fifths of those who need help receive enough support in all ADL dimensions. Children and grandchildren are the main caregivers. Age group, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, poverty status, and chronic illnesses were determinants of daily care needs in old age. CONCLUSIONS Although majority of older people who needed help received enough support in daily care, the need of care is more demanded in disadvantaged groups. Future community-based, long-term elderly care should focus on instrumental and intellectual ADLs among the general population of older people, and on basic ADLs among those with chronic illnesses. Socioeconomic determinants of care needs should be addressed in future interventions.
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Affiliation(s)
- Le V Hoi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Genet N, Boerma WG, Kringos DS, Bouman A, Francke AL, Fagerström C, Melchiorre MG, Greco C, Devillé W. Home care in Europe: a systematic literature review. BMC Health Serv Res 2011; 11:207. [PMID: 21878111 PMCID: PMC3170599 DOI: 10.1186/1472-6963-11-207] [Citation(s) in RCA: 259] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 08/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. METHODS A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. RESULTS Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. CONCLUSIONS Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires the gathering of information using a uniform framework and methodology.
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Affiliation(s)
- Nadine Genet
- NIVEL-Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
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Condelius A, Hallberg IR, Jakobsson U. Hospital and outpatient clinic utilization among older people in the 3-5 years following the initiation of continuing care: a longitudinal cohort study. BMC Health Serv Res 2011; 11:136. [PMID: 21627791 PMCID: PMC3133543 DOI: 10.1186/1472-6963-11-136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 05/31/2011] [Indexed: 11/28/2022] Open
Abstract
Background Few studies have investigated the subsequent rate of hospital and outpatient clinic utilization in those who receive continuing care and have documented frequent usage over one year. Such knowledge may be helpful in identifying those who would benefit from preventive interventions. The aim of this study was to investigate and compare the subsequent rate of hospital and outpatient clinic utilization among older people with 0, 1, 2, 3 or more hospital stays in the first year following the initiation of continuing care. A further aim was to compare these groups regarding demographic data, health complaints, functional and cognitive ability, informal care and mortality. Methods A total of 1079 people, aged 65 years or older, who received a decision regarding the initiation of continuing care during the years 2001, 2002 or 2003 were investigated. Four groups were created based on whether they had 0, 1, 2 or ≥3 hospital stays in the first year following the initiation of continuing care and were investigated regarding the rate of hospital and outpatient clinic utilization in the subsequent 3-5 years. Results Fifty seven percent of the sample had no hospital stay during the first year following the initiation of continuing care, 20% had 1 stay, 10% had 2 stays and 13% had three or more hospital stays (range: 3-13). Those with ≥3 hospital stays in the first year continued to have the significantly highest rate of hospital and outpatient care utilization in the subsequent years. This group accounted for 57% of hospital stays in the first year, 27% in the second year and 18% in the third year. In this group the risk of having ≥3 hospital stays in the second year was 27% and 12% in the third year. Conclusions There is a clear need for interventions targeted on prevention of frequent hospital and outpatient clinic utilization among those who are high users of hospital care in the first year after the initiation of continuing care. Perhaps an increased availability of medically skilled staff in the day to day care of these people in the municipalities could prevent frequent hospital and outpatient clinic utilization, especially hospital readmissions.
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Affiliation(s)
- Anna Condelius
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Abstract
BACKGROUND The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities aims to support and strengthen mental health services in the long-term care sector. The purpose of this paper is to identify broad principles that may underpin the drive towards meeting the mental health needs of residents of long-term care facilities and their families, as well as to enhance the overall delivery of residential care services. METHODS Principles of good care are extrapolated from an analysis of international consensus documents and existing guidelines and discussed in relation to the research and practice literature. RESULTS Although the attention to principles is limited, this review reveals an emerging consensus that: (1) residential care should be situated within a continuum of services which are accessible on the basis of need; (2) there should be an explicit focus on quality of care in long-term care facilities; and (3) quality of life for the residents of these facilities should be a primary objective. We take a broad perspective on the challenges associated with actualizing each of these principles, taking into consideration key issues for families, facilities, systems and societies. CONCLUSIONS Recommendations for practice, policy and advocacy to establish an internationally endorsed principles-based framework for the evolution and development of good mental health care within long-term care facilities are provided.
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Karlsson S, Edberg AK, Hallberg IR. Professional's and older person's assessments of functional ability, health complaints and received care and service. A descriptive study. Int J Nurs Stud 2010; 47:1217-27. [DOI: 10.1016/j.ijnurstu.2010.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/17/2010] [Accepted: 03/05/2010] [Indexed: 11/30/2022]
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Laudisio A, Marzetti E, Pagano F, Bernabei R, Zuccalà G. Masticatory dysfunction is associated with worse functional ability: a population-based study. J Clin Periodontol 2009; 37:113-9. [PMID: 20041974 DOI: 10.1111/j.1600-051x.2009.01518.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Because of the ageing of populations, disability has become an emergent problem from the clinical, social, and economic perspectives. Nevertheless, the determinants of disability in older subjects are still unclear. We assessed the association between self-assessed masticatory dysfunction (MD) and functional ability in older subjects. MATERIALS AND METHODS We analysed data of all 350 subjects aged 75+ living in Tuscania (Italy). Functional ability was estimated using the Katz' activities of daily living (ADLs), and the Lawton and Brody instrumental activities of daily living (IADLs) scales. RESULTS MD was reported by 145 (41%) participants. Disability in the ADLs and IADLs was found in 37 (25%) and 53 (37%) of participants with MD, respectively, but only in 11 (5%) and 30 (15%) of the other participants (p<0.001). MD was associated with disability in the ADLs [odds ratio (OR)=2.40, 95% confidence interval (CI)=1.05-5.51], and IADLs (OR=2.77, 95% CI=1.07-7.16) in logistic regression, after adjusting. The association of MD with disability was stronger among subjects aged 80+. CONCLUSIONS MD is independently associated with disability in community-dwelling elderly. Further studies are needed to evaluate the impact of early detection and correction of MD on the preservation of functional status in older populations.
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Affiliation(s)
- Alice Laudisio
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy.
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Condelius A, Edberg AK, Hallberg IR, Jakobsson U. Utilization of medical healthcare among people receiving long-term care at home or in special accommodation. Scand J Caring Sci 2009; 24:404-13. [PMID: 20030774 DOI: 10.1111/j.1471-6712.2009.00725.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the utilization of medical healthcare, hospital care and outpatient care, during a 1-year period in relation to informal care, multimorbidity, functional status and health complaints and to long-term care at home or in special accommodation among people aged 65+, with one or more hospital admissions and receiving long-term care. METHOD A total of 694 people receiving long-term care during the year 2001 were studied. Data were collected by means of the administrative registers Patient Administrative Support in Skåne and PrivaStat and through the study Good Ageing in Skåne. Those at home and those in special accommodation were compared regarding utilization of medical healthcare, informal care, multimorbidity, functional status and health complaints. Multiple logistic regression analysis was performed using at home vs. in special accommodation as the dependent variable and also two multiple linear regression analyses using the number of hospital stays and the number of contacts with the physician in outpatient care separately as dependent variables. FINDINGS Those at home were significantly younger (mean age: 81 vs. 84 years) and less dependent in personal and instrumental activities of daily living (PADL/IADL) than those in special accommodation. A larger proportion of those at home was admitted to hospital three times or more (21 vs. 14%) and they had significantly more contacts with physicians in outpatient care (md: 10 vs. md: 7). Informal care was associated with care at home (OR = 0.074) and with utilization of outpatient care (B = 2.045). Dependency in PADL was associated with care in special accommodation (OR = 1.375) and with utilization of hospital care (B = -0.060) and outpatient care (B = -0.581). CONCLUSION Medical healthcare seems more accessible to those who live at home are younger, less dependent and who have access to informal caregivers.
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Affiliation(s)
- Anna Condelius
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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