Signs of Inequality? Variations in Providing Home Health Care Across Care Organizations and Across European Countries in the IBenC Study

Most countries aim to allocate home health care to those in need in a fair and equal way. Equal allocation implies that the amount of home care a person receives would reflect the level of health impairment and the need for resources. It is not clear whether countries succeed in attaining this. Our objective was to explore signs of (un)equal home health care provisioning across care organizations and across European health countries. We used data of the IBenC study collected from 2718 older community care recipients from 33 organizations in 6 Western European countries (www.ibenc.eu). We benchmarked differences of provided and expected formal care time across organizations and countries. Expected formal care hours were estimated by multiplying the overall sample’s mean formal hours with recipients’ case mix weights from interRAI’s resources utilization group profiles. We found substantial variations in provided formal care time among organizations both within and across countries that could not be explained by the case mix differences of recipients. This implied presence of inequality of home care provisioning. These findings may alert professionals and policy makers striving for equal home health care provisioning for dependent older persons.

Serum lipids in adults with late age-related macular degeneration: a case-control study

Background

Lipids are implicated in the pathogenesis of age-related macular degeneration (AMD). The relationship between systemic lipids and AMD has not been well characterized. The objective was to investigate the relationship between serum lipids and AMD in older adults using a lipidomic approach.

Methods

In a case-control study, 240 adults, aged ≥66 years, a third each having geographic atrophy, neovascular AMD, or no signs of AMD, were selected from a population-based sample of participants in the Age Gene/Environment Susceptibility-Reykjavik Study. The exposure was serum lipids and risk factors for AMD. The outcome was late AMD, assessed through fundus images taken through dilated pupils using a 45-degree digital camera and grading for neovascular AMD and geographic atrophy using the modified Wisconsin Age-Related Maculopathy Grading System.

Results

Of 177 serum lipid species measured, there were no significant differences in serum lipids between controls and those with geographic atrophy or neovascular AMD, respectively. Adults with neovascular AMD had higher total serum lysophosphatidylcholine (LPC) (P = 0.004) and serum LPC 18:0 (P = 0.0002) compared to those with geographic atrophy.

Conclusion

Late AMD was not characterized by alterations in systemic lipids compared with normal controls. These findings suggest that there may be differences in the LPC pathway between adults with neovascular AMD and geographic atrophy.

Electronic supplementary material

The online version of this article (10.1186/s12944-018-0954-7) contains supplementary material, which is available to authorized users.

Social and functional health of home care clients with different levels of cognitive impairments

OBJECTIVES

The ability to manage one's life with some degree of independence, to fulfill basic obligations, and to participate in social activities are social functions that delineate the core of 'social health'. We examine to what extent clients of community care in Europe (n = 2884) complete such activities despite their cognitive problems. We focus on mildly and moderately impaired people, aged 65+ years.

METHODS

Data were collected using the interRAI HC-Assessment in IBenC-project. We tested the association between participants' capacity and performance in three LADLs (instrumental activities of daily living) and their cognitive performance and specific memory problems.

RESULTS

About 30% of home care clients in Europe suffer from mild-to-moderate cognitive impairment. Their relatively independent coping with requirements of routine activities is strongly determined by overall cognitive performance. Specific memory functions seem unimportant, except for procedural memory. It is striking that all clients, and particularly those with mild-to-moderate cognitive impairment, interact mostly with close relatives and friends. Mild-to-moderate cognitive limitations do not hinder clients from coping semi-independently with routine requirements.

DISCUSSION

When considering the influence of cognitive function on clients' capacity and performance in everyday activities and social relations, a comprehensive construct of cognitive function has to be applied.

Comparison of nurses' and physicians' documentation of functional abilities of older patients in acute care--patient records compared with standardized assessment

AIM

To compare nurses' and physicians' documentation of geriatric issues and explore double documentation and undocumented areas of importance in an acute care setting in two Nordic countries.

METHOD

158 participants, aged 75+, of whom the Minimum Data Set for Acute Care (MDS-AC) instrument was conducted at admission and from which 56 variables were taken in comparison with notes from patient records documented by nurses and/or physicians in two acute care hospitals, in Finland and Iceland.

FINDINGS

Documentation of the impairment of personal Activities of Daily Living (ADL) was missing in 40-60% of the nurses' reports and 80-97% of the physician's reports. Even poorer was the documentation of the impairment of Instrumental Activities of Daily Living (IADL), of which 75% was not reported by the nurses and 85-96% by the physicians. Cognitive function was recorded in only 30-40% of the cases.

CONCLUSIONS

The traditional patient record in acute care setting lacks several variables of functional abilities of the older patients. Nurses took more responsibility in the documentation of functional abilities, compared with physicians, but they could improve. Using a standardized instrument such as the MDS-AC can improve documentation and make a basis for a clearer delineation in responsibilities for documentation between nurses and physicians and thereby improve outcome of care.

Integrated health information systems based on the RAI/MDS series of instruments

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

Mapping of a familial essential tremor gene, FET1, to chromosome 3q13

Essential tremor (ET), the most common movement disorder in humans, appears to be inherited as an autosomal dominant trait in many families. The familial form is called familial essential tremor (FET), which seems similar to sporadic essential tremor. ET is a cause of substantial disability, particularly in the elderly. The prevalence of Parkinson's disease and dystonia may be increased in families with ET, but other movement disorders are seldom encountered in these families. Here we report the results of a genome-wide scan for FET genes in 16 Icelandic families with 75 affected individuals, in whom FET was apparently inherited as a dominant trait. The scan, which was performed with a 10-cM framework map, revealed one locus on chromosome 3q13 to which FET mapped with a genome-wide significance when the data were analysed either parametrically, assuming an autosomal dominant model (lod score = 3.71), or non-parametrically (NPL Z score = 4.70, p < 6.4 x 10(-6).

Hand osteoarthritis in the elderly. Application of clinical criteria

The American College of Rheumatology (ACR) classification criteria were used to define the prevalence of clinical hand osteoarthritis (OA) in an elderly population in Iceland. The prevalence of hand OA was 3.3% for men and 6.8% for women, however, 19.6% of the men and 32.0% of the women fulfilled the ACR examination but lacked required symptoms. The prevalence of clinical signs of OA in the interphalangeal joints were similar for both sexes but were much more common in the first carpometacarpal joint of women (31.3% vs. 1.0% in men, p < 0.0001). No differences were observed between former seamen (55% of the men) and nonseamen or between the right and left hand. Intra- and interobserver agreement in diagnosis ranged from 83% to 97%, but only 70% of subjects fulfilling the symptoms criterion fulfilled the same criterion six months later. Our results suggest that the present symptoms criterion of the ACR clinical criteria restricts their use in population surveys, being both insensitive and unstable over time.