Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.
The need for safe, accessible, client-centred, alcohol withdrawal services for seniors was recognized by health service workers in Victoria. A partnership of health and support service organizations developed and implemented a pilot project for treating alcohol withdrawal in the home. The project provided service that integrated well with a substance-abuse treatment program for seniors.
The objective of this study was to broaden our understanding of the specific characteristics of community-dwelling seniors who are at increased risk of falling and becoming injured, by paying particular attention to gender and veteran status. The 137 respondents included 69 senior male veterans and 68 seniors in the general population. Results indicated that the veterans were at higher risk of falling than the general senior population, and were at higher risk of becoming injured after falling. Senior women were at less risk of falling and becoming injured than the veterans, but were at higher risk than the senior nonveteran men. It is imperative to target screening and falls prevention activities at these and other specific subgroups in the senior population that are at high risk of falling and becoming injured.
The association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.
The cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999-2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.
Of the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P
To explore expressed needs, both formal and informal, of family caregivers of frail elderly. To evaluate roles of physicians.
Questionnaire survey of members of the Montreal Jewish community providing care for frail elderly family members.
Jewish community of Montreal.
Volunteer caregivers who were caring for a family member or friend 60 years or older, who had greatest responsibility for providing physical or emotional support to an elderly person, who saw themselves as caregivers, and who could speak English or French were studied. Of 118 volunteers, 32 were excluded because they withdrew for personal reasons or because they did not meet study criteria.
Demographic variables, functional status of the care receiver, use of home care services, and needs assessment to identify additional services.
An average of 75.4% respondents did not use formal support services. Just under half of caregivers were dissatisfied with the attention they received from the health care system, and more than one third expressed feelings of stress, depression, guilt, and isolation.
Hypotheses for this discontent are presented. Physicians may be uninterested in helping caregivers; even if they were receptive to counseling caregivers, they could be poorly remunerated for the types of counseling sessions that are usual for caregivers; and being a professional caregiver to family caregivers is demanding in itself.
A system for monitoring and evaluating the long-term care of the elderly and disabled is presented, and its problems of completeness, reliability, and validity are discussed.
Half-yearly (before 1987) and yearly (after 1987) surveys were taken from 1984 to 1990 of all persons living in the city of Solna, Sweden, who at May 1 and November 1, or November 1, were receiving long-term care services from the municipality or county council, or both.
Completeness of observations was studied by linking survey and admission/discharge observations and checking for breaks in the chain of care. Reliability was estimated by comparing involuntary double registrations. Validity of the chosen measures of need was tested by comparing them with the actual provision of care services.
Registrations concerning actually provided services, assessed need, social environment, and disability were collected on a regular basis by the staff responsible for the care services.
Completeness was estimated to be more than 99 percent after a special procedure was carried out for filling in gaps in the "care chain." Reliability testing of the disability measures showed between .69 and .76 Kappa coefficient of agreement. Disability variables were shown to explain 56 percent of variance in the need measure "appropriate level of care."
Tests of completeness, reliability, and validity showed satisfactory results with regard to the purpose of the monitoring system and the limitations inherent in a system intended for routine application.
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To describe the association between specific nursing interventions performed in the context of nurse case management and older people's quality of life and functional ability.
Nurse case management through a university hospital and two community health centers.
One hundred seventy-five community-dwelling frail older persons (> or =70 and at risk for repeated hospitalizations).
Specific groups of nursing interventions provided in the context of nurse case management over a 10-month period--coping assistance, lifespan care, risk management, and physical comfort promotion--were focused on. These interventions were recorded using a standardized nursing language. Outcomes were measured using telephone and home interview and medical record review using the 36-item Short Form and the Older American Resources and Services Multidimensional Functional Assessment Questionnaire.
Older people receiving coping assistance interventions demonstrated an increase in instrumental activity of daily living functioning although they had lower general health, role-emotional, and mental health scores.
Coping assistance is one nursing intervention of several provided in the context of nurse case management that is independently associated with improving the functional status of frail older persons even in the presence of declining health normally associated with aging over several months. Examining the relationships between specific nursing activities and health outcomes of frail older persons may be useful in furthering understanding of the results of randomized trials of nurse case management in this population.
In 1988, the demented in an elderly rural population (n = 851) were traced and assessed with the GBS geriatric rating scale. The aim of the study was to investigate the level of impairments of demented persons primary cared for and to relate their impairments to form of housing; to compare the distribution of care between not-demented and demented in an elderly population, and to establish the primary caregiver/patient ratio. The majority of the demented (44/50) were cared for in the studied primary health care area, despite the scarcity of staff. All received formal care. They consumed more formal care than the not-demented in the population. In relation to amount of elderly persons helped, the home-help personnel ratio was 0.30, in district care the ratio was 0.02, whereas the ratio of general practitioners was 0.002, estimated from the number of contacts and staff.
To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care.
A randomized controlled trial with 3, 6, and 12 months follow-up.
A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87).
Three-month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow-up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment.
Goal Attainment Scaling (GAS).
Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: chi = 46.4 +/- 5.9; GAS outcome chi = 48.0 +/- 6.6) compared with controls (total: chi = 38.7 +/- 4.1; outcome chi = 40.8 +/- 5.6) (P