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.
The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.
Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.
This is a descriptive and comparative cross-sectional study using qualitative methods.
The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.
Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.
Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues.
Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
With an ageing population an increased pressure on health care resources will be seen in most countries. Patients with delayed discharge from short-term hospitals, sometimes called "bed-blockers", are of special interest in Sweden, especially as liability for payments for these patients has been placed on the municipal authorities by a new reform in 1992. A retrospective study was made of 428 bed-blockers above the age of 64 years from one health district in Uppsala during the two-year period 1987-1988. The median age was 81.6 years, and the majority were women. The patients had a median number of diagnoses of 4.1. Additional medical events/symptoms were noted in half of the patients after they had been classified as medically ready for discharge. Even though they were classified "medically ready" for discharge, they still needed care. One-third needed further rehabilitation and another 1/3 further medical attention. Only 1/10 were independent in daily activities of living. At the final discharge 1/3 actually returned home and 16% died on the acute ward. The results clearly demonstrate that these patients often still had further medical needs after the application for transfer. One crucial question, that needs discussion, is the vague definition of a "bed-blocker". Related questions are when and where should these patients be transferred, as well as the relevance of the term "bed-blocker" from ethical perspectives.
To examine factors related to regularity of adult day center (ADC) attendance among seniors with functional limitations.
Using data collected as part of a larger study, we identified the proportion of scheduled days attended among 101 ADC users in Montréal and identified determinants of this attendance.
More regular attendance was associated with previous profession of ADC participant or spouse in a sector other than health care, receiving formal help for activities of daily living or instrumental activities of daily living on days of expected ADC participation, participating for the whole day rather than half a day, lower participation in prevention and health-promotion activities, and lower caregiver burden among persons with cognitive impairments and higher caregiver burden among persons without cognitive impairments.
To enhance ADC intervention effects, levels of participation should be maximized. Study findings suggest ways to promote more regular attendance.
The oral health and concerns of elderly residents were surveyed in a stratified random selection of 41 long-term care facilities in Vancouver. The residents who could participate were examined and interviewed to determine their oral health and concerns about dental treatment. The need and time required for treatment were estimated in six groups to reflect the propensity for treatment in dentate and edentate subjects. The propensity for treatment was high in about one-third of the participants whereas it was unlikely that one-tenth of those examined would ever use a dental service. In general, there was a widespread need for a diagnostic service because so few had been examined by a dentist in the previous year. Prosthodontics accounted for most of the treatment in all of the propensity groups, with substantially more time required by the dentate residents. There was also a substantial need for management of mucosal pathoses and oral hygiene and, to a lesser extent, for dental restorations and endodontics. Overall, our estimates indicate a substantial need for dental treatment among residents of long-term care facilities, although the need is reduced by half if the propensity for treatment is considered.
Preventive home visits (PHVs) to frail elderly patients, provided by the GP, have been widely promoted in many health care systems, including the Danish system. This study investigates to what extent PHVs are provided to patients with characteristics of frailty.
During a four-week period, GPs and their staff in three different parts of Denmark filled in a questionnaire for each patient aged 75 years or older who attended the clinic or received a home visit. The association between 20 different frailty characteristics and the receipt of a PHV was assessed through logistic regression.
A total of 73 GPs and 41 staff members sampled information about 3133 patients, of whom 332 patients (10.7%) had received a PHV within one year prior to their audit date. A PHV was closely associated with the patient's number of frailty characteristics. The adjusted odds ratios show that the receipt of a PHV was associated with a low walking distance 2.34 (1.65-3.31), dementia 3.35 (2.26-4.96), depression 2.24 (1.38-3.63) and a need for home care 3.40 (2.45-4.73), and increased with the GP's tendency to provide PHVs.
Most PHV-receiving elderly patients have several characteristics of frailty, the most significant being impaired mobility, dementia, depression and a need for home care. PHVs are also more often provided to patients listed with a GP who has an overall high tendency to conduct these visits.
Studies in the County of Stockholm reveal a malfunctioning care system for elderly persons with one or more diseases in conjunction with immobility and reduced strength. These multi-impaired elderly consume a substantial proportion of care and rehabilitation services. They would need a health co-ordinator to monitor the entire care process, dealing with all aspects of care, and whose sphere of responsibility is not unduly restricted. The communication of information from inpatient care to the primary care setting is highly problematic. Therefore it is proposed that the transfer of multi-impaired elderly individuals from inpatient care to outpatient primary care be a carefully monitored process. In addition, outside of the hospital an "elderly team" that would be composed of doctors, district nurses, rehabilitation personnel and care assistants is proposed. This team should have a geographically well-defined area of responsibility, in which they would provide care in the homes of these multi-impaired elderly.