Over a period of two months in 1988 and 1989 all general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. We report data from 1,384 house calls to elderly patients (65 years and older). House calls made up 11.3% of all face-to-face contacts between general practitioners and elderly patients. 59% of the visits were to female patients, and 60% were to patients 75 years and older. 23% of the house calls took place during weekends, and new diagnoses were made in 58% of the cases. The most common groups of diagnoses were cardiovascular (21%), respiratory (16%), and musculoskeletal diseases (13%). Drugs were prescribed for 42% of the house calls. 28% of all drugs prescribed were for the nervous system, while 26% were antibiotics for systemic use. Most house calls were made because of acute illnesses. Our results suggest that preventive home visits to the elderly are rarely, if ever, performed in general practice.
The aim of this study was to compare the estimation ability of a dental hygienist to that of a dentist when, independently, recording the oral health status and treatment need in a population of elderly, receiving home nursing. Seventy-three persons, enrolled in a home nursing long-time care programme, were recruited. For the oral examination a newly developed protocol with comparatively blunt measurement variables was used. The oral examination protocol was tested for construct validity and for internal consistency reliability. Statistical analyses were performed using Wilcoxon matched pairs signed rank sum test for testing differences, while inter-examiner agreement was estimated by calculating the kappa-values. Comparing the two examiners, good agreement was demonstrated for all mucosal recordings, colour, form, wounds, blisters, mucosal index, and for the palatal but not the lingual mucosa. For the latter, the dental hygienist recorded significantly more changes. The dental hygienist also recorded significantly higher plaque index values. Also regarding treatment intention and treatment need, the dental hygienist's estimation was somewhat higher. In conclusion, when comparing the dental hygienist's and the dentist's ability to estimate oral health status, treatment intention, and treatment need, some differences were observed, the dental hygienist tending to register "on the safe side", calling attention to the importance of inter-examiner calibration. However, for practical purpose the inter-examiner agreement was acceptable, constituting a promising basis for future out-reach activities.
This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.
The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients.
The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography.
Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. Data extraction A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy.
Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication.
A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.
Comment In: Int J Qual Health Care. 2010 Apr;22(2):75-720144941
BACKGROUND: Developed countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited. OBJECTIVES: To describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample. METHODS: The population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument. RESULTS: The amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the cognitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care. CONCLUSIONS: Informal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.
The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found.
This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009-2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada.
The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients' decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation.
Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as 'informal' caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.
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To plan for a new community leg ulcer service in one Ontario region, venous ulcer population characteristics and current community care practices were obtained from a home care cohort of people with venous ulcers. A secondary analysis was conducted on the venous ulcer cohort using data collected during a Regional Prevalence and Profile Study. Patients were identified based on the clinical syndrome for venous disease criteria described in the Royal College of Nurses clinical practice guidelines and by the presence of an ankle-brachial pressure index 0.8. The Regional Prevalence and Profile Study identified 263 people with leg ulcers for a rate of 2.0 per 1,000 people >25 years of age. One hundred, seven ulcers (41%) were the result of venous disease; of these, 83 (78% of cases) were associated with a single nursing agency and formed the study cohort. Most patients (51, 61%) were female and 65 years old. Thirty-eight (46%) had 4 comorbid conditions, 63 spoke English, 29 lived alone, 38 did not require physical aids or assistance for mobility, and 81 (98%) were able to travel outside of their home. The current ulcer had been present for an average of 15 months (median 6 months), 51 participants had a previous leg ulcer, and 22 had episodes of ulceration for > 5 years. Of the 121 ulcers in the study, 48 (41%) were located at the ankle, and the majority (85%) were > 1 cm2. General practitioners were the main medical care providers for 48 participants, and 52 (62%) had seen a specialist physician for their current ulcer. These findings are similar to large studies conducted in other industrialized countries and confirm that venous ulcers are a chronic problem in a population with complex health needs.
One percent of Canada's population are long-term residents of health care institutions. Of this group an estimated 97% have a disabling condition. This article profiles disabled people living in institutions using data from the Health and Activity Limitation Survey (HALS) undertaken by Statistics Canada. HALS collected data on: the nature, number and severity of disabilities; the underlying causes of the disabilities; and the degree of assistance required for daily activities. For the institutional component of HALS, a sample of 19,000 disabled individuals from 1,100 institutions was used. The institutional survey indicated that almost 80% of the disabled population in institutions were aged 65 or older, while about 90% had mobility and/or agility-related disabilities. The most frequently cited underlying cause of disability for respondents living in both institutions and households was disease or illness. Among young adults in institutions, mental retardation was the main disabling condition. Among the elderly, diseases of the musculoskeletal system and connective tissue (including arthritis) were most common. Most respondents in institutions required daily help with personal care, shopping and personal finances.
One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown.
This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N?=?41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with specialised palliative home care as reference.
Preferred place of death was unknown for 63% of hospitalised patients and consistent with the actual place of death in 25% compared to 97% in palliative home care. Hospitalised patients were less likely to be informed when death was imminent (OR: 0.3; CI: 0.28-0.33) as were their families (OR: 0.51; CI: 0.46-0.57). Validated screening tools were less often used in hospitals for assessment of pain (OR: 0.32; CI: 0.30-0.34) or other symptoms (OR: 0.31; CI: 0.28-0.34) despite similar levels of EOL symptoms. Prescriptions of as needed drugs against anxiety (OR: 0.27; CI: 0.24-0.30), nausea (OR: 0.19; CI: 0.17-0.21), or pulmonary secretions (OR: 0.29; CI: 0.26-0.32) were less prevalent in hospitals. Bereavement support was offered after 57% of hospital deaths compared to 87-97% in palliative care units and 72% in nursing homes.
Dying in hospital was associated with inferior end-of-life care quality among cancer patients in Sweden.
This article presents a descriptive study based on quantitative and qualitative methods. We wished to determine factors that promote or restrict home deaths. The Norwegian Central Bureau of Statistics released non-identifiable data for the time period 1990-1994 for all municipalities in Norway. Relevant health and social data from the Norwegian Social Science Data Service for the 24 municipalities, which had more than 20% or less than 10% of the cancer patients dying in their own homes, were analysed. Key persons in the home care teams were interviewed. There were few occurrences of home deaths in municipalities with a local hospital, good capacity in nursing homes or a larger percentage of one-person households. Indicators for several occurrences of home deaths were openness, good co-operation with physicians, and a stable, flexible staff. In addition, the patient had to have a strong desire to die at home. Finally, the employees had to be professionally confident and willing to go beyond the prescribed shift hours.