To study prevalence, functional capacity, and placement of demented patients in a randomly selected population.
Random sample from population registry of the City of Helsinki.
Nine hundred subjects aged 75 years, 80 years and 85-years, 300 in each group.
For each participant, we completed a questionnaire for the subject and an informant and a functional-capacity scale and Mini-Mental Status Examination by a community nurse, including the Clinical Dementia Rating (CDR) scale. Subjects with CDR of 0.5 or greater were examined by a neurologist who diagnosed the presence or absence of dementia according to DSM-III-R.
Ninety-three subjects of the 656 whose CDR was known were found to have dementia. Three-quarters of them lived in institutions, and they comprised 33%, 60%, and 68% of all institutionalized patients in the above-mentioned age groups, respectively. Community residents suffering from dementia often lived with a caring relative and needed many services. A considerable part of the need was not met.
In the older age groups, the need for institutional placement due to dementia is great. According to our study, it seems unlikely that these patients could be cared for in any other way, at least not on a large scale. The need for services for home-dwelling patients is also great, and the relatives carry a heavy load in taking care of demented patients.
BACKGROUND AND AIMS: The aim of the one-year follow-up was to evaluate formal care and the situation of informal caregivers from a gender perspective. METHODS: The present study targeted elderly persons (n = 147) living in their own homes 12 months after acute stroke, 94 women and 53 men. The median age of the women was 81 years and the men 80 years. RESULTS: A statistically significant gender difference was seen in living conditions. Eighty percent of the women were living alone compared with 28% of the men (CI 48-56%). The informal care given far exceeded that provided by the community: 65% of these elderly people had some kind of informal care and 44% received formal care from the community. There was a gender difference in daily informal personal care, 24% of men and 16% of women (CI 2-18%), and in daily informal household assistance (CI 15-43%). Formal care was provided by the community significantly more frequently to women (56%) than men (23%) (CI 21-45%). The women more frequently had community-based help with house-cleaning (CI 23-39%) and they also more frequently received help with personal care (CI 1-10%). CONCLUSIONS: This study showed statistically significant gender differences in the use of informal and formal care. Elderly caregivers' situations must be given greater attention, since informal care to stroke survivors represents a far greater burden than the care that is provided by the community. Most of the caregivers were elderly women, and preventive intervention measures should be developed in order to enable them to manage their everyday lives.
This article describes the social, socioeconomic and other health-related characteristics of people receiving formal, publicly funded home care services.
The data are from the household component of the 1994/95 National Population Health Survey. The analysis covers 16,291 respondents aged 18 or older.
Recipients of publicly funded home care services were profiled using weighted univariate frequencies and multivariate logistic regression.
Recipients of publicly funded home care services in 1994/95 numbered over half a million. People who were elderly, female, had two or more chronic conditions or were living with others accounted for large proportions of these recipients. Characteristics significantly associated with receiving home care included old age, poor or fair general health, abstinence from alcohol (compared with regular use), low income, living alone, needing help with some activity of daily living, and having cancer or the effects of a stroke.
To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life.
The data were derived from national registers. All those who died in 2002 or 2003 at the age of = 70 years were included except those who lived in very small municipalities. The services included were different types of hospitals, long-term care, and home care. The variation in service use was described by coefficients of variation (CV). To analyse local differences, three-level (individual, municipal, and regional) binary logistic and Poisson regression analyses were performed.
A total of 67,027 decedents from 315 municipalities in 20 hospital districts were included. There was considerable variation in service use between residents of different municipalities, especially in the types of hospital used. Of the individual-level variables age and use of other services were associated (p
Home care is the fastest growing segment of Canada's health care system. Since the mid-1990 s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario's home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions.
Survey responses to questions regarding utilization of health and social services among very old persons were compared to independently registered utilization records. Survey data came from in-person interviews with a sample of noninstitutionalized 75-84-year-olds and all noninstitutionalized individuals over the age of 84 in a Swedish community. Agreement regarding utilization vs no utilization during the past three months was found to be very high for hospitalizations and home help, somewhat lower for home visits by nurses, and lower yet for visits to physicians and to nurses. Except for visits to nurses, aggregate survey estimates of proportion with utilization were not significantly different from those based on records. Reporting patterns were generally in agreement with predictions made on the basis of frequency and saliency of service utilization. Reasons for over- and underreporting were investigated on the basis of register data, and some evidence for telescoping was observed.