This study will compare the clinical outcomes of 139 elders residing in long-term care (LTC) who received dental treatment with those who did not receive care under a comprehensive dental programme over 5 years.
Numerous studies have documented very poor oral health and limited access to dental care among frail older adults residing in LTC facilities. The University of British Columbia and Providence Healthcare developed a comprehensive dental programme to serve elderly LTC residents within seven Vancouver hospitals. Since 2002, the Geriatric Dentistry Programme has provided annual oral health assessments and access to comprehensive dental care.
A comprehensive oral health assessment was provided using CODE (an index of Clinical Oral Disorders in Elders). A change in oral health status (improvement or worsening) was evaluated by measuring CODE scores including caries and periodontal condition, and other aspects of the dentition.
Eighty-three residents received dental treatment of some form over the 5 years, while 56 did not receive any treatment beyond an annual examination. The percentage of residents initially recommended for treatment in 2002 was 97%, which declined to 70-73% after the 3rd year. The percentage of residents treated increased after the first year and remained at 56-72% thereafter. The comparison between CODE scores from baseline and 5 years later showed an improvement for those receiving care (p = 0.02, chi(2) = 7.9, df = 2).
Within the limitations of this study, residents who did consent and receive care showed an improvement in their oral health status after 5 years.
On July 14, 1980, at approximately 9:30 pm, a fire in the Extendicare Skilled Nursing Facility in Mississauga, Ontario, resulted in the deaths of 25 patients, most of them elderly. The area of origin of the accidental fire was a patient room on the top floor of the three-story, fire-resistive building. Significant factors that contributed to the fatalities in this fire were rapid fire development, the failure to extinguish the fire in its incipient stage, failure to keep the door to the room of origin closed, improper staff actions, and delayed alarm to the fire department.
The article takes as its subject Gaute Heivoll's latest novel Over det kinesiske hav [Across the Chinese Ocean], which describes the establishment of a private nursing home at Finsland in Vest-Agder county immediately before the liberation. The novel's protagonist describes retrospectively how his parents adopted a number of mentally disabled persons, among them a group of siblings from Stavanger. When their adoptive family is exposed to a tragedy, views on who are the providers and receivers of care are challenged, as are concepts such as madness and normality. The article shows how a fictional exposée of conditions for the mentally disabled in recent Norwegian history can provide new perspectives on historic health and care practices. Reading Gaute Heivoll's Over det kinesiske hav highlights the practice of placing patients in private care, as well as the 1934 Act that authorised the sterilisation of mentally disabled persons.
As the Canadian population ages, there is a need to improve long-term care (LTC) services. An increased understanding of the positive work experiences of LTC staff may help attract more human health resources to LTC.
To describe the perceptions of the roles and work of nurses and care assistants in LTC from interprofessional perspectives.
This study used qualitative data collected from a larger mixed-methods study, Care by Design. The qualitative phase explored the lived experience of LTC staff from the perspectives of key stakeholders via focus groups and individual interviews.
One central theme that emerged from the study was that of LTC staff going "above and beyond" their clinical duties to care for residents. This above and beyond theme was categorized into subthemes including: 1. familial bonds between residents and staff; 2. staff spending additional time with residents; 3. the ability to provide comfort to family members; and 4. staff dedication during end-of-life care.
The findings show that staff develop a kinship with residents, demonstrate respect towards residents' families and provide comfort at the end-of-life. In emphasizing these themes of positive and fulfilling work, the present study provides insight into why staff work in LTC.
To evaluate the nutritional and clinical consequences of changing from a centralized food delivery system to decentralized bulk food portioning; a system in which meal portioning occurs on residents' floors of a nursing home.
A pilot study with a pre-post design
The study took place on one floor of a home for elderly persons with dementia. Of the 34 residents, 22 (1 man) participated in this study. Average age was 82 years (range = 55 to 94 years). Nutritional status was verified before introduction of the bulk food portioning system by 3 nonconsecutive days of observed food intakes, anthropometric measurements (height, weight, triceps skinfold thickness, mid-upper-arm circumference), and biochemical parameters (albumin, lymphocytes, glucose, sodium, potassium, transferrin, vitamin B-12, folate, hemoglobin). Trained dietitians collected the dietary and anthropometric data and validated the food intake estimates and anthropometric measurements. Data were also collected 10 weeks after implementation of the new food distribution system.
Paired t tests adjusted by a Bonferroni correction assessed differences between values measured before and after introduction of the new food distribution system.
Average food consumption increased substantially and significantly after introduction of the bulk food portioning system. Mean energy intakes rose from 1,555 to 1,924 kcal/day and most other nutrients also increased, many significantly, but there were no changes in anthropometric values or biochemical parameters, except for albumin level which decreased to the lower normal limit.
Portioning of food in the residents' dining room simulates a homelike atmosphere thereby encouraging increased food consumption. With well-trained and enthusiastic staff, this system could contribute to improved nutritional status in the very elderly, even those who have dementia. Dietitians have a key role to play in overseeing residents' nutritional needs and in training, supervising, and motivating foodservice personnel.
To assess the acceptability and compliance with use of an energy-shunting hip protector in institutionalized elderly people.
A 6 month prospective follow-up in a Finnish nursing home.
19 ambulatory nursing home residents with a high risk of hip fracture.
The proportion of the residents who were willing to use the device, the number of hours of wearing the protector and the attitudes of the study subjects and the caregivers towards the appearance, comfort, fit, efficacy and laundering of the protector.
12 of the 19 ambulatory residents (63%) agreed to use the protector. During the study period, these subjects wore the protector on average for more than 90% of their active days, i.e. the days they were mobile. Two subjects wore the protectors at night time; the rest only during waking hours. Mean wearing time during waking hours exceeded 90%.
External hip joint protectors are a feasible strategy to prevent hip fractures in institutionalized elderly people. The attitude, education and motivation of the staff may be a factor in achieving good user compliance. Further community-based studies on acceptability and compliance in wearing external hip joint protectors are needed for verification of benefits to the general population of older people.
Comment In: Age Ageing. 1998 Mar;27(2):89-9016296665