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Sample records for acute elderly care

  1. Medication errors in elderly acute care--a systematic review.

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    Metsälä, Eija; Vaherkoski, Ulla

    2014-03-01

    Medication safety is a part of quality of care and patient safety. Old age brings many challenges for safe use of medication. In order to improve the prerequisites of medication safety in acute care of the elderly, we systematically reviewed studies to find out what kind of medication errors happen in elderly acute care. Cinahl, Medline, Cochrane, JBI Connect+ databases and Finnish healthcare databases Medic and Ohtanen were used in the search. The search was performed using both MeSH terms and keywords by the option 'search all text'. The original keywords were pharmacy or drugs, medical error or deviation and their Finnish synonyms. These keywords were united to the terms elderly, nursing or acute care or intensive care. Studies published between 2001 and 2011 were chosen. Medication errors mentioned in the studies were associated with (i) nursing competence, (ii) prescription- and patient-related factors, (iii) medication work organisation and nursing process and (iv) safety culture. This paper presents several practical implications for improving medication safety in the acute care of the elderly. The grey literature was not included because the authors wanted to limit to the best-quality research. In some studies, elderly acute care was not their exact context or the elderly formed only a part of study population. This may have undermined some types of medication errors typical to elderly acute care. To improve the prerequisites of medication, safety in acute care of the elderly management of the medication process should be improved. Also, cooperation within the medical team in making the medical care plans and checking out the medication of the elderly people should be improved. This is an important topic of lifelong education for nurses and other healthcare staff as well. © 2013 Nordic College of Caring Science. Published by Blackwell Publishing Ltd.

  2. Post-Acute Home Care and Hospital Readmission of Elderly Patients with Congestive Heart Failure

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    Li, Hong; Morrow-Howell, Nancy; Proctor, Enola K.

    2004-01-01

    After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce…

  3. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    Objective The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting This study was conducted in a large county hospital in western Sweden. Participants The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  4. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2016-12-01

    Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

  5. Discharge destination from an acute care for the elderly (ACE unit

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    Luis F Amador

    2007-10-01

    Full Text Available Luis F Amador1,2, Carlos A Reyes-Ortiz1,2, Diana Reed 3, Cheryl Lehman2,41Department of Internal Medicine, 2Sealy Center on Aging, 3Department Care Management, 4Department of Nursing, University of Texas Medical Branch at Galveston, TX, USA Abstract: Older adults age 65 and over account for a disproportional number of hospital stays and discharges compared to other age groups. The objective of this paper is to describe placement and characteristics of older patients discharged from an acute care for the elderly (ACE unit. The study sample consists of 1,351 men and women aged 65 years or older that were discharged from the ACE Unit during a 12-month period. The mean number of discharges per month was 109.2 ± 28.4. Most of the subjects were discharged home or home with home health 841, 62.3%. The oldest elderly and patients who had been admitted from long term care institutions or from skilled nursing facilities to the ACE unit were less likely to return to home.Keywords: hospitalization, geriatric, discharge disposition

  6. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

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    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  7. Nurses' ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study.

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    Goethals, Sabine; Dierckx de Casterlé, Bernadette; Gastmans, Chris

    2013-11-01

    In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses' decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses' reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009-April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses' decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.

  8. Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness

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    Kahn, Jeremy M.; Werner, Rachel M.; David, Guy; Have, Thomas R. Ten; Benson, Nicole M.; Asch, David A.

    2012-01-01

    Background For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit. Objective To examine the effectiveness of LTAC transfer in patients with chronic critical illness. Research Design Retrospective cohort study in United States hospitals from 2002 to 2006. Subjects Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care. Measures Survival, costs and hospital readmissions. We used multivariate analyses and instrumental variables to account for differences in patient characteristics, the timing of LTAC transfer and selection bias. Results A total of 234,799 patients met our definition of chronic critical illness. Of these, 48,416 (20.6%) were transferred to an LTAC. In the instrumental variable analysis, patients transferred to an LTAC experienced similar survival compared to patients who remained in an intensive care unit (adjusted hazard ratio = 0.99, 95% CI: 0.96 to 1.01, p=0.27). Total hospital-related costs in the 180 days following admission were lower among patients transferred to LTACs (adjusted cost difference = -$13,422, 95% CI: -26,662 to -223, p=0.046). This difference was attributable to a reduction in skilled nursing facility admissions (adjusted admission rate difference = -0.591 (95% CI: -0.728 to -0.454, p <0.001). Total Medicare payments were higher (adjusted cost difference = $15,592, 95% CI: 6,343 to 24,842, p=0.001). Conclusions Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in intensive care units, incur fewer health care costs driven by a reduction in post-acute care utilization, but invoke higher overall Medicare payments. PMID:22874500

  9. Struggles in (Elderly) Care

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene

    This book provides a critical engagement with the intensified struggles to be found within elderly care. Various social and political processes, including the forces of globalisation and the de-gendering of care, have changed how we might understand this national and global political concern...... ‘what is care?’ and redirects us to new sites of contestation. Dahl approaches these issues from a post-structuralist and radical feminist position, while drawing from feminist sociology, feminist political science, nursing philosophy and feminist history. In particular, Struggles In (Elderly) Care...

  10. Acute hepatitis A in an elderly patient after care worker travel to high endemicity country.

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    Aasheim, Erlend T; Seymour, Martin; Balogun, Koye; Ngui, Siew-Lin; Williams, Chris J; Shankar, Ananda Giri

    2013-11-01

    Hepatitis A virus (HAV) is considered one of the most important vaccine-preventable diseases in travelers. HAV spreads from person to person via the fecal-oral route and gives rise to an estimated 1.4 million cases worldwide each year. In developing countries with poor sanitary conditions people tend to be infected during childhood and have few symptoms, whereas in developed countries with good sanitary conditions fewer people develop immunity during childhood. This leads to susceptible populations of adults, who are also more prone to severe complications. Here we describe two confirmed cases of hepatitis A associated with a nursing home. The index case was a care worker who had recently traveled to a high-endemicity country, and the second case was a resident at the nursing home where the index case worked. Both cases had an identical genotype IIIA strain, consistent with a transmission event. Current policy does not include a requirement for hepatitis A vaccine in care workers who travel to high endemicity countries despite the fact that infected care workers can potentially spread the disease to elderly patients and other groups at risk of severe complications from HAV infection. We suggest that employers should consider hepatitis A vaccine upon employment; particularly in care workers who plan to visit areas where HAV is known to be endemic.

  11. Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

    Science.gov (United States)

    Goethals, S; Dierckx de Casterlé, B; Gastmans, C

    2013-05-01

    The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. [Hyponatremia in elderly patients admitted in an acute geriatric care unit. prevalence and prognosis].

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    Rubio-Rivas, Manuel; Formiga, Francesc; Cuerpo, Sandra; Franco, Jonathan; di Yacovo, Silvana; Martínez, Concepción; Pujol, Ramón

    2012-06-30

    In order to analyze the prevalence of hyponatremia in in-hospital elderly patients and its prognosis factor value, we performed a transversal prospective study in an Acute Geriatric Unit (AGU). Two hundred and sixty in-hospital patients were collected prospectively in an AGU. Sociodemographic and lab data were collected as well as the Barthel, Pfeiffer and Charlson tests. A questionnaire was performed in hospital. Hyponatremia was considered when the plasmatic sodium was ≤134 mmol/l. The sample consisted of 137 women (52.7%) and 123 men (47.3%). Mean age was 83.6 years (SD 7.9). Mean plasmatic sodium values were 137.3 mmol/l (range 112-168). Emergency lab tests showed 60 patients with hyponatremia (23.7%), 35 (13.6%) in the AGU. Cardiopulmonary were the most related diseases. Mean hospital length of stay was 12.8 days (SD 12.8). In-hospital mortality was 12.9%. We observed a statistic relationship between the presence of hyponatremia and a greater mean length of stay (15.53 vs 11.99 days, P=.003). No relationship was found between hyponatremia and mortality (15 vs 12.7%, P=.588). Hyponatremia in patients admitted in an AGU is a prevalent disorder related with a greater hospital length of stay, but not with mortality. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  13. Modelos de serviços hospitalares para casos agudos em idosos Hospital services for acute care of elderly people

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    João Macedo Coelho Filho

    2000-12-01

    Full Text Available Embora a atenção ao idoso seja uma prioridade emergente no Brasil, pouca ênfase tem sido dada a modelos de organização de serviços hospitalares para pacientes geriátricos. São revisados modelos de serviços hospitalares para admissão e manuseio de casos agudos em idosos, com ênfase na discussão sobre o papel e o posicionamento da medicina geriátrica (incluindo sua interface com especialidades e com a clínica médica no âmbito da atenção hospitalar. Foi realizada pesquisa na base de dados Medline (1989-1999, bem como nos principais livros-texto de geriatria e de gerontologia, buscando identificar descrições de serviços hospitalares para cuidado agudo de pacientes idosos. As características dos modelos identificados foram compiladas e descritas à luz de sua adequação à realidade dos serviços de saúde no Brasil. Exemplos de intervenções em geriatria, com efetividade demonstrada através de revisões sistemáticas, foram também citadas. Os modelos mais freqüentemente relatados foram cuidado prolongado, tradicional, baseado na idade cronológica, não especializado e integrado. Adaptações e variantes de alguns desses modelos foram freqüentemente relatadas, assim como seu impacto potencial na efetividade do cuidado geriátrico. Evidências sobre o melhor modelo a seguir não foram identificadas, mas aqueles modelos favorecendo a integração da geriatria com a clínica geral pareceram mais adequados à nossa realidade. Ressalta a necessidade de reestruturação de serviços de saúde para responder às novas demandas que surgem com o envelhecimento da população, bem como do delineamento de serviços hospitalares para casos agudos, importantes para a efetividade do cuidado geriátrico e que devem ser objeto de maior debate e pesquisa no Brasil.Although the implementation of geriatric services is an emerging priority in Brazil, little emphasis has been put on the type of acute care that should be provided for elderly

  14. Hospital-Acquired Infections in Elderly Versus Younger Patients in an Acute Care Hospital

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    Solis-Hernandez

    2015-11-01

    Full Text Available Background A growing number of elderly patients are hospitalized for various causes and age has been described inconsistently as a risk factor for acquiring nosocomial infections with a subsequent higher mortality rate compared to younger patients. Objectives To describe the incidence, type, and microbiological characteristics of nosocomial infections in elderly and non-elderly patients. Patients and Methods Retrospective analysis of all hospital-acquired infections (HAIs in an academic community hospital. Patients were stratified into two groups: non-elderly (18 - 64 years and elderly (> 65 years. Results A total of 18469 patients were included (108555 hospital days in this study. About 79.6% of HAI were infected non-elderly and 20.3% elderly (P 0.05. Hospital mortality increased with every HAI diagnosed per patient. Conclusions The study showed that HAIs were more frequent in elderly population predominately with respect to VAP and infections by Gram-negative pathogens. Overall mortally was greater in the elderly group although the odds ratio for death was higher in younger patients and increased with every HAI diagnosed.

  15. Elderly Care Centre

    Science.gov (United States)

    Wagiman, Aliani; Haja Bava Mohidin, Hazrina; Ismail, Alice Sabrina

    2016-02-01

    The demand for elderly centre has increased tremendously abreast with the world demographic change as the number of senior citizens rose in the 21st century. This has become one of the most crucial problems of today's era. As the world progress into modernity, more and more people are occupied with daily work causing the senior citizens to lose the care that they actually need. This paper seeks to elucidate the best possible design of an elderly care centre with new approach in order to provide the best service for them by analysing their needs and suitable activities that could elevate their quality of life. All these findings will then be incorporated into design solutions so as to enhance the living environment for the elderly especially in Malaysian context.

  16. Elder Care Comes of Age.

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    Herndon, Mary D.

    1995-01-01

    A discussion of elder care looks at the extent to which government and employers are addressing the issue, how elder care affects the work performance of and productivity of employed caregivers, and how human resource professionals can respond effectively to the needs of both employee and employer as these needs relate to the issue of elder care.…

  17. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    OpenAIRE

    Travers Catherine M; Morris John N; Jones Richard N; Wright Olivia; Martin-Khan Melinda; Brand Caroline A; Tropea Joannne; Gray Leonard C

    2011-01-01

    Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to...

  18. Improving Customer Service in Elderly Care

    OpenAIRE

    Nielsen, Chris

    2015-01-01

    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  19. Functional gain following rehabilitation of recurrent ischemic stroke in the elderly: experience of a post-acute care rehabilitation setting.

    Science.gov (United States)

    Mizrahi, E H; Fleissig, Y; Arad, M; Adunsky, A

    2015-01-01

    The aim of the study was to evaluate whether rehabilitation of patients with recurrent ischemic strokes is associated with functional gain. We studied a total of 919 consecutive post-acute ischemic stroke elderly patients admitted for rehabilitation. 22% out of the patients had recurrent stroke on index day. Functional outcomes of first-ever stroke patients and recurrent ischemic stroke patients were assessed by the Functional Independence Measurement scale (FIM™) at admission and discharge. Data was analyzed by t-test, Chi-square test and by multiple linear regression analysis. There were 716 patients with first ever stroke and 203 patients with recurrent stroke. Total and motor FIM scores at admission and total, motor, gain and Montebello Rehabilitation Factor (RFG) FIM scores at discharge were similar in the two groups. A multiple linear regression analysis showed that age (beta=-0.13, p=0.001) length of stay (beta=0.21, pstroke admitted to rehabilitation ward, showed similar FIM gain scores at discharge, compared with first-ever stroke patients. It is concluded that recurrent stroke should not be considered as adversely affecting the short-term functional outcomes of patients in a post-acute rehabilitation setting.

  20. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  1. Comprehensive geriatric care reduces acute perioperative delirium in elderly patients with hip fractures: A meta-analysis.

    Science.gov (United States)

    Wang, Yiyang; Tang, Jun; Zhou, Feiya; Yang, Lei; Wu, Jianbin

    2017-06-01

    The aim of the current meta-analysis was to assess the treatment effect of comprehensive geriatric care in reducing acute perioperative delirium in older patients with hip fractures, compared with the effect of a routine orthopedic treatment protocol. We conducted a search of multiple databases to identify randomized controlled trials (RCTs) and quasi-RCTs comparing comprehensive geriatric care and routine orthopedic treatment regarding the following outcomes: incidence of delirium, assessment of cognitive status, and duration of delirium. Odds ratios (ORs) and mean differences (MDs) were pooled using either a fixed-effects or a random-effects model, depending on the heterogeneity of the trials included in the analysis. Six RCTs and 1 quasi-RCT provided data from 1840 patients. These data revealed that comprehensive geriatric care may reduce the incidence of perioperative delirium (OR = 0.71; 95% confidence interval [CI], 0.57-0.89; P = .003) and that it was associated with higher cognitive status during hospitalization or at 1 month postoperatively (MD = 1.03; 95% CI, 0.93-1.13; P ≤ .00001). There was no significant difference in duration of perioperative delirium between the 2 treatment groups (MD = -2.48; 95% CI, -7.36 to 2.40; P = .32). Based on the quality of evidence provided, comprehensive geriatric care may reduce the incidence of perioperative delirium. To obtain evidence regarding the merits of comprehensive geriatric care in reducing severity of delirium and shortening the duration of delirium, there is a need for multicenter RCTs with high methodological quality.

  2. The geriatric patient: use of acute geriatrics units in the emergency care of elderly patients in France.

    Science.gov (United States)

    Somme, D; Lazarovici, C; Dramé, M; Blanc, P; Lang, P O; Gauvain, J B; Voisin, T; Gonthier, R; De Wazières, B; Jeandel, C; Couturier, P; Blanchard, F; Saint-Jean, O

    2011-01-01

    We studied the factors influencing the choice of admission to Geriatrics units, instead of other acute hospital units after an emergency visit. We report the results from a cohort of 1283 randomly selected patients aged >75 years hospitalized in emergency and representative of the French University hospital system. All patients underwent geriatric assessment. Baseline characteristics of patients admitted to Geriatrics and other units were compared. A center effect influencing the use of Geriatrics units during emergencies was also investigated. Admission to a Geriatrics unit during the acute care episode occurred in 499 cases (40.3%). By multivariate analysis, 4 factors were related to admission to a Geriatrics unit: cognitive disorder: odds ratio (OR)=1.79 (1.38-2.32) (95% confidence interval=95% CI); "failure to thrive" syndrome OR=1.54 (1.01-2.35), depression: OR=1.42 (1.12-1.83) or loss of Activities of Daily Living (ADL): OR=1.35 (1.04-1.75). The emergency volume of the hospital was inversely related to the use of Geriatrics units, with high variation that could be explained by other unstudied factors. In the French University Emergency Healthcare system, the "geriatrics patient" is defined by the existence of cognitive disorder, psychological symptoms or installed loss of autonomy. Nevertheless, considerable nation-wide variation was observed underlining the need to clarify and reinforce this discipline in the emergency healthcare system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Glioblastoma care in the elderly.

    Science.gov (United States)

    Jordan, Justin T; Gerstner, Elizabeth R; Batchelor, Tracy T; Cahill, Daniel P; Plotkin, Scott R

    2016-01-15

    Glioblastoma is common among elderly patients, a group in which comorbidities and a poor prognosis raise important considerations when designing neuro-oncologic care. Although the standard of care for nonelderly patients with glioblastoma includes maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide, the safety and efficacy of these modalities in elderly patients are less certain given the population's underrepresentation in many clinical trials. The authors reviewed the clinical trial literature for reports on the treatment of elderly patients with glioblastoma to provide evidence-based guidance for practitioners. In elderly patients with glioblastoma, there is a survival advantage for those who undergo maximal safe resection, which likely includes an incremental benefit with increasing completeness of resection. Radiotherapy extends survival in selected patients, and hypofractionation appears to be more tolerable than standard fractionation. In addition, temozolomide chemotherapy is safe and extends the survival of patients with tumors that harbor O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation. The combination of standard radiation with concurrent and adjuvant temozolomide has not been studied in this population. Although many questions remain unanswered regarding the treatment of glioblastoma in elderly patients, the available evidence provides a framework on which providers may base individual treatment decisions. The importance of tumor biomarkers is increasingly apparent in elderly patients, for whom the therapeutic efficacy of any treatment must be weighed against its potential toxicity. MGMT promoter methylation status has specifically demonstrated utility in predicting the efficacy of temozolomide and should be considered in treatment decisions when possible. Cancer 2016;122:189-197. © 2015 American Cancer Society.

  4. Sexual Harassment towards Newcomers in Elder Care

    DEFF Research Database (Denmark)

    Krøjer, Jo; Lehn-Christiansen, Sine; Nielsen, Mette Lykke

    2014-01-01

    focusing on the relation between elderly citizens in need of care and their professional caregivers. In this article, we argue that sexual harassment from the elderly toward newcomers in elder care should also be seen as an effect of institutional practices. Based upon a Foucauldian-inspired notion...

  5. Gerodontology - Orodental care for elderly

    OpenAIRE

    Vinay Kumar Bhardwaj

    2012-01-01

    Changing demographics, including an increase in life expectancy and the growing numbers of elderly, has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health. Oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balance...

  6. Residential care for the elderly.

    Science.gov (United States)

    Alber, J

    1992-01-01

    This article maps variations in a standardized way in residential care for elderly people in three Western nations. Measured by the number of available places per person aged sixty-five and over and by the number of staff members per bed in nursing homes, the United Kingdom has the most highly developed standards. The United States ranks second, with Germany lagging considerably behind. The variations are explained by four variables: the pressure of the problem, as defined by the percentage of the population aged sixty-five and over; the caretaker potential in the family system, which alleviates this pressure; the structure and financing of the supply of residential care; and decision-making procedures in health care policy-making. My analysis emphasizes the last two variables. In the United Kingdom and the United States, the public and private providers who supply care have either political or market incentives to expand their services. Germany's mix of public and private, by contrast, is dominated by voluntary associations that are neither responsible to an electorate nor allowed to make profits. Thus, their clients do not have opportunities to articulate their needs. Health care decision making in Germany takes place through a collective bargaining process between the sickness funds and the providers. In such a system, the interests of groups who are not represented at the negotiation table--such as the elderly--tend to be neglected. A national health system of the British type links political decision makers via the election mechanism more closely to the concerns of the public. As older people represent growing proportions of the electorate, their needs find more adequate consideration in the policy process. In the United States, political officeholders also have to pay attention to the needs of increasingly organized older people, since the tax-financed and federally regulated Medicaid system is largely responsible for financing long-term care for the elderly.

  7. Gerodontology - Orodental care for elderly

    Directory of Open Access Journals (Sweden)

    Vinay Kumar Bhardwaj

    2012-01-01

    Full Text Available Changing demographics, including an increase in life expectancy and the growing numbers of elderly, has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity is an integral component of general health. Oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balanced diet, not to mention aesthetical considerations and facial alterations leading to anxiety and depression. Certain strategies should be adopted for improving oral health of the elderly, including the management and maintenance of oral conditions, which are necessary for re-establishing effective masticatory function. Oral health is often neglected in the elderly and oral diseases associated with aging are complex, adversely affecting the quality of life. Although majority of oral health problems are not usually associated with mortality, nearly more than half of the deaths due to oral cancer occur at an age of 65 years plus. This review of geriatric dentistry, which is dedicated to geriatric physicians, geriatric dentist and specialists in oral medicine, emphasizes on age-related oral changes in elderly patients and efforts to summarize the effects of aging in hard and soft oral tissues.

  8. 老年支气管哮喘急性发作期的护理%Nursing Care of Acute Attack of Bronchial Asthma in the Elderly

    Institute of Scientific and Technical Information of China (English)

    杨芙蓉

    2014-01-01

    Objective To investigate the elderly patients with acute attack of bronchial asthma and nursing during the.Methods 52 cases of our hospital patients as the object of observation,communication,education on patients and nursing,psychological nursing.Results During hospitalization patients receive effective treatment. Conclusion Scientific and publicize the knowledge of prevention and control for patients,make patients and nursing understanding and trust, greatly improving the satisfaction of patients for nursing care.%目的:探讨老年支气管哮喘患者急性发作期间的护理。方法以我院收治的52例患者作为观察对象,对患者及陪护进行沟通、宣教,做好心理护理。结果患者住院期间得到有效治疗。结论对患者进行科学防治知识宣传,取得患者及陪护的理解和信任,大大提高了患者对护理的满意度。

  9. The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

    LENUS (Irish Health Repository)

    O'Connor, K A

    2012-02-03

    INTRODUCTION: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS: To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS: Deranged [Na+] is common among elderly patients admitted to hospital.

  10. Social innovation in public elder care

    DEFF Research Database (Denmark)

    Bilfeldt, Annette; Andersen, John

    2013-01-01

    The chapter addresses the role of action research in social innovation related to elder care work at public nursing homes in Denmark. It is shown how critical utopian action research can contribute to the development of humanity in elder care to the benefit of the residents life quality...

  11. Social innovation in public elder care

    DEFF Research Database (Denmark)

    Bilfeldt, Annette; Andersen, John

    2013-01-01

    The chapter addresses the role of action research in social innovation related to elder care work at public nursing homes in Denmark. It is shown how critical utopian action research can contribute to the development of humanity in elder care to the benefit of the residents life quality...... and the employees working life....

  12. Planning elderly and palliative care in Montenegro

    Directory of Open Access Journals (Sweden)

    Mark McCarthy

    2009-04-01

    Full Text Available Introduction: Montenegro, a newly independent Balkan state with a population of 650,000, has a health care reform programme supported by the World Bank. This paper describes planning for integrated elderly and palliative care. Description: The current service is provided only through a single long-stay hospital, which has institutionalised patients and limited facilities. Broad estimates were made of current financial expenditures on elderly care. A consultation was undertaken with stakeholders to propose an integrated system linking primary and secondary health care with social care; supporting people to live, and die well, at home; developing local nursing homes for people with higher dependency; creating specialised elderly-care services within hospitals; and providing good end-of-life care for all who need it. Effectiveness may be measured by monitoring patient and carers’ perceptions of the care experience. Discussion: Changes in provision of elderly care may be achieved through redirection of existing resources, but the health and social care services also need to enhance elderly care budgets. The challenges for implementation include management skills, engaging professionals and political commitment. Conclusion: Middle-income countries such as Montenegro can develop elderly and palliative care services through redirection of existing finance if accompanied by new service objectives, staff skills and integrated management.

  13. Anciano que cuida a anciano Elderly caring for elderly

    Directory of Open Access Journals (Sweden)

    Maria João Costa Pacheco

    2007-09-01

    Full Text Available El envejecimiento es un proceso complejo, continuo, irreversible y dinámico al que la población portuguesa no es ajena. Con la longevidad, los ancianos son cada vez menos autónomos, más dependientes de cuidados de terceros, y estos cuidados aparecen, cada vez más, proporcionados por otro anciano. Actualmente los enfermeros deben dar una atención especial a este fenómeno para suministrar un apoyo mejor a los cuidadores ancianos que cuidan a otros ancianos, también ellos personas con problemas geriátricos. Deberán proporcionar una mayor dedicación a la adquisición y mantenimiento de este papel para promover la autonomía y minimizar la dependencia del anciano cuidado.Aging is a complex process, continuous and irreversible, a phenomenon to which Portuguese population is not stranger. With longevity the elderly becomes less autonomous, depending on the case of others, starting to emerge a growing number of elderly much more elderly, many of them taking care of another elder. In the present nurses should give special attention to this phenomenon in order to provide better support to the elderly caregivers of the elderly, who also have geriatrics problems, proving a greater satisfaction in the acquisition and maintenance of this role and in this way promoting self-governing and minimizing the dependency of the cared elder.

  14. Sexual Harassment towards Newcomers in Elder Care

    DEFF Research Database (Denmark)

    Krøjer, Jo; Lehn-Christiansen, Sine; Nielsen, Mette Lykke

    2014-01-01

    Sexual harassment is illegal and may have very damaging effects on the people exposed to it. One would expect organizations, employers, and institutions to take very good care to prevent employees from exposure to sexual harassment from anyone in their workplace. And yet, many people, mostly women......, are exposed to sexual harassment at work. In care work, such behaviour is often directed toward their female caregiver by elderly citizens in need of care. Contemporary Nordic studies of working life and work environment have primarily investigated the interpersonal dimensions of sexual harassment, thus...... focusing on the relation between elderly citizens in need of care and their professional caregivers. In this article, we argue that sexual harassment from the elderly toward newcomers in elder care should also be seen as an effect of institutional practices. Based upon a Foucauldian-inspired notion...

  15. Paradoxical constructions in Danish elderly care

    DEFF Research Database (Denmark)

    Liveng, Anne

    2015-01-01

    Transformations take place in Danish elderly care due to neo-liberal modernization processes which imply a conception of human beings as rational and autonomous while simultaneously increasing the level of governance and control. Inspired by trends in gerontology these transformations form a radi...... collide when they talk about the elderly and in the daily interactions....

  16. Paradoxical constructions in Danish elderly care

    DEFF Research Database (Denmark)

    Liveng, Anne

    2015-01-01

    a radical change in the understanding of the relationships between those in need of support and the professionals. The critical questions raise concern as to where this leaves the elderly in need of care, the care workers, and the ideas of a welfare state responsible for those who cannot care for themselves....... This article explores these questions drawing on care ethics and theory of recognition. It presents the new conception of the elderly and illustrates, through analysis of empirical data from activity centres, how the transformations pose challenges to care workers and are reflected as different logics which...

  17. Elder Care for Alzheimer's: Choosing a Provider

    Science.gov (United States)

    ... elder care center for a loved one with Alzheimer's. What should I look for when considering a ... provide an opportunity for your loved one with Alzheimer's to receive assistance and therapeutic activities in a ...

  18. Two Principles of good elderly care

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene; Eskelinen, Leena; Boll Hansen, Eigil

    ) which is a possibility for the elderly to choose a private provider. Stressing the self-determination of the elderly and the help provided as service is potentially at odds with one of the existing principles of elderly care, namely the professional principle of help-to-self help. It aims at activating...... the elderly person to manage as much as possible themselves and is based upon a socio-pedagogical culture, where the professional is teaching elderly people about the proper behavior. It’s based upon a formal knowledge of aging and upon different techniques to motivate and involve the elderly....... These are clearly different logics. However, no research has so far studied how these concepts are translated from a national to the municipal level to groups of home helpers and to individual home helpers. And how are these principles played out in different contexts of private firms and public providers...

  19. A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

    NARCIS (Netherlands)

    Blanc-Bisson, C.; Dechamps, A.A.; Gouspillou, G.; Dehail, P.; Bourdel-Marchasson, I.

    2008-01-01

    OBJECTIVE: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). DESIGN: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual

  20. A Vocational Calling: Exploring a Caring Technology in Elderly Care

    Science.gov (United States)

    Fejes, Andreas; Nicoll, Katherine

    2010-01-01

    In this article we explore the relationship of care of a group of health care workers in elderly care, through their descriptions of themselves and their work. We have an interest in how relationships of care may be explored and characterised in and across disparate vocational settings. This is a critical response to policy discourses of…

  1. [Nutrition for elderly acute stroke patients].

    Science.gov (United States)

    Ha, Lisa; Iversen, Per Ole; Hauge, Truls

    2008-09-11

    Elderly people have an increased risk of malnutrition due to biological and physiological changes and underlying disease. Almost 90% of the stroke patients are older than 65 years, and the consequences of acute stroke may lead to additional nutritional problems. This paper reviews nutritional therapy for stroke patients. PubMed was searched (non-systematically) for prospective cohort studies of occurrence, diagnostics and consequences of undernutrition in stroke patients. Randomized trials were examined to identify clinical effects of oral protein and energy supplements or tube feeding on nutritional status and intake, functional status, infections, length of stay, quality of life and mortality. 8-35% of stroke patients are undernourished. Body weight is one of the most important parameters for assessment of nutritional status. Dysphagia occurs in up to 80% of patients with acute stroke and increases the risk of undernutrition, which again leads to prolonged length of stay, reduced functional status and poorer survival. Early nasogastric tube feeding does not increase the risk of pneumonia and may improve survival after six months. Oral supplements lead to a significantly improved nutritional intake in undernourished stroke patients, as well as improved nutritional status and survival in undernourished elderly. Nutritional treatment can improve the clinical outcome after an acute stroke, provided that there are good procedures for follow-up and monitoring of the treatment.

  2. Intersectional perspective in elderly care

    Directory of Open Access Journals (Sweden)

    Marta Cuesta

    2016-05-01

    Full Text Available Earlier research has shown that power relationships at workplaces are constructed by power structures. Processes related to power always influence the working conditions for (in this study in elderly care the working groups involved. Power structures are central for intersectional analysis, in the sense that the intersectional perspective highlights aspects such as gender and ethnicity (subjective dimensions and interrelates them to processes of power (objective dimension. This qualitative study aims to explore in what way an intersectional perspective could contribute to increased knowledge of power structures in a nursing home where the employees were mostly immigrants from different countries. By using reflexive dialogues related to an intersectional perspective, new knowledge which contributes to the employees’ well-being could develop. Narrative analysis was the method used to conduct this study. Through a multi-stage focus group on six occasions over 6 months, the staff were engaged in intersectional and critical reflections about power relationship with the researchers, by identifying patterns in their professional activities that could be connected to their subjectivities (gender, ethnicity, etc.. The result of this study presents three themes that express the staff's experiences and connect these experiences to structural discrimination. 1 Intersectionality, knowledge, and experiences of professionalism; 2 Intersectionality, knowledge, and experiences of collaboration; and 3 Intersectionality, knowledge, and experiences of discrimination. The result demonstrates that an intersectional perspective reinforces the involved abilities, during the conversations, into being clear about, for example, their experiences of discrimination, and consequently developing a better understanding of their professionalism and collaboration. Such deeper reflections became possible through a process of consciousness raising, strengthening the employee

  3. Team Performance and Risk-Adjusted Health Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)

    Science.gov (United States)

    Mukamel, Dana B.; Temkin-Greener, Helena; Delavan, Rachel; Peterson, Derick R.; Gross, Diane; Kunitz, Stephen; Williams, T. Franklin

    2006-01-01

    Purpose: The Program of All-Inclusive Care for the Elderly (PACE) is a community-based program providing primary, acute, and long-term care to frail elderly individuals. A central component of the PACE model is the interdisciplinary care team, which includes both professionals and non-professionals. The purpose of this study was to examine the…

  4. Concept of Care, Caring Expectations, and Caring Frustrations of the Elderly Suffering from Chronic Illness

    Science.gov (United States)

    de Guzman, Allan B.; Santos, Charisse Izobelle Q.; Santos, Ivan Benedict A.; Santos, Jedda A.; Santos, Justin E.; Santos, Justo Martin S.; Santos, Vincent Emmanuelle E.

    2012-01-01

    While it is true that elderly concepts of care and caring expectations have been ascertained in previous literatures, little is known about how the elderly population views caring frustrations--particularly that of the Filipino elderly. This study purports to surface the lebenswelt of healthcare expectations and frustrations based on the…

  5. Relational agency in elderly care work

    DEFF Research Database (Denmark)

    Tuominen, Tiina; Fuglsang, Lars; Hasu, Mervi

    the cocreative frameworks and patterns of relational agency in three different elderly care contexts. The findings provide new knowledge about the contextual, relational nature of value cocreation and invite further research to reveal the patterns of relational agency in different contexts of public service......In this paper, we aim to understand how elderly care work is changing alongside the introduction of new co-creative frameworks and practices. The ideas of value co-creation and service co-production are expanding rapidly to new service areas also in the public sector. The elderly care context may...... the concept of ‘relational agency’ to discuss how the interests and capabilities of the workers and users to co-create value are relationally constructed, and how these agentic properties contribute to the manner in which value is co-created. We demonstrate the usefulness of this approach by analysing...

  6. Why do care workers withdraw from elderly care?

    DEFF Research Database (Denmark)

    Liveng, Anne

    2012-01-01

    . At the same time it illustrates the care workers' commitment to the elderly. A paradoxical "empathy at a distance" is characteristic of the scene. When analyzing my written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions...... between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a "hermeneutical key" which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own care...

  7. REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial.

    Science.gov (United States)

    Sahota, Opinder; Drummond, Avril; Kendrick, Denise; Grainge, Matthew J; Vass, Catherine; Sach, Tracey; Gladman, John; Avis, Mark

    2014-03-01

    falls in hospitals are a major problem and contribute to substantial healthcare burden. Advances in sensor technology afford innovative approaches to reducing falls in acute hospital care. However, whether these are clinically effective and cost effective in the UK setting has not been evaluated. pragmatic, parallel-arm, individual randomised controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital. Primary outcome measure number of in-patient bedside falls per 1,000 bed days. 1,839 participants were randomised (918 to the intervention group and 921 to the control group). There were 85 bedside falls (65 fallers) in the intervention group, falls rate 8.71 per 1,000 bed days compared with 83 bedside falls (64 fallers) in the control group, falls rate 9.84 per 1,000 bed days (adjusted incidence rate ratio, 0.90; 95% confidence interval [CI], 0.66-1.22; P = 0.51). There was no significant difference between the two groups with respect to time to first bedside fall (adjusted hazard ratio (HR), 0.95; 95% CI: 0.67-1.34; P= 0.12). The mean cost per patient in the intervention group was £7199 compared with £6400 in the control group, mean difference in QALYs per patient, 0.0001 (95% CI: -0.0006-0.0004, P= 0.67). bed and bedside chair pressure sensors as a single intervention strategy do not reduce in-patient bedside falls, time to first bedside fall and are not cost-effective in elderly patients in acute, general medical wards in the UK. isrctn.org identifier: ISRCTN44972300.

  8. Families and Elder Care in the Twenty-First Century

    Science.gov (United States)

    Bookman, Ann; Kimbrel, Delia

    2011-01-01

    Although most Americans know that the U.S. population is aging, they are far less informed about the reality of providing elders with personal care, health care, and social support. Families--particularly women--have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care…

  9. Incidence and cause of acute confusion in elderly patients

    Directory of Open Access Journals (Sweden)

    Rejeki A. Rahayu

    2002-03-01

    Full Text Available Acute confusion is a clinical syndrome in the elderly whose diagnosis is made by acute onset of disturbance of consciousness, impairment of cognition and fluctuating perception and has an underlying medical cause associated with usually serious medical illness. Acute confusion has a high morbidity and mortality, and patient need to stay longer in the hospital, have a higher risk for institutionalization and immobilization. The aim of this study is to recognize the incidence and most of medical illness, which cause acute confusion in elderly patients, a retrospective study based on medical record of elderly patients who were hospitalized in Dr Kariadi hospital since 1998 to 1999. 5407 elderly patients were hospitalized, but only 5191 were analyzed and included in this study. 35% (992 men and 846 women elderly patients had acute confusion on first arrival and 7% ( 197 men and 176 women acute confusion appears in the ward. Total acute confusion was 40.89%. The mortality rate was 29% (263 women and 381 men. Three most frequent cause of death were sepsis (10.04%; hemorrhagic stroke (5.11%; multifactor (4.16%. Top ten diseases, which cause acute confusion, were hepatic encephalopathy, hemorrhagic stroke, sepsis, moderate dehydration due to gastoenteritis, hyponatremia, acute myocardial infarction, pneumonia, urinary tract infection, congestive heart failure, and arrhythmia cordis. (Med J lndones 2002; 11: 30-35Keywords: acute confusional state, geriatric patients, hospital study

  10. The knowledge management on the elderly care

    Science.gov (United States)

    Arve, Seija; Ovaskainen, Païvi; Randelin, I.; Alin, Jouni; Rautava, Païvi

    2009-01-01

    Purpose The elderly care pathway from the public health emergency unit to the university hospital and back home needs rationalising. Another purpose is to utilise the information of the electronic patient record system in care coordination. Theory The processed knowledge from the electronic patient record system enables the geriatric professionals to deal with the information of the elderly care pathway effectively and to develop the care in a patient-centred way. Methods All the 75-year-old or older patients who had visited the emergency unit of Turku health care centre were analysed. The data were collected from the Pegasos® electronic patient record system. The method used was time-series analysis. Statistical analyses were run on SAS System for Windows, release 9.1. Results Twenty-three thousand-three hundred and seventy-two older patients visited the emergency unit and 25% of them were referred to hospital, less to the Turku city hospital, more to the university hospital. The information of transitions into the local organisations could be followed, but there were many information gaps in transitions to the university hospital. Conclusion Older people are cared for in the university hospital too often. The expensive care begins at the emergency unit and leads to the long-term institutional care. The care pathway of older patients has to be based on professional capability, co-operation and knowledge management.

  11. Why do care workers withdraw from elderly care?

    DEFF Research Database (Denmark)

    Liveng, Anne

    2012-01-01

    . The article illustrates how working consciously with the researcher's subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers' need for emotional supervision.......Care workers frequently withdraw from elderly people in their care; this has resulted in a number of scandals in the media. Here I analyze an empirical scene observed at an old people's home in Denmark, which contains behavioral patterns among the care workers which could be seen as withdrawal....... At the same time it illustrates the care workers' commitment to the elderly. A paradoxical "empathy at a distance" is characteristic of the scene. When analyzing my written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions...

  12. Caring for the elderly female psychiatric patient.

    Science.gov (United States)

    Bashir, Mudhasir; Holroyd, Suzanne

    2010-06-01

    With the growth of the elderly population, and the female elderly population in particular, healthcare providers will see increasing numbers of elderly women with psychiatric disorders. To properly care for this group of patients, better understanding is needed not only of group differences in this patient population but also of the differences in each individual, as they age, given their unique life experiences, cohort effects, medical comorbidity, social situation, and personality traits. Understandably, these characteristics will interact with psychiatric disorders in ways that may increase the challenge to correctly diagnose and treat these patients. In addition, understanding late life changes, the prevalence of various mental disorders and the sometimes unique presentation of mental disorders in this age group is required to better diagnose and treat this population.

  13. Common presentations of elder abuse in health care settings.

    Science.gov (United States)

    Powers, James S

    2014-11-01

    Health care professionals encounter elder abuse in the community and in medical offices, emergency rooms, hospitals, and long-term care facilities. Keen awareness of risk factors for elder abuse and the variety of presentations in different health settings helps promote detection, treatment, and prevention of elder abuse.

  14. Formal care for elderly people in Poland.

    Science.gov (United States)

    Synak, B

    1989-04-01

    This paper starts by giving some brief information about the institutional care system for the elderly in Poland. The supportive network for old people is identified as being firmly based on that of the family. Social services are particularly directed to those without children and close relatives. There are many economic and socio-cultural reasons for raising the importance of institutional help - e.g. the growth of female professional activity, migration processes, the disintegration of the multi-generational family. The family contacts with old persons staying in hospitals and in nursing homes are described and the attitudes of the elderly towards institutional care are discussed in this paper. Presently old people expect financial help mainly from the state but care and help in everyday contingencies from their family (e.g. in case of illness, only 2% of old people would like to be cared for by nurses). This paper also shows some reasons for differentiating the attitudes and generational expectations. The family responsibility for elderly people reflects on the one hand the attitudes and systems of values of both the generations and shortage of institutional services on the other. Examples relating to some of the issues discussed are given in this paper.

  15. Does informal care reduce public care expenditure on elderly care? Estimates based on Finland's Age Study.

    Science.gov (United States)

    Kehusmaa, Sari; Autti-Rämö, Ilona; Helenius, Hans; Rissanen, Pekka

    2013-08-15

    To formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care. Data from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects' physical health. Elder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care. Our analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure.

  16. The use of Functional Consequences Theory in acutely confused hospitalized elderly.

    Science.gov (United States)

    Kozak-Campbell, C; Hughes, A M

    1996-01-01

    Acute confusion is a common complication of hospitalization in the elderly that impacts on both the use of health care resources and the functional status of individuals. Providing optimum nursing care for these patients depends on three factors: 1) the nurse's ability to differentiate acute confusion from other common conditions in the hospitalized elderly, chiefly dementia or depression, 2) the nurse's ability to identify factors contributing to this condition, and 3) the implementation of interventions to minimize the effects of these factors on the patient. This article differentiates the clinical features of acute confusion from those of depression and dementia, and discusses the use of the Functional Consequences Theory, developed by Miller (1990), as a framework for nursing assessment and management of care for elderly patients with this condition. The functional consequences theory framework assists the nurse to identify risk factors associated with the development of acute confusion in the hospitalized elderly. Further it guides the development of interventions to minimize the effects of this condition in this population. The use of this framework in the clinical setting is illustrated through a case study.

  17. Malnutrition screening in acutely unwell elderly inpatients.

    Science.gov (United States)

    Sharma, Yogesh; Miller, Michelle; Shahi, Rashmi; Hakendorf, Paul; Horwood, Chris; Thompson, Campbell

    2016-10-13

    The rate of malnutrition among hospitalised elderly patients in Australia is 42.3%. Malnutrition is known to lead to significant adverse outcomes for the patients and increase hospital costs through increased use of resources. This study assessed nutrition screening adequacy and investigated factors associated with missed opportunity to diagnose malnutrition. A prospective cross-sectional study involving 205 general medical patients aged ≥60 years admitted acutely in a tertiary hospital over a period of 1 year. Patients who were not given initial nutritional screening were noted and all patients underwent nutritional assessment. The researchers assessed demographic data and performed univariate analysis of factors responsible for missed nutritional screening. Only 99 patients (49.5%) were screened for malnutrition and 100 (50.3%) missed initial nutritional screening (data incomplete for 6 patients). Of those screened, more were malnourished (n=64; 61.5%) than those not screened (n=40; 38.5%), pmalnutrition; these include apparently adequate nutritional status, lower staff to patient ratios and outlier ward locations. Ensuring consistent nutrition screening with appropriate therapeutic interventions for patients and educational interventions for staff could pay dividends not only in terms of improved patient health but also in terms of hospital reimbursement.

  18. 1例急性冠脉综合征老年患者的药学监护%Pharmaceutical Care for an Elderly Patient with Acute Coronary Syndrome

    Institute of Scientific and Technical Information of China (English)

    张新茹; 付秀娟; 朱大胜

    2011-01-01

    OBJECTIVE: To explore the methods and ideas of developing pharmaceutical care according to the pharmaceutical care for an elderly patient with acute coronary syndrome. METHODS: Clinical pharmacist provided pharmaceutical care for an elderly patient with acute coronary syndrome in respect of drug interactions, drug dose and medication time, effect of drugs on electrolyte and so on. RESULTS: According to the characteristic of the patients and drug combination, clinical pharmacist suggested to change felodipine to fosinopril, withdraw nicergoline, reduce dose of digoxin, adjust administration time of nitrates, and monitor potassium concentration, etc. The doctors adopted the suggestions of clinical pharmacist to avoid the adverse drug interactions, reduce the risk of cumulative intoxication, resistance and electrolyte imbalance. The condition of the patient was improved significantly. CONCLUSION: Elderly patients often suffer from multiple chronic diseases and physiological dysfunction, and should apply a variety of drugs, so that the probability of adverse drug reactions and drug interactions increase significantly. Therefore, in the course of treatment in elderly patients, clinical pharmacist should cooperate with clinical physicians, provide active pharmaceutical care and optimize drug scheme to guarantee the safety of drug use.%目的:通过对1例急性冠脉综合征老年患者的药学监护,探讨开展药学服务的方法和思路.方法:临床药师对1例急性冠脉综合征老年患者在药物相互作用、药物剂量和给药时间以及药物对电解质的影响等方面实行药学监护.结果:临床药师结合患者特点及合并用药情况,建议将降压药物由非洛地平改为福辛普利、停用尼麦角林、降低地高辛剂量、调整硝酸酯类药物给药时间、密切监测血钾等,医师采纳临床药师建议,有效避免了不利的药物相互作用、降低了药物蓄积中毒、耐药和电解质紊乱等风险,

  19. Nutritional status and mealtime experiences in elderly care recipients

    OpenAIRE

    2007-01-01

    Elderly people receiving municipal services and care are at risk for malnutrition due to frailty and chronic diseases. In this work, the nutritional status of elderly patients (>65 y) was evaluated in three different populations. One population lived in various care settings, i.e. service flats (SF), old peoples home (OPH), group living for demented (GLD) and nursing homes (NH) (Study I). The other two populations were free-living elderly receiving home nursing care (HNC) ...

  20. Green care farms promote activity among elderly people with dementia

    NARCIS (Netherlands)

    Bruin, de S.R.; Oosting, S.J.; Kuin, Y.; Hoefnagels, E.C.M.; Blauw, Y.H.; Groot, de C.P.G.M.; Schols, J.M.G.A.

    2009-01-01

    In the Netherlands, an increasing number of green care farms are providing day care to community-dwelling elderly people with dementia. Currently, it is unknown whether activities, activity participation, and facility use of elderly people with dementia at green care farms differ from those at

  1. Green care farms promote activity among elderly people with dementia

    NARCIS (Netherlands)

    Bruin, S.R. de; Oosting, S.J.; Kuin, Y.; Hoefnagels, E.C.M.; Blauw, Y.H.; Groot, C.P.G.M. de; Schols, J.M.G.A.

    2009-01-01

    In the Netherlands, an increasing number of green care farms are providing day care to community-dwelling elderly people with dementia. Currently, it is unknown whether activities, activity participation, and facility use of elderly people with dementia at green care farms differ from those at regul

  2. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Hall, E.O.C.; Wagner, L.

    2007-01-01

    AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...... of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD......: In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We...

  3. Conflicting views on elder care responsibility in Japan.

    Science.gov (United States)

    Lee, Kristen Schultz

    2016-05-01

    I examine the attitudinal ambivalence created by conflicting social expectations regarding parent-child devotion, filial obligation and family membership, and gender norms in a national population of Japanese adults. I ask: in a context of rapidly changing family and elder care norms, how do different beliefs and attitudes overlap and conflict and how are they related to elder care preferences? I analyze data from the 2006 Japanese General Social Survey and use Latent Class Analysis to identify latent groups in the population defined by their beliefs and examine the relationship between class membership and elder care preferences. I found variation in the population with respect to the measured beliefs as well as a relationship between patterns of beliefs and choice of elder caregiver. I found conflicting expectations regarding elder care responsibility in one latent class and this class also expressed elder care preferences that conflict with at least some of their strongly held beliefs.

  4. Negotiating care in the context of Finnish and Italian elder care policies.

    Science.gov (United States)

    Zechner, Minna; Valokivi, Heli

    2012-06-01

    Negotiation is an integral part of all elder care, which by definition involves a relation between at least two people. In this article, we analyse negotiations concerning elder care in the context of Finnish and Italian elder care policies. At the macro level negotiations on elder care are shaped by elder care policies and at the micro level by individual skills and resources. Our focus is on the negotiations on eligibility that take place when elders attempt to access care. The data consist of qualitative interviews with Finnish and Italian elders in need of care. The analysis of individual experiences of care negotiations reflects the practical consequences of elder care policies to older people. The results indicate that the most negotiated eligibility criteria when seeking access to elder care are need, money and social relations. These criteria are negotiated when seeking eligibility to different sources of care: informal care, grey market, market-based, non-profit and public services. In Italy, negotiation is particularly crucial when accessing grey market care. Cash as the main Italian elder care policy tool tends to enhance the role of and need for negotiation. In Finland, a greater part of elder care is provided by the public sector and therefore the process of negotiation is more standardized than in Italy.

  5. Coexisting principles and logics of elder care

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene; Eskelinen, Leena; Boll Hansen, Eigil

    2015-01-01

    Healthy and active ageing has become an ideal in Western societies. In the Nordic countries, this ideal has been supported through a policy of help to self-help in elder care since the 1980s. However, reforms inspired by New Public Management (NPM) have introduced a new policy principle of consumer......-oriented service that stresses the wishes and priorities of older people. We have studied how these two principles are applied by care workers in Denmark. Is one principle or logic replacing the other, or do they coexist? Do they create tensions between professional knowledge and the autonomy of older people......? Using neo-institutional theory and feminist care theory, we analysed the articulation of the two policy principles in interviews and their logics in observations in four local authorities. We conclude that help to self-help is the dominant principle, that it is deeply entrenched in the identity...

  6. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients

    Institute of Scientific and Technical Information of China (English)

    Chan Sun Park; Hee Seok Jeong; Ki Bae Kim; Joung-Ho Han; Hee Bok Chae; Sei Jin Youn; Seon Mee Park

    2016-01-01

    BACKGROUND: Acute cholangitis in old people is a cause of mortality and prolonged hospital stay. We evaluated the effects of methods and timing of biliary drainage on the outcomes of acute cholangitis in elderly and very elderly patients. METHODS: We analyzed 331 patients who were older than 75 years and were diagnosed with acute calculous cholangitis. They were admitted to our hospital from 2009 to 2014. Pa-tients’ demographics, severity grading, methods and timing of biliary drainage, mortality, and hospital stay were retrospec-tively obtained from medical records. Clinical parameters and outcomes were compared between elderly (75-80 years,n=156) and very elderly (≥81 years,n=175) patients. We analyzed the effects of methods [none, endoscopic retrograde cholangio-pancreatography (ERCP), percutaneous transhepatic biliary drainage, or failure] and timing (urgent or early) of biliary drainage on mortality and hospital stay in these patients. RESULTS: Acute cholangitis in older patients manifested as atypical symptoms characterized as infrequent Charcot’s triad (4.2%) and comorbidity in one-third of the patients. Patients were graded as mild, moderate, and severe cholangitis in 104 (31.4%), 175 (52.9%), and 52 (15.7%), respectively. Urgent bili-ary drainage (≤24 hours) was performed for 80.5% (247/307) of patients. Very elderly patients tended to have more severe grades and were treated with sequential procedures of tran-sient biliary drainage and stone removal at different sessions. Hospital stay was related to methods and timing of biliary drainage. Mortality was very low (1.5%) and not related to patient age but rather to the success or failure of biliary drainage and severity grading of the acute cholangitis. CONCLUSIONS: The methods and timing used for biliary drainage and severity of cholangitis are the major determi-nants of mortality and hospital stay in elderly and very elderly patients with acute cholangitis. Urgent successful ERCP is mandatory for

  7. Sufficient competence in community elderly care? Results from a competence measurement of nursing staff

    OpenAIRE

    Bing-Jonsson, Pia C; Hofoss, Dag; Kirkevold, Marit; Bjørk, Ida T; Foss, Christina

    2016-01-01

    Background Multi-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly car...

  8. Hospital Care for Frail Elderly Adults: From Specialized Geriatric Units to Hospital-Wide Interventions

    NARCIS (Netherlands)

    Bakker, F.C.; Olde Rikkert, M.G.M.

    2015-01-01

    Much of the acute care provided in hospitals is for elderly people. Frailty is a common clinical condition among these patients. Frail patients are vulnerable to undergoing adverse events, to developing geriatric syndromes and to experiencing functional decline during or due to hospitalization. The

  9. Elder care and intergenerational relationships in rural Yogyakarta, Indonesia

    NARCIS (Netherlands)

    Keasberry, I.N.

    2001-01-01

    In Indonesia, as in most other societies, intergenerational relationships are considered most important for elder care. Children are expected to take care of their elderly parents. However, processes of social change such as industrialisation, urbanisation and migration can have a negative impact on

  10. Demand of elderly people for residential care: an exploratory study

    NARCIS (Netherlands)

    van Bilsen, P.; Hamers, J.; Groot, W.; Spreeuwenberg, C.

    2006-01-01

    Background: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that

  11. Position paper: robots as companions and therapists in elderly care

    NARCIS (Netherlands)

    Gallego-Pérez, Jorge; Lohse, Manja; Evers, Vanessa

    2013-01-01

    Given the increasing portion of elderly people in the western world and severe lacks in care-taking, we believe that we should research possibilities to employ robots in elderly care. Social robots could offer companionship as well as treatment of physical and psychological disturbances. In our rese

  12. Future elderly care in China, how should it be?

    DEFF Research Database (Denmark)

    Cai, Hao; Cai, Yanguang; Tao, Yingshan

    2016-01-01

    The Chinese healthcare system is at a crossroads of the history. Multiple challenges are encountered due to the demographic changes. The aim of this study was to investigate the aspects of the Chinese youngsters on the future elderly care system. A significant social-cultural consciousness...... difference of youngsters on elderly care was found between China and other parts of the world....

  13. Demand of elderly people for residential care: an exploratory study

    Directory of Open Access Journals (Sweden)

    Groot W

    2006-03-01

    Full Text Available Abstract Background Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources that are associated with this demand. Furthermore, the accuracy of the waiting list as a reflection of this demand has been examined. Methods 67 elderly people waiting for admission into a home for the elderly, are subjected to semi-structured interviews. The data are analyzed by using multivariate statistics. Results Elderly people who indicate that they would refuse an offer of admission into a home for the elderly feel healthier (p = 0.02, have greater self-care agency (p = 0.02 and perceive less necessity of admission (p Conclusion The results contribute to the understanding of waiting lists and the demand for residential care. It became apparent that not everybody who asks for admission into a home for the elderly, really needed it. The importance of elderly people's resources like social networks and the ability to manage everyday activities in relation to the demand for care became clear. These findings are important because they indicate that resources also play a role in predicting elderly people's demand and as a result can guide the development and the (redesign of adequate health care services.

  14. Depression and issues of control among elderly people in health care settings.

    Science.gov (United States)

    Barder, L; Slimmer, L; LeSage, J

    1994-10-01

    This descriptive study investigated the relationship between both demographic characteristics and type of health care setting and elderly people's attributions for control, functional status, mood, type of helplessness, and perception of self-efficacy. Results of the study demonstrate that elderly people in long-term care settings are more vulnerable to experiencing learned helplessness and depression than elderly people in acute or rehabilitation settings. The findings indicate that the critical period for the development of learned helplessness and depression is for subjects with a length of stay of 7 weeks to 6 months. The study supports other research which concludes that depression in elderly people is better explained by the original learned helplessness theory rather than being related to attributions about the cause of loss of control.

  15. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Wagner, Lis; Hall, Elisabeth O.C.

    2007-01-01

    of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD......: In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We...... interactively compared data and display matrices to describe self-care as a health resource. RESULTS: Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action...

  16. Managing acute care.

    Science.gov (United States)

    Russell, J S

    1993-02-01

    In the last few years, much medical-facility construction has been driven by what insurers want. Hospitals have built facilities for well-reimbursed procedures and closed money-losing ones. Health-maintenance organizations increasingly expect to hold down costs by making prepayment arrangements with doctors and their hospitals. President Clinton has pledged early action on health-care reform, which will likely change planners' priorities. Whether the nation goes to Clintonian "managed competition" or a Canadian-style nationwide single-payer system (the two most likely options), the projects on these pages reflect two large-scale trends that are likely to continue: the movement of more procedures from inpatient to outpatient facilities and the separation of treatment functions from ordinary office and administrative tasks so that the latter are not performed in the same high-cost buildings as technology-intensive procedures. Various schemes that make care more "patient-centered" have been tried and been shown to speed healing, even for outpatients, but such hard-to-quantify issues get short shrift in an era of knee-jerk cost containment. The challenge in tomorrow's healthcare universe--whatever it becomes--will be to keep these issues on the table.

  17. Sexual Harassment of Newcomers in Elder Care. An Institutional Practice?

    Directory of Open Access Journals (Sweden)

    Jo Krøjer

    2014-03-01

    Full Text Available Sexual harassment is illegal and may have very damaging effects on the people exposed to it. One would expect organizations, employers, and institutions to take very good care to prevent employees from exposure to sexual harassment from anyone in their workplace. And yet, many people, mostly women, are exposed to sexual harassment at work. In care work, such behaviour is often directed toward their female caregiver by elderly citizens in need of care. Contemporary Nordic studies of working life and work environment have primarily investigated the interpersonal dimensions of sexual harassment, thus focusing on the relation between elderly citizens in need of care and their professional caregivers. In this article, we argue that sexual harassment from the elderly toward newcomers in elder care should also be seen as an effect of institutional practices. Based upon a Foucauldianinspired notion of practice-making, the article carries out a secondary analysis of three different empirical studies in order to explore how sexual harassment is produced and maintained through institutional practices in elder care. The term institution in this perspective includes three dimensions; a political, an educational (educational institutions in health and elder care, and a work organizational dimension. By examining elder care in these different dimensions, we identify how sexual harassment of professional caregivers is produced and maintained through institutional practice-making in elder care. The article thus contributes to our knowledge on working life by expanding and qualifying the understanding of the problematic working environment in care work, and by offering an alternative theoretical and analytical approach to the study of sexual harassment. Together, these insights suggest how elder care institutions might act to prevent sexual harassment toward caregivers.

  18. Learning from other lands. Caring for elderly demented Koreans.

    Science.gov (United States)

    Lee, H; Kim, S; You, K S

    1997-09-01

    The aims of the study reported here were to describe the socio-demographic characteristics of caregivers of demented elders in Korea and their care recipients and to compare the positive and negative meanings and outcomes of the caregiving experiences of caregivers who had admitted their elderly demented relative to a nursing home (G1: n = 24) and caregivers still caring for their elderly demented relatives at home (G2: n = 30). Most caregivers were female (80%), married (89%), and related to the care receiver as daughter-in-law (39%), daughter (22%), wife (15%), son (13%), or neighbor (6%). Social class differences were found between the home care and nursing home groups: the upper classes were significantly more likely to have placed their demented elder in a nursing home, whereas the low social classes were more likely to keep taking care of their demented elder at home instead of placing them in a nursing home. Caregivers who had admitted their relative to a nursing home (G1) reported significantly more difficulties from disturbed sleep, disrupted children's studies, and limited personal life when they were caring for the elder at home (p care group (G2) had significantly greater satisfaction in serving as a model for their children and practicing religion (p care receiver than those who have placed their demented elder in a nursing home, although the difference in this case was not significant.

  19. Two Principles of good elderly care

    DEFF Research Database (Denmark)

    Dahl, Hanne Marlene; Eskelinen, Leena; Boll Hansen, Eigil

    the elderly person to manage as much as possible themselves and is based upon a socio-pedagogical culture, where the professional is teaching elderly people about the proper behavior. It’s based upon a formal knowledge of aging and upon different techniques to motivate and involve the elderly...

  20. Incidence and prevention of venous thromboembolism in acutely ill hospitalized elderly Chinese

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-ying; FAN Jin; CHENG You-qin; WANG Yan; YAO Chen; ZHONG Nan-shan

    2011-01-01

    Background As the third most frequent cardiovascular disease, venous thromboembolism (VTE) remains a major cause of morbidity and mortality in hospitalized patients. The aim of this study was to determine the incidence of VTE and steps for its prevention in acutely ill hospitalized elderly Chinese patients.Methods A prospective multi-center study was conducted from June 2006 to November 2007. A total of 607 patientsfrom 40 research centers in China were enrolled. Data of the patients' baseline characteristics, VTE events and prophylaxis/therapy methods were collected.Results Fifty-nine patients (9.7%) had an objectively confirmed VTE during the 90-day follow-up, of which, 59.3%occurred during the first week and 75% within 14 days. Forty-one patients died (6.6%) during the follow-up, 36.6% died within three weeks. We also found that medical disorders including respiratory failure (16.4%), acute brain infarction (15.6%), acute infectious diseases (14.3%), acute coronary artery syndrome (8.7%) and heart failure (7.6%) play a role in provoking VTE. Only 13.0% of the elderly patients with high risk of VTE used low dose unfractionated heparin, 7.1% used low molecular weight heparin, 5.4% used warfarin,0.3% used graduated compression stockings and none of them used intermittent pneumatic compression.Conclusions Our study showed similar results between our study and western countries in the VTE incidence by day 90 in elderly hospitalized patients with acute medical illness. Great caution must be applied in the care of acutely ill elderly hospitalized patients to deal with the complications of VTE. Application of safe and effective prophylaxes against embolism remains a critical challenge.

  1. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun

    2008-01-01

    AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

  2. Ingestive Skill Difficulties are Frequent Among Acutely-Hospitalized Frail Elderly Patients, and Predict Hospital Outcomes

    DEFF Research Database (Denmark)

    Hansen, Tina; Faber, Jens Oscar

    2012-01-01

    .0%). When adjusting for frailty status, difficulties in self-feeding and texture management were related to prolonged LOS, and difficulties in positioning and liquid ingestion were related to discharge to institutional care. Conclusion : Ingestive skill difficulties among acutely-hospitalized frail elderly...... patients were frequent and characterized by great complexity. This necessitates a broad range of management strategies related to the patients’ ability in positioning, self-feeding skills, as well as oropharyngeal sensorimotor skills. Read More: http://informahealthcare.com/doi/full/10.3109/02703181.2012.736019......Purpose : To examine the relationship between ingestive skill performance while eating and drinking and frailty status in acutely-hospitalized elderly patients and to examine whether there is a relationship between the proportion of ingestive skill difficulties and Length of Hospital Stay (LOS...

  3. Early rehabilitation and neuroprotective drug therapy outcomes in elderly patients with acute stroke

    Institute of Scientific and Technical Information of China (English)

    Yue Chen; Lufang Chen; Yiqing Tao; Feixue Zhou; Chunlan Cui; Shichao Liu

    2011-01-01

    Sixty elderly patients, who suffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 (75%) of the patients exhibited cognitive impairment to varying degrees, and 25 (45%) of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 (20%) required intermittent supervision, and 20 (36%) required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.

  4. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India.

    Science.gov (United States)

    Joe, William; Rudra, Shalini; Subramanian, S V

    2015-11-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.

  5. Threats and violence in Swedish community elderly care.

    Science.gov (United States)

    Josefsson, Karin; Ryhammar, Lars

    2010-01-01

    Violence in elderly care has been reported on a global scale. The aim of this study was to describe nurses' perceptions of threats and violence, directed at themselves and other staff in community elderly care. Another aim was to describe nurses' access to prevention measures for handling threats and violence. A questionnaire was answered by registered nurses (RNs) (n=213) in community elderly care. Data was analyzed by SPSS. The results showed that nurses had experienced high-degree indirect threats (48%), direct threats of violent acts (40%) and violent acts (40%). Forty-five percent of the nurses had witnessed violence and threats toward other staff. Twenty percent of the nurses stated to have access to education in managing threats and violence. The conclusions were that violence occurred frequently in community elderly care, as perceived by nurses, as well as that community authority should increase staff education for handling violence.

  6. The attitude of nurses towards the care of elderly people

    Directory of Open Access Journals (Sweden)

    J. N. Gwala

    1995-05-01

    Full Text Available The number of nurses entering the nursing profession is decreasing, but demands placed upon the Health Services are increasing primarily due to the increasing number of people in our society. People are living longer and it is apparent that some extra provision must be made to care effectively for the elderly members of our society. Various studies have shown that care of the elderly is an unpopular clinical field for nurses. (Shape, 1986. Notter, 1992. Vickels 1982.

  7. The attitude of nurses towards the care of elderly people

    OpenAIRE

    J. N. Gwala; B. M. Zungu; B. B. Ntombela

    1995-01-01

    The number of nurses entering the nursing profession is decreasing, but demands placed upon the Health Services are increasing primarily due to the increasing number of people in our society. People are living longer and it is apparent that some extra provision must be made to care effectively for the elderly members of our society. Various studies have shown that care of the elderly is an unpopular clinical field for nurses. (Shape, 1986. Notter, 1992. Vickels 1982).

  8. Rib Fracture Protocol Advancing the Care of the Elderly Patient.

    Science.gov (United States)

    Leininger, Susan

    This article discusses unique factors associated with rib fractures in the elderly patient population and explains the process used in one facility to develop a revised protocol for the management of elderly patients with a rib fracture. The goals were to eliminate gaps in early trauma care management and employ a care routine that would improve outcomes for this vulnerable group of patients with fracture.

  9. [Acute confusion syndrome in the hospitalized elderly].

    Science.gov (United States)

    Regazzoni, C J; Aduriz, M; Recondo, M

    2000-01-01

    Our purpose was to determine the in-hospital incidence of delirium among elderly patients, its relation to previous cognitive impairment and the time between admission and its development. We performed an observational study of follow-up in the internal medicine area of a university hospital. We included consecutively and prospectively every patient 70 years or older upon admission. Patients with delirium on admission were excluded, as also were those taking antipsychotic drugs, with severe language or audition impairment, or coming from other sites of internation. We subsequently eliminated patients whose follow-up had not ended by the time the study was concluded, and patients in whom psychosis was diagnosed. Clinical and laboratory data were collected, and patients were prospectively followed until discharge from the hospital, using the Confusion-Assessment-Method (CAM) for the diagnosis of delirium. We analyzed 61 patients of whom 13 developed delirium while hospitalized (in-hospital incidence: 21.31%--CI 95%: 11.03-31.59%). Patients with delirium had had lower scores on Mini Mental State upon admission (median 17 vs 22; p 0.001). During the first 4 days of hospitalization 58.3% of delirium cases occurred not modifying the duration of hospitalization (average: 10.22 days vs 14.38; p = NS). We conclude that the incidence of delirium is high among hospitalized elderly patients specially during the first days, and in those with previous cognitive impairment. We suggest that delirium could be an associated disorder in severe diseases among patients with previous cognitive damage.

  10. Causes of persistent dizziness in elderly patients in primary care.

    NARCIS (Netherlands)

    Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; Weert, H.C. van; Windt, D.A. van der; Riet, G. ter; Horst, H.E. van der

    2010-01-01

    PURPOSE: Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of

  11. Causes of Persistent Dizziness in Elderly Patients in Primary Care

    NARCIS (Netherlands)

    Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; van Weert, H.C.; van der Windt, D.A.; ter Riet, G.; van der Horst, H.E.

    2010-01-01

    PURPOSE Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of

  12. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    Directory of Open Access Journals (Sweden)

    Jane Andreasen

    2015-06-01

    Full Text Available Introduction: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. Methods: The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. Results: Four main categories were identified: “The system,” “Keeping a social life,” “Being in everyday life,” and “Handling everyday life.” These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. Conclusion and discussion: Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

  13. Are Nutritional Care Adequate for Elderly Hospitalized Patients? A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Helene Kjøllesdal Eide

    2016-12-01

    Full Text Available This article assesses nutritional care in identifying and treating nutritional risk in elderly hospitalized patients. A cross-sectional study was conducted at a large Norwegian University hospital in the period 2011 to 2013. Data on nutritional risk and care for elderly patients (≥70 years without dementia were collected at 20 wards by 173 second-year nursing students in acute-care clinical studies. A stratified sampling technique was utilized to improve the representativeness of the sample. In total, 508 patients (48.8% women with a mean age of 79.6 years participated. The internationally and nationally recommended nutritional care was not implemented at the hospital, suggesting that nutritional care for elderly hospitalized patients was not adequate. This implies that the majority of the elderly patients nutritionally at risk are neither identified nor treated according to their needs. The article highlights the importance of having systematic nutritional care practices to make it possible for the hospital ward staff to routinely identify nutritional risk and initiate appropriate nutritional treatment measures.

  14. Surgical acute abdomen in elderly patients.

    Directory of Open Access Journals (Sweden)

    Itengré Ouédraogo

    2004-08-01

    Full Text Available Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo Aldereguía Lima¨ University Hospital of Cienfuegos with this diagnostic. The primary data were obtained from clinical cards of the patients and the daily clinical observation until the debit. Results: The patients presented an average age of 74 years, being the most frequent causes of the syndrome intestinal obstruction (32,4%, the biliary tract affections (22,5%, and acute appendicitis (21,6%. The most frequent symptom was abdominal pain (96,08%, and we noticed tachycardia in 80,4%. Postoperating complications in 47,06% of the patients appeared and was observed a mortality of 26,5% with statistically significant relation with the age, ASA classification, surgical risk, time of evolution and the surgical time. The peritonitis heads the direct causes of death.

  15. Obesity and its Association with Food Consumption, Diabetes Mellitus, and Acute Myocardial Infarction in the Elderly

    Science.gov (United States)

    da Silveira, Erika Aparecida; Vieira, Liana Lima; Jardim, Thiago Veiga; de Souza, Jacqueline Danesio

    2016-01-01

    Background Obesity affects a large part of elderly individuals worldwide and is considered a risk predictor for the development of chronic diseases such as cardiac diseases, the leading causes of death in the elderly population. Objective To investigate the prevalence of obesity and associated factors, with emphasis on the occurrence of other diseases and on food consumption in elderly individuals treated at the Brazilian Unified Health System (Sistema Único de Saúde, SUS). Methods Cross-sectional sampling study performed in the city of Goiânia (Brazil) including elderly individuals (≥ 60 years) receiving primary care. During home visits, we performed anthropometric measurements and applied a structured, standardized, and pre-tested questionnaire assessing socioeconomic, demographic and lifestyle conditions, occurrence of diseases, and food consumption. We performed multiple Poisson regression analysis using a hierarchical model and adopting a significance level of 5%. Results We evaluated 418 elderly patients with a mean age of 70.7 ± 7 years. Their body mass indices had a mean value of 27.0 kg/m2 and were higher in women than in men (27.4 kg/m2 versus 26.1 kg/m2, respectively, p = 0.017). Obesity had a prevalence of 49.0%, a risk 1.87 times higher between the ages of 60-69 years and 70-79 years, and a rate 1.4 times higher among individuals with more than four morbidities. On multivariate analysis, the factors associated with obesity were age 60-69 and 70-79 years, inadequate consumption of whole-wheat grains and adequate consumption of fruit, musculoskeletal diseases, diabetes mellitus, and acute myocardial infarction. Conclusions Obesity had a high prevalence in the evaluated elderly population and was associated with food consumption, musculoskeletal disease, diabetes mellitus, and acute myocardial infarction.

  16. Health care utilization in the elderly Mexican population: Expenditures and determinants

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    García-Peña Carmen

    2011-03-01

    Full Text Available Abstract Background Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social or because of the increase that comes with older age (individual. Objective To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. Methods A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT, 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Results Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. Conclusions The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age

  17. Decitabine in the treatment of acute myeloid leukemia in elderly patients

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    Malik P

    2014-02-01

    Full Text Available Priya Malik, Amanda F CashenWashington University School of Medicine, St Louis, MO, USAAbstract: The majority of patients with acute myeloid leukemia (AML are elderly and have a poor prognosis despite induction therapy. Decitabine, a DNA-hypomethylating agent that induces differentiation and apoptosis of leukemic cells, is a well-tolerated alternative to aggressive chemotherapy. It is currently FDA-approved for myelodysplastic syndrome, including patients with 20%–30% bone marrow blasts. Recent clinical attention has focused on evaluating decitabine as frontline therapy for untreated high-risk elderly AML patients. A large randomized international phase III study comparing decitabine to supportive care and cytarabine in elderly AML patients demonstrated significantly improved complete remission rates, but the survival difference did not reach significance. Due to this, decitabine did not achieve FDA approval for AML, but continues to be used off-label. Current research is focused on further defining subgroups of elderly AML patients who may derive greater benefit from decitabine therapy and combining it with other low-intensity active agents for AML.Keywords: decitabine, elderly, AML

  18. Communication in acute ambulatory care.

    Science.gov (United States)

    Dean, Marleah; Oetzel, John; Sklar, David P

    2014-12-01

    Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.

  19. PATHWAYS TO INSTITUTIONAL CARE FOR ELDERLY ...

    African Journals Online (AJOL)

    User

    strengthen family support systems so that institutionalisation only serves ... Thirdly, elderly Africans previously wielded considerable power, privilege and ..... portion of land, fishing, setting rabbit traps to supplement my relish, and strolling.

  20. Sensitizing home care aides to the needs of the elderly.

    Science.gov (United States)

    Guariglia, W

    1996-08-01

    Creative teaching strategies can be used to teach all home care providers how to empathize with their elderly patients. This article describes a simulation exercise used successfully by one educator to allow home care aide students to experience the limitations of aging and to better understand the situations of their patients.

  1. Elderly Care and Intrafamily Resource Allocation when Children Migrate

    Science.gov (United States)

    Antman, Francisca M.

    2012-01-01

    This paper considers the intrafamily allocation of elderly care in the context of international migration where migrant children may be able to provide financial assistance to their parents but are unable to offer physical care. To investigate sibling interaction, I estimate best response functions for individual physical and financial…

  2. Cost-Benefit Analysis in Social Care for Elderly People

    Science.gov (United States)

    Dutrenit, Jean-Marc

    2005-01-01

    Social care at home for elderly people is now growing rapidly in France. A new question is, What are better forms of care for the different partners concerned? The research presented here, and made for the Comity of Lille Employment Area with cooperation of the Caisse Primaire d'Assurance Maladiede Lille (the local board of the national social…

  3. Study on the Virtual Care System for the Elderly

    Directory of Open Access Journals (Sweden)

    Hao Xuetao

    2015-01-01

    Full Text Available The virtual care system for the elderly is designed to make them healthier and safer under the increasingly serious aging situation. By using the image processing, speech recognition and relative sensors based on the intelligent terminals, the system accomplishes six functions: sports statistics, heart rate measurement, drug manager, intelligent navigation home and reminder, SOS voice for help and kitchen reminder. Experiments show that it can provide health analysis and safe tutelage for the elderly comprehensively and accurately.

  4. Lifestyle of the Elderly Receiving Home Care in Spain

    OpenAIRE

    Puig Llobet, Montserrat; Rodríguez Ávila, Núria; Lluch Canut, Ma. Teresa; Farràs i Farràs, Jaume

    2013-01-01

    The aim of this study is to examine the lifestyle characteristics and health status of the elderly in order to identify aspects that might help promote active ageing. Participants were 26 elderly citizens aged 75 or over who were the recipients of home care services in Vilafranca del Penedès (Barcelona, Spain). They were recruited by means of convenience sampling, and a case study approach was adopted. Fieldwork was conducted in April 2007, with a specially designed questionnaire administered...

  5. [Nutritional status and nutritional rehabilitation of elderly people living in long-term care institutions].

    Science.gov (United States)

    Lelovics, Zsuzsanna

    2009-11-01

    We review our studies on the most important factors related to feeding and nutrition in long-term care institutions, as well as we present the nutritional status of elderly people living in social homes, and, based on our results, we make recommendations concerning nutritional rehabilitation. We aimed to assess the following: nutritional status of people older than sixty years (elderly) living in long-term care institutions; changes in the body mass index of elderly living in long-term care institutions; changes in the nutritional status of elderly living in long-term care institutions during the last half decade; relations and correlations between acute and chronic diseases and nutritional status; the sip feed provision for elderly living in long-term care institutions; relationship between the discovered potential influencing factors and nutritional status screened by Malnutrition Universal Screening Tool (MUST). We screened the nutritional status of altogether 4774 (men: 28.9-30.9%, women: 69.1-71.19%; mean age: 77.8+/-8.9 years) elderly long-term care residents who volunteered to participate. In 2004 and 2006 the MUST and our questionnaire, in 2008 the nutritionDay questionnaire was used. Risk of malnutrition is high (26.8-77.0%) in elderly residents of social homes. Assessment of nutritional status is done four times a year or even more rarely in 29.5% of the residents. Nutritional status is multifactorial; it is influenced by immobility, fever, etc. Loss of appetite and swallowing difficulties are 2.5-fold, limited mobility, dementia and missing teeth are almost two-fold (1.6-1.7) more frequent in the group of high risk elderly than in the elderly living in social homes. Neurological diseases are in a significant correlation with nutritional status. Incidence of neurological diseases increased significantly in the last years. Nutritional rehabilitation does not end with screening the nutritional status, moreover, it begins with that. Individual diet has to

  6. Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria

    Science.gov (United States)

    Rodhe, Nils; Löfgren, Sture; Strindhall, Jan; Matussek, Andreas; Mölstad, Sigvard

    2009-01-01

    Objective Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. Design Comparative laboratory. Setting Primary care. Subjects A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. Main outcome measures Urinary levels of IL-1β, TNF-α, IL-12, IL-18, CXCL1 (GRO-α), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. Results Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36–84) and 96% (95% CI 77–100) (cut-off > 285 pg/mg creatinine), 81% (95% CI 54–95) and 96% (95% CI 77–100) (cut-off > 30 pg/mg creatinine), and 88% (95% CI 60–98) and 79% (95% CI 57–92) (cut-off > 2, on a scale of 0–4), respectively. Conclusions The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value > 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population. PMID:19247873

  7. Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

    NARCIS (Netherlands)

    Askari, M.; Wierenga, P.C.; Eslami, S.; Medlock, S.; de Rooij, S.E.; Abu-Hanna, A.

    2011-01-01

    Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studi

  8. Sleep in acute care units.

    Science.gov (United States)

    BaHammam, Ahmed

    2006-03-01

    Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium. Over the past few years, many studies have endeavored to objectively assess sleep in the ACUs, as well as the effect of mechanical ventilation and circadian rhythm changes critically ill patients. At this time, therefore, it is important to review published data regarding sleep in ACUs, in order to improve the knowledge and recognition of this problem by health care professionals. We have therefore reviewed the methods used to assess sleep in ACUs, factors that may affect sleep in the ACU environment, and the clinical implications of sleep disruption in the ACU.

  9. Acute suppurative parotitis: a dreadful complication in elderly surgical patients.

    Science.gov (United States)

    Lampropoulos, Pavlos; Rizos, Spyros; Marinis, Athanasios

    2012-08-01

    Acute suppurative parotitis (ASP) is a severe infection seen particularly in elderly surgical patients. Factors that increase the risk of ASP include post-operative dehydration, debilitating conditions, and immunosuppressed states. Case report and literature review. An 82-year-old female patient was admitted because of paralytic ileus, dehydration, and poor oral hygiene, and was in distress. After two days of hospitalization, the patient developed a progressive painful swelling of her right parotid gland and fever up to 39.0°C. Computed tomography scanning showed an abscess in the parotid gland. Because of her progressive clinical deterioration, the patient underwent operative drainage of the abscess and removal of the necrotic material. Unfortunately, she suffered multiple organ dysfunction syndrome and died. Acute suppurative parotitis requires prompt aggressive treatment that nevertheless may fail.

  10. LONG-TERM CARE OF DEPENDENT ELDERLY AND QUALITY

    OpenAIRE

    Macková Marie

    2013-01-01

    This article focuses on the issue of long-term care of dependent elderly and quality of life of their carers. Elderly care has an impact on the quality of life of family members. The research was carried out through a questionnaire and interview. The quality of life was measured using the WHOQOL instrument. The research aimed to identify the current levels of family members’ quality of life and the factors influencing the quality of life thereof. The research findings showed a lower quality o...

  11. PATHWAYS TO INSTITUTIONAL CARE FOR ELDERLY ...

    African Journals Online (AJOL)

    User

    African Journal of Social Work, 7(1), June 2017 .... Basing on this theory, the elderly's past social life brought out reasons for them .... reported lack of close family due to death or unmaintained or severed relationships. .... wishing to be repatriated are assisted by their respective countries' Ambassadors, who first locate their.

  12. [Home nursing care for depressed elderly people].

    Science.gov (United States)

    Floch, Catherine

    2011-01-01

    The freelance nurse must be adaptable and reactive in order to meet the needs of a depressed or suicidal elderly person. In addition to her own particular relationship with the patient, the nurse must activate a network of other professionals who can carry out home visits.

  13. CARE: Context Awareness in Residences for Elderly

    NARCIS (Netherlands)

    B. Kröse; T. van Kasteren; C. Gibson; T. van den Dool

    2008-01-01

    In this paper we present a system that is able to monitor activities of people in a domestic environment. The application area is that of ambient assisted living. Because of the increasing number of elderly living at home and the foreseen shortage in the number of caregivers, remote ICT-based applic

  14. Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan

    Directory of Open Access Journals (Sweden)

    Shih-Chao Kang

    2012-05-01

    Conclusion: Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded.

  15. Source apportionment of indoor PM10 in Elderly Care Centre.

    Science.gov (United States)

    Almeida-Silva, M; Faria, T; Saraga, D; Maggos, T; Wolterbeek, H T; Almeida, S M

    2016-04-01

    Source contribution to atmospheric particulate matter (PM) has been exhaustively modelled. However, people spend most of their time indoors where this approach is less explored. This evidence worsens considering elders living in Elderly Care Centres, since they are more susceptible. The present study aims to investigate the PM composition and sources influencing elderly exposure. Two 2-week sampling campaigns were conducted-one during early fall (warm phase) and another throughout the winter (cold phase). PM10 were collected with two TCR-Tecora(®) samplers that were located in an Elderly Care Centre living room and in the correspondent outdoor. Chemical analysis of the particles was performed by neutron activation analysis for element characterization, by ion chromatography for the determination of water soluble ions and by a thermal optical technique for the measurement of organic and elemental carbon. Statistical analysis showed that there were no statistical differences between seasons and environments. The sum of the indoor PM10 components measured in this work explained 57 and 53 % of the total PM10 mass measured by gravimetry in warm and cold campaigns, respectively. Outdoor PM10 concentrations were significantly higher during the day than night (p value < 0.05), as well as Ca(2+), Fe, Sb and Zn. The contribution of indoor and outdoor sources was assessed by principal component analysis and showed the importance of the highways and the airport located less than 500 m from the Elderly Care Centre for both indoor and outdoor air quality.

  16. Meanings and expressions of care and caring for elders in urban Namibian families:

    Directory of Open Access Journals (Sweden)

    CJ Leuning

    2000-09-01

    Full Text Available Since Namibia’s Independence in 1990, the population of elders—persons 65 years old and older—in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger’s theory of culture care diversity and universality and the ethnonursing research method, emic (insider meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what caring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one’s elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

  17. Cognitive assessment on elderly people under ambulatory care

    Directory of Open Access Journals (Sweden)

    Bruna Zortea

    2015-04-01

    Full Text Available Objective: to evaluate the cognitive state of elderly people under ambulatory care and investigating the connection between such cognitive state and sociodemographic variables, health conditions, number of and adhesion to medicine. Methods: transversal, exploratory, and descriptive study, with a quantitative approach, realized with 107 elderly people under ambulatory care in a university hospital in southern Brazil, in november, 2013. The following variables were used: gender, age, civil status, income, schooling, occupation, preexisting noncommunicable diseases, number and type of prescribed medications, adhesion, mini-mental state examination score, and cognitive status. Data was analyzed through inferential and descriptive statistics. Results: the prevalence of cognitive deficit was of 42.1% and had a statistically significant connection to schooling, income, civil status, hypertension, and cardiopathy. Conclusion: nurses can intervene to avoid the increase of cognitive deficit through an assessment of the elderly person, directed to facilitative strategies to soften this deficit.

  18. Inequalities in care in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Shabnam Rashid; Alexander Simms; Phillip Batin; John Kurian; Chris P Gale

    2015-01-01

    Coronary heart disease is the single largest cause of death in developed countries. Guidelines exist for the management of acute myocardial infarction(AMI),yet despite these,significant inequalities exist in the care of these patients. The elderly,deprived socioeconomic groups,females and non-caucasians are the patient populations where practice tends to deviate more frequently from the evidence base. Elderly patients often had higher mortality rates after having an AMI compared to younger patients. They also tended to present with symptoms that were not entirely consistent with an AMI,thus partially contributing to the inequalities in care that is seen between younger and older patients. Furthermore the lack of guidelines in the elderly age group presenting with AMI can often make decision making challenging and may account for the discrepancies in care that are prevalent between younger and older patients. Other patients such as those from a lower socioeconomic group,i.e.,low income and less than high school education often had poorer health and reduced life expectancy compared to patients from a higher socioeconomic group after an AMI. Lower socioeconomic status was also seen to be contributing to racial and geographical variation is the care in AMI patients. Females with an AMI were treated less aggressively and had poorer outcomes when compared to males. However even when females were treated in the same way they continued to have higher in hospital mortality which suggests that gender may well account for differences in outcomes. The purpose of this review is to identify the inequalities in care for patients who present with an AMI and explore potential reasons for why these occur. Greater attention to the management and a better understanding of the root causes of these inequalities in care may help to reduce morbidity and mortality rates associated with AMI.

  19. The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States.

    Science.gov (United States)

    Mui, A C

    2001-01-01

    This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.

  20. Quality of care: from the perspective of elderly people: the QUOTE-Elderly instrument.

    NARCIS (Netherlands)

    Sixma, H.J.; Campen, C. van; Kerssens, J.J.; Peters, L.

    2000-01-01

    Background: patient views on the quality of care are usually assessed by means of patient satisfaction questionnaires. Aim: to develop an instrument that would: (i)produce data to the expectations and experiences of non-institutionalized elderly people, (ii) contain items that has been formulated in

  1. Two populations in need. The Metropolitan Elder Care Alliance.

    Science.gov (United States)

    Bridgeman, M; Karoll, N; Schuerman, C K

    1993-04-01

    The elderly population in the Chicago area benefits from an unusual home care aide program--one in which the aides also benefit: aides are drawn from the population receiving public assistance and given training that offers them a career ladder and opportunity they might otherwise not have had, all while helping others.

  2. Future elderly care in China, how should it be?

    DEFF Research Database (Denmark)

    Cai, Hao; Cai, Yanguang; Tao, Yingshan;

    2016-01-01

    The Chinese healthcare system is at a crossroads of the history. Multiple challenges are encountered due to the demographic changes. The aim of this study was to investigate the aspects of the Chinese youngsters on the future elderly care system. A significant social-cultural consciousness...

  3. Use of Informal In-Home Care by Rural Elders.

    Science.gov (United States)

    Newhouse, Janette K.; McAuley, William J.

    1987-01-01

    Examined use of in-home services by older rural people who received assistance exclusively from informal sources. Results suggest that informal caregiver is essential in community-based care for rural elderly. Having a car, distance to friend, economic resources, physical health, and performance in daily living activities related to use of more…

  4. [A determined team caring for an elderly detainee].

    Science.gov (United States)

    Sifaoui, Brigitte

    2011-01-01

    The arrival of an elderly person in a remand centre reveals the extent to which the prison system is ill-equipped to deal with this type of detainee. The cooperation between the prison, nursing and social care teams however compensates for the many difficulties his case presents.

  5. [Freelance nurses and social care workers working with the elderly].

    Science.gov (United States)

    Douguet, Florence; Vilbrod, Alain

    2013-05-01

    Freelance nurses are in contact with an array of professionals working to help elderly people to continue living at home. In particular they form close ties with social service assistants and home care support workers. Between diverging perspectives and actual collaboration, these relationships seem atthe very least extremely contrasting.

  6. Filipino Arts among Elders in Institutionalized Care Settings

    Science.gov (United States)

    de Guzman, Allan B.; Satuito, James Cyril B.; Satumba, Miko Anne E.; Segui, Diego Rey A.; Serquina, Faith Evelyn C.; Serrano, Lawrence Jan P.; Sevilla, Madelyn D.

    2011-01-01

    The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of…

  7. Why Do Care Workers Withdraw From Elderly Care? Researcher’s Language as a Hermeneutical Key

    Directory of Open Access Journals (Sweden)

    Anne Liveng

    2012-11-01

    Full Text Available Care workers frequently withdraw from elderly people in their care; this has resulted in a number of scandals in the media. Here I analyze an empirical scene observed at an old people’s home in Denmark, which contains behavioral patterns among the care workers which could be seen as withdrawal. At the same time it illustrates the care workers’ commitment to the elderly. A paradoxical “empathy at a distance” is characteristic of the scene. When analyzing my written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a “hermeneutical key” which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own care relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important theme. The article illustrates how working consciously with the researcher’s subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers’ need for emotional supervision.

  8. [Factors influencing health care needs of solitude elderly].

    Science.gov (United States)

    Lee, Myung-Suk

    2003-10-01

    This study was to identify factors that influence the health care needs of that over 65 years of age in Mokpo, Korea. The data was collected from June 2002 to September 2002. The subjects were 120 homebound solitude elderly(age=76.8). Subjects were interviewed with structured questionnaire in order to identify the health care needs, health variables (perceived health status, risk of malnutrition, K-IADL), psychological variables(self-esteem, depression) and demographic variables. physiological health variables (height, weight, blood pressure, pulse, blood sugar)were assessed after the interview. In general perceived health status was poor, risk of malnutrition was high, number of disease was 3 disease, self-esteem was low but depression was high and health care needs were relatively high. Among the elderly education & counseling needs topped the list. In regression analysis, health care needs were significantly influenced by IADL(23%), duration of solitudes(4%), sex(3%), and education(1%). These variables explained 31% of the variances in health care needs. The result identified that health care needs should be a considered in IADL, female, duration of solitudes and education for the solitude elderly.

  9. Essential competencies for the education of nursing assistants and care helpers in elderly care

    NARCIS (Netherlands)

    Oeseburg, Barth; Hilberts, Rudi; Roodbol, Petrie F

    2015-01-01

    BACKGROUND: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains inade

  10. Reforming the Health Care System for Children and the Elderly to Balance Cure and Care.

    Science.gov (United States)

    Callahan, Daniel

    1992-01-01

    Issues in balancing health services and costs in a changing society, where groups have differential access to health care, are discussed, including need for a universal health care system, growing cost of health care for the elderly, prolongation of life among older adults, and the claims of children on services. (MSE)

  11. Essential competencies for the education of nursing assistants and care helpers in elderly care

    NARCIS (Netherlands)

    Oeseburg, Barth; Hilberts, Rudi; Roodbol, Petrie F

    2015-01-01

    BACKGROUND: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains inade

  12. Caring for and Keeping the Elderly in Their Homes

    Institute of Scientific and Technical Information of China (English)

    Hong Tao; Susan McRoy

    2015-01-01

    Population aging is a global issue. The problem is especially critical in societies, such as China and India, where there has been both rapid aging of the population and a tradition that children are the primary caregivers for their elderly parents who are no longer independent. This article discus-ses a variety of options for various types of professional and non-professional caregivers and serv-ices for the elderly in their homes used in the U. S. and how technology has been used to support this heterogeneous model of caregiving. Efforts have been made to coordinate among caregivers and outside services and track changes in health conditions effectively over time through the greater use of technology. These ideas offer a possible path for other societies, such as China and India, facing growing health needs and limited resources to care for the elderly.

  13. Regular Source of Care for the Elderly: A Cross-National Comparative Study of Hong Kong With 11 Developed Countries.

    Science.gov (United States)

    Wong, Samuel Yeung-Shan; Zou, Dan; Chung, Roger Y; Sit, Regina W; Zhang, Dexing; Chan, Dicken; Yeoh, Eng Kiong; Woo, Jean W

    2017-09-01

    This study aimed to give an international perspective of health service gaps for caring for elderly individuals and explore the role of primary care for caring for elderly individuals with chronic conditions in Hong Kong. Cross-sectional, telephone survey. Hong Kong. A sample of 1000 Chinese participants in Hong Kong aged 60 or older. Questionnaire extracted from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. Similar to the 11 countries, more than half (about 65%) of Hong Kong respondents suffered from chronic conditions, whereas approximately one-third of them had at least 2 chronic conditions. US respondents had highest rate of having chronic conditions. Only 65% of Hong Kong respondents reported having a regular source of care and a higher proportion of elderly reported having poor self-rated health when compared with overseas counterparts. However, the proportion of elderly individuals who could access same-day or next-day medical care was higher compared with findings of other countries. Both Hong Kong and US respondents were more likely to report cost-related problems when accessing care. Waiting time for specialists in Hong Kong was much longer and coordination between regular doctors was poorer than in all other countries. Although half of Hong Kong respondents had a management plan for chronic conditions, a smaller proportion of them considered it helpful. Hong Kong has the lowest rate of regular source of care when compared with 11 developed countries, although people in Hong Kong were more likely to be able to access same-day or next-day medical care. To cope with increasing needs of chronic disease care, there may be a need to further develop the provision of regular source of care for elderly individuals, including the development of quality primary care in Hong Kong. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  14. Primary health care to elderly people: Occupational Therapy actions perspectives

    Directory of Open Access Journals (Sweden)

    Cassio Batista Alves

    2015-09-01

    Full Text Available In Brazil, Occupational Therapy (OT was legislated in 1969, and was introduced into the Primary Health Care (PHC in the 90s. At this level of care, the OT serves various stages of human development, including aging, in a perspective of care and active aging line, seeks to optimize opportunities for health, participation and safety, using clinical reasoning in order to plan, guide, conduct and reflect their actions in producing the line of care. This career considers human activities as part of the construction of the man himself as an expertise area and seeks to understand the relationships that the active human establishes in its life and health. This study aimed to verify the actions and identify the occupational therapy line of care with the elderly in APS. This is a qualitative study that used a semi-structured interview applied during April to May 2013 with six occupational therapists that cared for older people in the APS at Uberaba-MG. The data was analyzed using the Collective Subject Discourse (CSD technique. We observed that the OT actions to produce line of care for the elderly happen according to the general public care, whether individual or group, with the team during case discussions, referrals or work management and the territory during the territorial diagnosis and networks formation, all permeated by the principles of fairness, integrity, intersectoriality and clinical reasoning in OT.

  15. Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores

    NARCIS (Netherlands)

    Kok, L.; Berden, C.; Sadiraj, K.

    2015-01-01

    A comparison of the costs of residential care and home care shows that the former is more expensive for society. However, elderly people seem to be happier in residential care. All stakeholders, except the state (and thus the taxpayer), benefit if elderly people enter residential care. This reveals

  16. (Transnational intergenerational care contract. Attitudes and practises of transnational families towards elderly care

    Directory of Open Access Journals (Sweden)

    Łukasz Krzyżowski

    2015-02-01

    Full Text Available In this article I am focused on the functioning of the transnational intergenerational care system. This is dynamic,as it is bound up with the life cycle of the transnational family, and on the one hand, denotes practices associatedwith any assistance parents provide to their migrant children and on the other – in the event of elderly peoplebeing faced with health and basic living problems – with the phenomenon of migrants caring for their parentsin old age. The transnational system of care also incorporates the involvement (or lack of involvement, as faras this triggers consequences that are of relevance here of relatively immobile people, for example the siblingsof migrants who provide (or not, as the case may be domestic support for their elderly parents. In this articleI adopt the thesis that migrants who function in different care regimes change not only their own but also theirparents’ attitudes towards elderly care.

  17. Three dialogues concerning robots in elder care.

    Science.gov (United States)

    Metzler, Theodore A; Barnes, Susan J

    2014-01-01

    The three dialogues in this contribution concern 21st century application of life-like robots in the care of older adults. They depict conversations set in the near future, involving a philosopher (Dr Phonius) and a nurse (Dr Myloss) who manages care at a large facility for assisted living. In their first dialogue, the speakers discover that their quite different attitudes towards human-robot interaction parallel fundamental differences separating their respective concepts of consciousness. The second dialogue similarly uncovers deeply contrasting notions of personhood that appear to be associated with respective communities of nursing and robotics. The additional key awareness that arises in their final dialogue links applications of life-like robots in the care of older adults with potential transformations in our understandings of ourselves - indeed, in our understandings of the nature of our own humanity. This series of dialogues, therefore, appears to address a topic in nursing philosophy that merits our careful attention.

  18. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit.

    Science.gov (United States)

    Harwood, Rowan H; Goldberg, Sarah E; Whittamore, Kathy H; Russell, Catherine; Gladman, John Rf; Jones, Rob G; Porock, Davina; Lewis, Sarah A; Bradshaw, Lucy E; Elliot, Rachel A

    2011-05-13

    Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of life, cognitive function, disability, behavioural and

  19. Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

    Directory of Open Access Journals (Sweden)

    Gladman John RF

    2011-05-01

    Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of

  20. Health care practice patterns for balance disorders in the elderly.

    Science.gov (United States)

    Roberts, Daniel S; Lin, Harrison W; Bhattacharyya, Neil

    2013-10-01

    Characterize health care practice patterns for balance disorders in the elderly. Cross-sectional analysis of national health care survey. Balance disorder cases in patients aged ≥65 years were extracted from the 2008 National Health Interview Survey. Records were analyzed for health professionals seen, diagnostic testing ordered, diagnoses given, and treatments offered. Relationships between diagnostic success, imaging studies, and specialty providers seen were compared. Among 7.02 ± 0.22 million elderly persons reporting a balance problem, 50.0% (3.44 ± 0.16 million) saw a health professional, and 35.8% saw ≥3 providers; 59.6% of elderly patients reported a diagnosed cause for the balance problem. The most common causes were medication side effects (11.3%), inner ear infection (11.0%), heart disease (8.6%), and loose ear crystals (7.9%). Imaging studies had been obtained in 56.7% (2.00 ± 0.11 million cases). Among 24.3% of patients receiving some form of treatment, 61.7% had been taking prescription medication, most commonly diuretic agents (36.5%), anxiolytic agents (25.1%), and meclizine (21.4%). Seeing an otolaryngologist or neurologist was associated with a higher but similar rate of diagnostic imaging studies (70.1%, P = .029 and 78.5%, P balance disorder (61.5% with imaging vs. 56.9% without, P = .265). Despite a high prevalence of balance problems in the elderly, a significant proportion do not come to a clear diagnosis. There is a noteworthy rate of prescription medication utilization in this population. Given an increasingly aging population, attention needs to be given to balance problems in the elderly to optimize diagnosis and health care utilization. 2b. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Addressing workplace violence among nurses who care for the elderly.

    Science.gov (United States)

    Rodwell, John; Demir, Defne

    2014-03-01

    The objective of this study was to examine the social-situational (ie, Job Demands-Resource model) and individual (ie, negative affectivity) factors that might be associated with violence among nurses caring for the elderly (aged care nurses). Workplace violence is recognized as a serious issue among nurses. Effective intervention and prevention require an understanding of antecedent factors. Nurses working in elderly care facilities across an Australian healthcare organization participated in a cross-sectional survey. Job demands were associated with all of the externally sourced types of violence. Low job control was linked with external emotional abuse and physical assault. Outside work support was related to external physical assault and verbal sexual harassment. Finally, high negative affectivity was linked to internal and external emotional abuse and threat of assault. Both the Job Demands-Resource model and negative affectivity were useful in identifying relationships with violence, supporting suggestions that situational and individual factors are associated with violence among nurses who care for the elderly.

  2. Perception of elderly men about health and primary health care

    Directory of Open Access Journals (Sweden)

    Camila Polisello

    2014-09-01

    Full Text Available Objective: to understand the perceptions of elderly men about the following themes: “Health”, “Family Health Unit” and “Groups of Health Approaches”. Methods: exploratory and descriptive survey with a qualitative approach, using a convenience sample. Participants were selected from a list of elderly men who used the health unit. A semi-structured interview was designed for data collection. The data were analyzed based on a thematic analysis orientation. Results: eleven men were interviewed. They showed a wide conception of health, considering biopsychosocial factors in their descriptions, as well as a good relationship with the Family Health Unit, where they go for medical appointments and to join health prevention and promotion groups. The participants reported that they did not undergo as many preventive activities as women. They evaluated Groups of Health Approaches as beneficial, with positive implications for health and for life. However some participants have group models from other contexts, especially from the work setting, which do not match the models recommended for Groups of Health Approaches. Conclusion: as the participants are elderly and have more available time and a greater relationship with the unit, they are able to engage in more activities of promotion and prevention at the Family Health Unit. This study also showed that the health unit and the groups act as protective factors for this population; elderly men favor receiving care and engaging in social relations. However, factors associated with gender still hinder a better health care for men.

  3. Quality of assistive technologies in the home care for elderly.

    Science.gov (United States)

    Hauer, Katharina

    2015-01-01

    Due to demographic changes, the number of elderly people who are in need of care is increasing. Assistive technologies make it possible for many elderly people to remain home despite their health conditions, which many prefer. Quality is an essential element of nursing care, and the elderly are becoming increasingly aware of this and are beginning to make high demands. The aims of this paper, which is based on a master's thesis, were to identify quality criteria in the field of assistive technologies and to present indicators for measuring quality. An extensive literature research was conducted for the theoretical part, and the empirical part employed a qualitative survey. The results show that the elderly's contentment and quality of life are the decisive factors for quality. A catalogue of quality indicators was developed by merging the results from literature with those from the expert consultation. To conclude, further research in this context, based on the results of this paper, is needed, in order to support the increasing use of assistive technologies.

  4. Features and Prognostic Factors for Elderly With Acute Poisoning in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Yu-Hui Hu

    2010-02-01

    Conclusion: Our results demonstrated that elderly patients with acute poisoning had a mortality rate of 9.6%. Suicide attempts resulted in more serious complications. The risk factors for mortality were herbicide intoxication, hypotension and respiratory failure.

  5. Spatial analysis of elderly access to primary care services

    Directory of Open Access Journals (Sweden)

    Lozano-Gracia Nancy

    2006-05-01

    Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across

  6. Improving coordination of care centers for the elderly through IT support

    DEFF Research Database (Denmark)

    Johansen, Andreas Kaas; Lauridsen, Frederik Vahr Bjarnø; Manea, Vlad

    2015-01-01

    In Denmark, care of elderly people involves numerous and relatively autonomous care providers, including care centers, activity centers, physiotherapists, doctors, and other specialists. However, due to a poor coordination of activities, many elderly experience a lack of continuity of care, misse...

  7. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

    Science.gov (United States)

    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  8. The Acute Care Theater Conference.

    Science.gov (United States)

    Horwitz, Rany J.; And Others

    1991-01-01

    The University of Illinois' medical school has a third-year program of weekly role-playing exercises focusing on management of acute medical problems. Students are responsible for creating the cases, complete with scenarios and treatment teams, simulating them, and successfully treating or reaching an impasse. Little teacher preparation time is…

  9. Caring for elderly patients with dementia: nursing interventions

    OpenAIRE

    Joosse LL; Palmer D; Lang NM

    2013-01-01

    Laura L Joosse,1 Debra Palmer,1 Norma M Lang21University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA; 2University of Wisconsin-Milwaukee, College of Nursing, Knowledge Based Nursing Research Initiative, Milwaukee, WI, USAAbstract: Elderly patients suffering from chronic cognitive decline/dementia are susceptible to poor quality of care which further erodes their quality of life. Seemingly benign events can create cascade iatrogenesis in those whose compensatory ability is c...

  10. Special acute care unit for older adults with Alzheimer's disease.

    Science.gov (United States)

    Soto, Maria E; Nourhashemi, Fati; Arbus, Christophe; Villars, Hélène; Balardy, Laurent; Andrieu, Sandrine; Vellas, Bruno

    2008-02-01

    To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Four-hundred and ninety-two patients were assessed. Their mean age was 81.1+/-7.7, the mean length of stay was 10.7+/-6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5+/-7.4; a mean total ADL score of 3.7+/-1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright (c) 2007 John Wiley & Sons, Ltd.

  11. Caring for Mom and Neglecting Yourself? The Health Effects of Caring for an Elderly Parent

    NARCIS (Netherlands)

    Coe, N.B.; Van Houtven, C.H.

    2008-01-01

    We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, and carefully control for baseline health and work status of the adult

  12. Caring for Mom and Neglecting Yourself? The Health Effects of Caring for an Elderly Parent

    NARCIS (Netherlands)

    Coe, N.B.; Van Houtven, C.H.

    2008-01-01

    We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, and carefully control for baseline health and work status of the adult

  13. Caring for elderly patients with dementia: nursing interventions

    Directory of Open Access Journals (Sweden)

    Joosse LL

    2013-08-01

    Full Text Available Laura L Joosse,1 Debra Palmer,1 Norma M Lang21University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA; 2University of Wisconsin-Milwaukee, College of Nursing, Knowledge Based Nursing Research Initiative, Milwaukee, WI, USAAbstract: Elderly patients suffering from chronic cognitive decline/dementia are susceptible to poor quality of care which further erodes their quality of life. Seemingly benign events can create cascade iatrogenesis in those whose compensatory ability is compromised by impairments in multiple domains. Under recognition, misrecognition, or failure to intervene and manage this vulnerable population leads to suboptimal care. This places them at risk for cognitive decline, functional decline, and challenging behaviors, creating financial and emotional burdens for not only the patients but also family, staff, and organizations that are attempting to provide care. Identifying, managing, and therapeutically responding to confused elderly is complex. Recognizing the challenges makes the development of tools that guide comprehensive assessment planning, interpretation of findings, and treatment plans imperative. Innovative and effective assessment and interventional approaches are present in the literature. This article synthesizes the scientific evidence to guide clinicians to implement in practice.Keywords: dementia, older adults, assessment, intervention, quality of life, elderly, cognitive decline

  14. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2014-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  15. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described....

  16. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor

    2015-01-01

    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described....

  17. Relationships between elderly care recipients and their migrant live-in home care workers in Israel.

    Science.gov (United States)

    Porat, Irit; Iecovich, Esther

    2010-01-01

    In Israel more than 54,000 immigrant live-in home care workers are providing personal care to frail elders. These home care workers emigrate from various countries and different cultures, speak other languages, and have other religions. The purposes of this study were: (a) to examine the patterns of the interpersonal relationships that develop between disabled elderly persons who were being cared for by migrant live-in home care workers, and (b) to explore the factors that best explain the patterns of these relationships. A convenience sample that included 100 frail elderly people was selected and respondents were face-to-face interviewed at their homes, using a structured questionnaire. The findings showed that the relationships that developed between migrant live-in home care workers and elderly care recipients were close and that language was not a significant barrier in establishing close relationships between them. Further, the findings showed that perceived similarity in personal qualities played the most significant role in determining the extent to which the relationships between them will be close. A similar cultural background such as ethnicity, and nonverbal and good understanding, rather than speaking a common language, were significant factors in facilitating close relationships.

  18. [Current Status of Preoperative Professional Oral Care by Dentists for Elderly Patients Undergoing Lung Resection and Occurrence of Postoperative Pneumonia].

    Science.gov (United States)

    Hoshikawa, Yasushi; Tanda, Naoko; Matsuda, Yasushi; Katsumata, Hiroshi; Notsuda, Hirotsugu; Watanabe, Tatsuaki; Niikawa, Hiromichi; Noda, Masafumi; Sakurada, Akira; Kondo, Takashi; Okada, Yoshinori

    2016-01-01

    Pneumonia in elderly people is mainly caused by silent aspiration due to an age-related impairment of cough and swallowing reflexes. Because most of the patients with lung cancer are elderly people, we hypothesized that the age-related impairment of these protective reflexes might exist or occur in patients undergoing lung surgery, and cause postoperative pneumonia. We revealed that many elderly patients showed depressed swallowing reflex even before surgery and transient attenuation of cough reflex after surgery, and that postoperative pneumonia occurred only in the patients whose cough and/or swallowing reflex was abnormal postoperatively. Then, we prospectively showed that 30 elderly patients who received perioperative intensive oral care, including professional assessment of oral status, dental cleaning, and patient education for self-oral care by dentists, followed by intensive oral care by intensive care unit nurses, and encouragement of self-oral care by floor nurses, did not develop pneumonia after lung resection. In this study, we retrospectively reviewed the execution status of professional oral care by dentists and the occurrence of postoperative pneumonia in 159 consecutive patients aged 65 or older undergoing lung resection from 2013 to 2014. Thoracic surgeons in our institute asked dentists to provide professional oral care before lung resection only in 30.3% of the subjects in 2013, and 45.8% in 2014. Postoperative pneumonia occurred in 3 out of 76 subjects(3.9%)in 2013, and 1 out of 83(1.2%) in 2014. In 2013, 1 patient who did not receive preoperative professional oral care developed aspiration pneumonia postoperatively followed by acute exacerbation of idiopathic pulmonary fibrosis and in-hospital death. We need to make an effective system to provide preoperative professional oral care by dentists especially for elderly patients and high-risk patients before lung resection.

  19. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients.

    Science.gov (United States)

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46-26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

  20. Treatment of acute deep burns in lower extremities of the elderly

    Institute of Scientific and Technical Information of China (English)

    Babur M. Shakirov

    2015-01-01

    Objective: To study the different surgical treatments in 154 elderly patients with acute deep burns of lower extremities admitted in Burn Department of RSCUMA.Methods:Skin grafts in extensive burns were performed in 32 patients for the purpose of achieving early closure of the burn area. In 116 patients with burn surface area of 6-25 %, skin grafting was performed on the granulating wound when the wound was ready for accepting skin graft. In these 19 cases, a stamp graft procedure was used in 12 patients and Mowlen-Jackson method of skin grafting in 7 cases.Results:Analysis of the nearest results showed that 28 out of 154 patients came back to the hospital for new surgery due to loss of ability of normal movement of their extremities.Conclusions:Careful patient selection and timing of surgery will help to avoid any adverse effect on patient outcome.

  1. Skin care in the frail, elderly, dependent, incontinent patient.

    Science.gov (United States)

    Jeter, K F; Lutz, J B

    1996-01-01

    Despite a plethora of recommendations, protocols and dictums in the nursing literature, no research studies have defined the basic elements of preventive skin care for incontinent patients, and the prevalence of skin problems associated with incontinence is unknown. Yet the importance of skin care for incontinent elderly or immobilized patients has long been acknowledged. This literature review sought to determine current practices and principles for skin care of frail, elderly, dependent, incontinent patients. Protocols vary widely. And although there is mounting evidence that incontinence, particularly fecal incontinence, is a primary risk factor for pressure ulcer development, most preventive efforts focus on pressure relief, repositioning, and nutrition, rather than incontinence care. More clinical trials are needed in this area. The design and analysis of these trials should take into account the frequency and manner in which skin is cleansed, products used for skin care, risks and benefits of absorbent products and devices, the presence of infection, and patients' concomitant medical conditions and degree of immobility.

  2. [Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness].

    Science.gov (United States)

    Condorhuamán-Alvarado, Patricia Ysabel; Menéndez-Colino, Rocío; Mauleón-Ladrero, Coro; Díez-Sebastián, Jesús; Alarcón, Teresa; González-Montalvo, Juan Ignacio

    2017-06-03

    To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  3. Critical care in acute ischemic stroke.

    Science.gov (United States)

    McDermott, M; Jacobs, T; Morgenstern, L

    2017-01-01

    Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics. In this chapter, we discuss aspects of acute ischemic stroke care that are of particular relevance to a neurointensivist, covering neuropathology, neurodiagnostics and imaging, blood pressure management, glycemic control, temperature management, and the selection and timing of antithrombotics. We also focus on the care of patients who have received intravenous thrombolysis or mechanical thrombectomy. Complex clinical decision making in decompressive hemicraniectomy for hemispheric infarction and urgent management of basilar artery thrombosis are specifically addressed. © 2017 Elsevier B.V. All rights reserved.

  4. Multimedia Education Increases Elder Knowledge of Emergency Department Care

    Directory of Open Access Journals (Sweden)

    Thomas E. Terndrup

    2013-03-01

    Full Text Available Introduction: Elders who utilize the emergency department (ED may have little prospectiveknowledge of appropriate expectations during an ED encounter. Improving elder orientation toED expectations is important for satisfaction and health education. The purpose of this study wasto evaluate a multi-media education intervention as a method for informing independently livingelders about ED care. The program delivered messages categorically as, the number of tests,providers, decisions and disposition decision making.Methods: Interventional trial of representative elders over 59 years of age comparing pre andpost multimedia program exposure. A brief (0.3 hour video that chronicled the key events after ahypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED healthcare providers, and 2 professional actors for the patient and spouse. Pre- and post-video testsresults were obtained with audience response technology (ART assessed learning using a 4point Likert scale.Results: Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signedranktests. The following four learning objectives showed significant improvements: number oftests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50(0.00, 1.00]; number of providers expected 1.0 (1.00, 1.50; communications 1.0 (1.00, 1.50;and pre-hospital medical treatment 0.50 (0.00, 1.00. Elders (96% judged the intervention asimproving their ability to cope with an ED encounter.Conclusion: A short video with graphic side-bar information is an effective educational strategy toimprove elder understanding of expectations during a hypothetical ED encounter following calling911.

  5. Ethics as an important determinant of success of orthopaedic dental care for debilitated and elderly patients.

    Science.gov (United States)

    Schwartzseid, E E

    1989-01-01

    Ethical aspects of orthopaedic dental care for debilitated and elderly patients--the most complex and the least studied aspects of dentistry--are discussed here. Many articles on dental ethics, as a rule, do not cover the essential ethical aspects of orthopaedic care for the elderly or cover them only partially without reflecting on the problem at large. Understanding of the problem may help to provide more efficient dental care for the elderly population thus improving their quality of life.

  6. Interprofessional education in primary care for the elderly : a pilot study

    NARCIS (Netherlands)

    Oeseburg, Barth; Hilberts, Rudi; Luten, Truus A.; van Etten, Antoinette V. M.; Slaets, Joris P. J.; Roodbol, Petrie F.

    2013-01-01

    Background: The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of nurses and physicians required to meet this demand. At present, the main focus of health care in the Netherlands lies on illness and treatment. However, (frail) elderly ne

  7. Acute respiratory infections in elderly people: the role of micronutrients and lifestyle

    NARCIS (Netherlands)

    Graat, J.M.

    2003-01-01

    Acute respiratory infections are the most frequent of all infectious diseases. In popular speech common cold, flu (influenza), and pneumonia all denote acute respiratory infections. Elderly people show an increased risk of these infections and their complications. In The Netherlands about 2.000 elde

  8. Acute respiratory infections in elderly people: the role of micronutrients and lifestyle

    NARCIS (Netherlands)

    Graat, J.M.

    2003-01-01

    Acute respiratory infections are the most frequent of all infectious diseases. In popular speech common cold, flu (influenza), and pneumonia all denote acute respiratory infections. Elderly people show an increased risk of these infections and their complications. In The Netherlands about 2.000 elde

  9. Predicting hemorrhagic transformation by microvascular permeability using perfusion CT acute cerebral infarction in elderly patients

    Institute of Scientific and Technical Information of China (English)

    田超

    2014-01-01

    Objective To study the possibility of microvascular permeability(PS)value derived from perfusion CT(PCT)in predicting hemorrhagic transformation(HT)in acute cerebral infarction in elderly patients.Methods 52consecutive patients with middle cerebral artery acute ischemic stroke who received thrombolytic therapy were divided into HT group and control group,and patients in

  10. Endoscopic management of acute cholangitis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Naresh Agarwal; Barjesh Chander Sharma; Shiv K Sarin

    2006-01-01

    AIM: To evaluate clinical presentation, etiology, complications and response to treatment in elderly patients with acute cholangitis.METHODS: Demographics, etiology of biliary obstruction, clinical features, complications and associated systemic diseases of 175 patients with acute cholangitis were recorded. Endoscopic biliary drainage was performed using nasobiliary drain or stent. The complications related to ERCP, success of biliary drainage, morbidity, mortality and length of hospital stay were evaluated.RESULTS: Of 175 patients, 52 aged≥60 years (groupⅠ,age<60 years; groupⅡ,age≥60 years) and 105 were men. Fever was present in 38 of 52 patients of group Ⅱ compared to 120 of 123 in group Ⅰ. High fever (fever≥38.0℃) was more common in group Ⅰ (118/120 vs 18/38). Hypotension (5/123 vs 13/52),altered sensorium (3/123 vs 19/52), peritonism (22/123 vs 14/52), renal failure (5/123 vs 14/52) and associated comorbid diseases (4/123 vs 21/52) were more common in group Ⅱ. Biliopancreatic malignancy was a common cause of biliary obstruction in group Ⅱ (n = 34) and benign diseases in group Ⅰ (n = 120). Indications for biliary drainage were any one of the following either singly or in combination: a fever of≥38.0℃ (n=136),hypotension (n=18), peritonism (n=36), altered sensorium (n=22), and failure to improve within 72h of conservative management (n=22). High grade fever was more common indication of biliary drainage in group Ⅰ and hypotension, altered sensorium, peritonism and failure to improve within 72 h of conservative management were more common indications in group Ⅱ. Endoscopic biliary drainage was achieved in 172 patients (nasobiliary drain: 56 group Ⅰ, 24 group Ⅱ,stent: 64 group Ⅰ, 28 group Ⅱ) without any significant age related difference in the success rate. Abdominal pain, fever, jaundice, hypotension, altered sensorium,peritonism and renal failure improved after median time of 5 d in 120 patients in group Ⅰ (2-15 d

  11. Causes of Persistent Dizziness in Elderly Patients in Primary Care

    Science.gov (United States)

    Maarsingh, Otto R.; Dros, Jacquelien; Schellevis, François G.; van Weert, Henk C.; van der Windt, Danielle A.; Riet, Gerben ter; van der Horst, Henriette E.

    2010-01-01

    PURPOSE Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of dizziness. METHODS We performed a cross-sectional diagnostic study among elderly patients in the Netherlands consulting their family physician for persistent dizziness. All patients underwent a comprehensive evaluation according to a set of diagnostic tests that were developed during an international Delphi procedure. Data for each patient were independently reviewed by a panel consisting of a family physician, a geriatrician, and a nursing home physician, which resulted in major and minor contributory causes of dizziness. RESULTS From June 2006 to January 2008, we included 417 patients aged 65 to 95 years. Presyncope was the most common dizziness subtype (69%). Forty-four percent of the patients were assigned more than 1 dizziness subtype. Cardiovascular disease was considered to be the most common major contributory cause of dizziness (57%), followed by peripheral vestibular disease (14%), and psychiatric illness (10%). An adverse drug effect was considered to be the most common minor contributory cause of dizziness (23%). Sixty-two percent of the patients were assigned more than 1 contributory cause of dizziness. CONCLUSIONS Contrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one-quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies. PMID:20458102

  12. Care work and diffusion of innovation in Danish elder care

    DEFF Research Database (Denmark)

    Langergaard, Luise Li

    2017-01-01

    care. Care work, in some sense, relies on relational and contextual knowledge which may lead to challenges when innovation and best practices are to be diffused across organizations. This is especially true since diffusion often relies on codification of practices and knowledge. Caring rationality...... is essential to how technologies and methods are practiced in the care situation, and thus also essential for best practices and how they are disseminated. However, other types of codified and explicit rationality are equally important. The article concludes that there are several types of knowledge in play...... in care work practices and innovation, and it indicates that communities of practice could be key to understanding how to share and learn from best practices across organizations....

  13. First-line managers' experiences of alternative modes of funding in elderly care in Sweden.

    Science.gov (United States)

    Antonsson, Helen; Korjonen, Susanne Eriksson; Rosengren, Kristina

    2012-09-01

    The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden. A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care. Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care. © 2012 Blackwell Publishing Ltd.

  14. [Home care to the elderly who had stroke].

    Science.gov (United States)

    Pedreira, Larissa Chaves; Lopes, Regina Lúcia Mendonça

    2010-01-01

    The purpose was to Identify the knowledge production about the stroke in elderly under home care. Bibliographic research whose data were collected though the abstracts from 1997 to 2007, contained in LILACS and SciELO databases. The following key words were used: home assistance, aged people and cerebrovascular accident. Fifty-two references were found in the LILACS database, nine in the SciELO Brazil, and three in the SciELO Cuba. Most of the researches were carried out in 2000. Regarding the method, qualitative method predominance were observed, and central theme is related to the care giver, as well as to the clinical and epidemiologic aspects of the disease. It was observed that this knowledge is still established in Brazil, and the themes related to the person submitted to home care and violence to the aged are still little explored.

  15. Representation of elderly persons and women in published randomized trials of acute coronary syndromes.

    Science.gov (United States)

    Lee, P Y; Alexander, K P; Hammill, B G; Pasquali, S K; Peterson, E D

    2001-08-08

    Elderly persons and women were underrepresented in randomized controlled trials (RCTs) prior to 1990. Since then, efforts have been made to correct these biases, but their effect is unclear. To determine whether the percentage of elderly persons and women in published clinical trials of acute coronary syndromes has increased and how this enrollment compared with disease prevalence. The MEDLINE and Cochrane databases were searched for English-language articles from January 1966 to March 2000 regarding myocardial infarction, unstable angina, or acute coronary syndromes. Additional data sources included meta-analyses, review articles, and cardiology textbooks. Estimates of community-based myocardial infarction rates came from the National Registry of Myocardial Infarction and the Worcester Heart Study. Published RCTs of acute coronary syndrome patients were included and trials enrolling 50 patients or fewer, those without clinical end points, papers published in a language other than English, and unpublished manuscripts were excluded. Of 7645 studies identified, 593 RCTs were selected for review. The RCTs were abstracted by 2 of the authors for year of publication, source of support (ie, funding), pharmacotherapy, study phase, number of study sites, trial location, number of patients, mean age of the study population, and any age exclusion criteria for enrollment. The number of published RCTs with explicit age exclusions has declined from 58% during 1966-1990 to 40% during 1991-2000. Trial enrollment of patients aged 75 years or older increased from 2% for studies published during 1966-1990 to 9% during 1991-2000, but remains well below their representation among all patients with myocardial infarction (37%) in the United States. Enrollment of women has risen from 20% for studies published between 1966-1990 to 25% during 1991-2000, but remains well below their proportion of all patients with myocardial infarction (43%) in the United States. Attempts at making

  16. Managing Organized Insecurity: The Consequences for Care Workers of Deregulated Working Conditions in Elderly Care

    Directory of Open Access Journals (Sweden)

    Lene Ede

    2015-06-01

    Full Text Available Part-time work is more than twice as common among women than men in Sweden. New ways of organizing working hours to allow for more full-time jobs have been introduced for care workers in elderly care, which means unscheduled working hours based on the needs of the workplace. The aim of the study is to analyze how the organization of the unscheduled working hours affect employees’ daily lives and their possibility to provide care. The Classic Grounded Theory method was used in a secondary analysis of interviews with employees and managers in Swedish municipal elderly care. The implementation of unscheduled working hours plunged employees into a situation of managing organized insecurity. This main concern for the care workers involved a cyclic process of first having to be available for work because of economic and social obligations to the employer and the co-workers, despite sacrifices in the private sphere. Then, they had to be adaptable in relation to unknown clients and co-workers and to the employer, which means reduced possibilities to provide good care. Full-time jobs were thus created through requiring permanent staff to be flexible, which in effect meant eroded working conditions with high demands on employee adaptability. Solving the part-time problem in elderly care by introducing unscheduled working hours may in effect be counter-productive.

  17. Attitudes to a Robot Bathtub in Danish Elder Care

    DEFF Research Database (Denmark)

    Beedholm, Kirsten; Frederiksen, Kirsten; Frederiksen, Anne-Marie Skovsgaard

    2015-01-01

    In Western countries, assistive technology is implemented on a large scale in elder care settings. Only a few studies have attempted to explore the different attitudes to assistive technology among various groups of users. In this study, we investigated and explained the different attitudes among...... implicit quality criteria, and ascribed different symbolic significance to the robot bathtub. Thus, the study demonstrated how attitudes toward the robot bathtub were connected to the informants’ institutional role. The findings challenge the current paradigm, where technology is expected to operate...

  18. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

    Directory of Open Access Journals (Sweden)

    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  19. Idosos asilados em hospitais gerais Long-term care elderly residents in general hospitals

    Directory of Open Access Journals (Sweden)

    Milton Luiz Gorzoni

    2006-12-01

    Full Text Available Instituições de longa permanência para idosos interagem periodicamente com hospitais gerais para internações de casos agudos ou dos que necessitam de métodos diagnósticos complexos e da atenção de várias especialidades simultaneamente. A decisão de indicar hospitalização é multifatorial, sendo influenciada por circunstâncias como a gravidade do quadro clínico e a infra-estrutura das instituições de longa permanência para idosos. Internações hospitalares apresentam benefícios e riscos, como o desenvolvimento de iatrogenias, delirium e declínios funcionais, podendo resultar em piora do estado geral e da qualidade de vida do idoso asilado durante e/ou após a hospitalização. O objetivo do estudo foi abordar aspectos peculiares na avaliação, tratamento e manejo de idosos asilados em internações hospitalares, particularmente quanto a cuidados que os auxiliem efetivamente nessas circunstâncias. Discutiram-se situações freqüentes como delirium, iatrogenias, desnutrição, declínio funcional e cuidados paliativos e características próprias de residentes em instituições para idosos durante internações em hospitais gerais.Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care

  20. Caregiving and Stress: Experience of People Taking Care of Elderly Relations in South-eastern Nigeria

    Directory of Open Access Journals (Sweden)

    UO Okoye

    2011-01-01

    Full Text Available Providing care especially to the elderly, takes a huge toll, both physically and emotionally on the caregiver. With the population of the elderly growing in Nigeria, one of the emerging issues is the care and support of elderly persons in years to come. Few people are prepared for the responsibilities and tasks involved in caring for the aged because of the stress involved. This study investigates the experiences of caregivers of elderly relatives. Questionnaires were distributed to 330 respondents. Result shows that there exists a significant relationship between caregiver’s age and level of stress (p=0.001. The sex of care receiver, the level of education of caregivers, level of education of care receiver are all significantly related to the level of stress. The role of social workers in future care and support of the elderly in Nigeria is discussed.

  1. Construction of elderly identity within an education programme for care workers

    DEFF Research Database (Denmark)

    Jensen, Anne Winther

    , the paper focuses on how elderly identity is constructed within an adult basic education programme in the social and health care sector in Denmark. The programme being involved is for adults who would like to work in the social and health care sector at a basic level; the programme consists of theoretical......Elderly living in nursing homes or receiving home help in their private homes are often very dependent on the help provided by care workers. The paper deals with how the character of the provided help is influenced by the way the care workers perceive the elderly and their situation. In particular...... courses and on-the-job training in a nursing home or in the private homes of the elderly. The paper suggests that throughout the theoretical courses a specific elderly identity is constructed alongside the future care helper identity: E.g. while the care helpers are construed as activating and motivating...

  2. Professionalism in rural acute-care nursing.

    Science.gov (United States)

    Zibrik, Kelly J; MacLeod, Martha L P; Zimmer, Lela V

    2010-03-01

    Professionalism is commonly discussed in nursing but little is known about how it is experienced in everyday nursing practice.This study examines rural nurses experiences of professionalism and articulates the nature of professionalism in rural acute-care settings. Interview data from 8 nurses in rural acute-care facilities in British Columbia and Alberta, Canada, were analyzed using an interpretive description approach.The findings indicate that professionalism among rural nurses is a dynamic, enduring phenomenon that exists in workplace and community contexts.To experience professionalism in rural nursing means being visible in the community while embracing reality in the workplace. Understanding professionalism in a rural context has significant implications in terms of affirming and identifying sources ofjob satisfaction among rural nurses and creating professional practice environments in rural areas.

  3. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

    Directory of Open Access Journals (Sweden)

    José Carlos Llamas Reyes

    2016-01-01

    Full Text Available Aim: To study all the elderly patients (≥75 years who were admitted in an Intensive Care Unit (ICU of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3% were older than 75 years. The mean age was 79.9 years, 317 (57.3% were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%. When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001, Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II on admission (P 75 years was not significant (P = 0.1390. Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.

  4. "Unpaid and Paid Care: The Effects of Child Care and Elder Care on the Standard of Living"

    OpenAIRE

    Kim, Kijong; Antonopoulos, Rania

    2011-01-01

    Transforming care for children and the elderly from a private to a public domain engenders a series of benefits to the economy that improve our standard of living. We assess the positive impacts of social care from both receivers' and providers' points of view. The benefits to care receivers are various, ranging from private, higher returns to education to enhancing subjective well-being and health outcomes. The economy-wide spillovers of the benefits are noteworthy. Early childhood education...

  5. MINDFULNESS : Introduction of Meditation Technique & Effects with the Elderly in Home Care Services

    OpenAIRE

    Nguyen, Tan

    2013-01-01

    Thesis Description: Research and analysis of the introduction of meditation techniques & their effects upon the elderly volunteer participants in home care services. Theoretical summary: To introduce meditation techniques and to examine the effects upon mental and physical health amongst elderly volunteers in home care. The hypothesis is that if elderly people are meditating regularly, stress and depressive effects will be reduced or greatly minimised, and may even disappear, with a view ...

  6. Contemporary percutaneous reperfusion therapy for acute myocardial infarction in the elderly

    Institute of Scientific and Technical Information of China (English)

    Kimberly A. Skelding; Charanjit S. Rihal

    2005-01-01

    Elderly patients with acute myocardial infarction have not been specifically studied in the context of a large randomized clinical trial. Estimates of the efficacy of available treatments are gleaned from subset analyses of clinical trials, retrospective analysis and singlecenter experiences. In western countries the population is aging and a disproportionate number of myocardial infarctions occur in the elderly. Usage of appropriate therapy in this age group is becoming increasingly important given the potential for benefit but also the potential for harm. Recent publications have found steady improvement in outcomes in the elderly population utilizing contemporary interventions.

  7. A cerebrovascular stroke following endoscopy for an elderly patient with acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Ahmed Gado

    2016-03-01

    Full Text Available Elderly people constitute an increasing proportion of those presenting with acute upper gastrointestinal bleeding. Not only in upper gastrointestinal bleeding is advanced age a risk of death, but also exceeding 60 years of age results in an increased risk of cerebrovascular and cardiovascular events. Factors likely to influence the morbidity and mortality associated with endoscopy in an elderly cohort with acute gastrointestinal bleeding include the acuity and severity of bleeding and the presence of comorbid conditions. Audits have shown a surprisingly high incidence of both morbidity and mortality following upper gastrointestinal endoscopy. The following incident is a case report of a cerebrovascular accident following diagnostic upper gastrointestinal endoscopy for an elderly patient with acute upper gastrointestinal bleeding.

  8. Health care professionals' perspectives on barriers to elder abuse detection and reporting in primary care settings.

    Science.gov (United States)

    Schmeidel, Amy N; Daly, Jeanette M; Rosenbaum, Marcy E; Schmuch, Gretchen A; Jogerst, Gerald J

    2012-01-01

    The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.

  9. Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

    Directory of Open Access Journals (Sweden)

    Hsiu-Hung Wang

    2012-09-01

    Full Text Available The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.

  10. Oral health screening of elderly people attending a community care centre.

    Science.gov (United States)

    Diu, S; Gelbier, S

    1989-08-01

    A socio-dental survey was carried out to determine the level of dental disease and treatment requirement among elderly people attending a Community Care Centre. A screening programme involving 293 elderly people demonstrated a normative need of 82% and a felt need of 53%. Seventy-six per cent would have benefited from dental care. Many individuals who both needed and wanted dental care were not receiving it because they were discouraged from doing so predominantly because of poor mobility. It is recommended, therefore, that dentists be included in multi-disciplinary teams caring for elderly people so that they can be screened and given the opportunity to obtain dental care.

  11. "Dr. Right": Elderly Women in Pursuit of Negotiated Health Care and Mutual Decision Making

    Science.gov (United States)

    Evans, Kevin; Robertson, Suzanne

    2009-01-01

    This study explores a group of elderly women who were searching for physicians that were interested in providing negotiated health care options with particular interest in mutual decision making. The grounded theory approach was used to explore the health care interactions between the physicians and the elderly women (Strauss & Corbin, 1998).…

  12. Epidemiological investigation of a norovirus GII.4 Sydney outbreak in a China elder care facility.

    Science.gov (United States)

    Zheng, Qing-ming; Zeng, Hua-tang; Dai, Chuan-wen; Zhang, Shun-xiang; Zhang, Zhen; Mei, Shu-jiang; He, Ya-qing; Ma, Han-wu

    2015-01-01

    An outbreak of norovirus GII.4/Sydney_2012 affected a China elder care facility in December 2012. A total of 39 elderly people and staff met the outbreak case definition. The attack rates in the elderly and the staff were 15.9% (31/195) and 23.2% (19/82), respectively, including 13 asymptomatic cases in the staff. The result of gene sequencing revealed that the outbreak was caused by norovirus GII.4 Sydney. The mode of transmission of this outbreak was proven to be person-to-person. The first case (a self-cared elder) was affected outside the elder care facility and was not isolated after returning. Norovirus was transmitted via close contact among the self-cared elderly. Then, through service-related close contact, the attendants promoted the cross-transmission between the self-cared elderly and the nursed elderly. The virus was also spread among the staff via daily contact. In the elder care facility, the asymptomatic cases in the attendants played an important role in the transmission of norovirus, which deserves high attention.

  13. Institutional abuse toward the elderly: Perceptions of health care providers and older adult

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    M. Guadalupe Ruelas-González

    2014-11-01

    Full Text Available Objective. To analyze the health care providers (HCP and elderly patients’ perceptions about abuse of the elderly by health personnel of public health services, in selected cities in Mexico. Materials and methods. A qualitative study and a strategy of data triangulation were performed during 2009 and 2012; 13 HCPs and 12 elders were interviewed, in order to obtain their experience regarding elder abuse. Grounded Theory proceedings were used for the analysis. Results. Elder abuse is a naturalized practice, from HCP and elderly people’s point of view; these perceptions are showed in different ways. Conclusion. Institutionalization, historical professionalization and lack of consciousness about needs of the elderly (sociocultural and economic, require changes in planning, organization and monitoring process in the Health System; training and educational interventions on staff and exchange attitudes and behavior are necessary in order to offer a health care that is comprehensive, decent, human and with respect for the human rights.

  14. A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis.

    Science.gov (United States)

    Chang, U-Im; Kim, Hyung Wook; Noh, Yong-sun; Wie, Seong-Heon

    2015-05-01

    Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level ≥ 15 mg/dL, and patients with a leukocyte count ≥ 15,000/mm(3) in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.

  15. Psychologically abusive behavior by those caring for the elderly in a domestic context.

    Science.gov (United States)

    Wang, Jing-Jy; Lin, Jong-Ni; Lee, Feng-Ping

    2006-01-01

    Psychological abuse of elders is a growing but hidden problem. This study attempted to determine whether caregivers psychologically abuse their elderly care recipients and identify risk factors contributing to such abuse. Ninety-two caregivers completed this study. The Demographic Sheet, the Caregiver Psychological Elder Abuse Behavior scale (CPEAB), and the Caregiver's Burden Scale were used to collect data. The CPEAB scores for caregivers of the elderly were 20 to 51 (mean 30.45 +/- 7.03). The level of abusive behavior was positively associated with gender, education level, and caregiver's burden and negatively correlated with age (P social interventions and policies for improving the quality of life of elderly people.

  16. Comprehensive care of elderly patients with hip fracture: the orthogeriatric model

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    Carlo Frondini

    2013-04-01

    Full Text Available Introduction: Hip fractures in the elderly are a major source of morbidity and mortality. Interdisciplinary hospital care models proposed for the treatment of these patients include consultant teams, integrated orthopedic-geriatric care, and comprehensive geriatric-led care settings. A prospective interventional cohort study was conducted in 4 public hospitals in the Emilia-Romagna Region of Italy to compare the outcomes of these different care models. This report presents the preliminary results obtained with an orthogeriatric model in one of these centers, a large teaching hospital in Bologna. Materials and methods: Beginning in February 2008, all patients older than 75 years admitted to the University of Bologna’s Sant’Orsola-Malpighi Hospital for hip fractures were cared for in an orthogeriatric unit. The unit consisted of 10 beds in the orthopedic ward that were managed by a geriatric specialist and a multidisciplinary team, which met daily and included an orthopedic surgeon, a physiatrist, a nurse case-manager, staff nurses, a physical therapist, and a social worker. The management protocol included a thorough geriatric work-up to identify comorbidities and risk factors, systematic assessment and prevention of pain and acute disorientation, early verticalization and moblization, postacute rehabilitation therapy, family support, and regular follow-up after discharge. Preliminary results were compared with those achieved in the same orthopedic ward prior to the creation of the Orthogeriatric Unit. Results: During 2008, 226 elderly patients (mean age 86.2 + 5.5 years, 73.4% of whom were women, were admitted to the Orthogeriatric Unit for hip fractures. The mean Charlson comorbidity index of this cohort was 3.0 + 1.8. Half the patients had Activity of Daily Living scores < 4, and cognitive impairment was common (mean score on Short Portable Mental Status Questionnaire: 5.9 + 3.2. Compared with figures obtained in the hospital

  17. The impact of oral health on taste ability in acutely hospitalized elderly.

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    Kirsten Solemdal

    Full Text Available OBJECTIVE: To investigate to what extent various oral health variables are associated with taste ability in acutely hospitalized elderly. BACKGROUND: Impaired taste may contribute to weight loss in elderly. Many frail elderly have poor oral health characterized by caries, poor oral hygiene, and dry mouth. However, the possible influence of such factors on taste ability in acutely hospitalized elderly has not been investigated. MATERIALS AND METHODS: The study was cross-sectional. A total of 174 (55 men acutely hospitalized elderly, coming from their own homes and with adequate cognitive function, were included. Dental status, decayed teeth, oral bacteria, oral hygiene, dry mouth and tongue changes were recorded. Growth of oral bacteria was assessed with CRT® Bacteria Kit. Taste ability was evaluated with 16 taste strips impregnated with sweet, sour, salty and bitter taste solutions in 4 concentrations each. Correct identification was given score 1, and maximum total taste score was 16. RESULTS: Mean age was 84 yrs. (range 70-103 yrs.. Total taste score was significantly and markedly reduced in patients with decayed teeth, poor oral hygiene, high growth of oral bacteria and dry mouth. Sweet and salty taste were particularly impaired in patients with dry mouth. Sour taste was impaired in patients with high growth of oral bacteria. CONCLUSION: This study shows that taste ability was reduced in acutely hospitalized elderly with caries activity, high growth of oral bacteria, poor oral hygiene, and dry mouth. Our findings indicate that good oral health is important for adequate gustatory function. Maintaining proper oral hygiene in hospitalized elderly should therefore get high priority among hospital staff.

  18. Etiology of acute diarrhea in the elderly in China: A six-year observational study

    Science.gov (United States)

    Geng, Qibin; Yang, Wanqi; Chen, Yu; Wu, Jianguo; Jing, Huaiqi; Yang, Weizhong; Li, Zhongjie

    2017-01-01

    Acute diarrhea leads to a substantial disease burden among the elderly worldwide. However, in the context of increasingly aging trend in China, the prevalence of etiological agents among elderly diarrheal patients was undetermined. This study aimed to explore the major enteropathogens of acute diarrhea among outpatients older than 65 years in China, and also the epidemiological features of the pathogens. Demographic and clinical data for acute diarrhea among outpatients older than 65 years were collected from 213 participating hospitals from 2009 to 2014. Stool specimens were collected and tested for 13 enteric viruses and bacteria. The proportion of outpatients positive for targeted pathogens was analyzed by residential areas and seasonal patterns. Among the 7,725 patients enrolled, 1,617 (20.9%)were positive for any one of the 13 study pathogens. The predominant pathogen was norovirus (9.0%), followed by diarrheagenic Escherichia coli (DEC) (5.5%), rotavirus (3.9%), non-typhoidal Salmonella (NTS) (2.9%), and Shigella spp. (2.5%). The prevalence of Shigella spp. among rural patients (6.9%) was higher than that among urban patients (1.6%) (p spp. in summer. A wide variety of enteropathogens were detected among the elderly with acute diarrhea in China, with norovirus and DEC being the most commonly isolated pathogens. A strong seasonal pattern was observed for major pathogens of acute diarrhea among the elderly. PMID:28323855

  19. Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study.

    Science.gov (United States)

    Leuning, C J; Small, L F; van Dyk, A

    2000-09-01

    Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

  20. Oral health care in long-term care facilities for elderly people in southern Brazil: a conceptual framework.

    Science.gov (United States)

    Mello, Ana Lúcia Schaefer Ferreira de; Erdmann, Alacoque Lorenzini; Brondani, Mario

    2010-03-01

    To present a theoretical model for understanding oral health care for the elderly in the context of long-term care institutions (LTCI). Open-ended individual interviews were conducted with the elderly residing in LTCI, their carers, nursing technicians and nurses, directors of care, dental surgeons and managers of public health services. A grounded theory methodological approach was adopted for data collection and analysis. The emerging core category revealed a basic social process: 'Promoting oral health care for the elderly based on the context of LTCI'. This process was composed of two contradicting yet correlated aspects: the oral health care does not minimise the poor oral epidemiological condition, and at the same time, there was a continued improvement in the oral care expressed by better care practices. These aspects were related to the: attribution of meaning to oral health, social determination of oral health, the ageing process, interactions established in the oral health care practices, oral health care management in LTCI, inclusion of oral health care into the political-organisational dimension and possibility of conjecturing better oral health care practices. The core concept of 'Promotion of oral health care for elderly people based on the context of LTCI' is capable of explaining the variations in the structure and process of LTCI, as well as in helping to understand the meaning of the oral health care practices for the institutionalised elderly.

  1. Biological air contamination in elderly care centers: geria project.

    Science.gov (United States)

    Aguiar, Lívia; Mendes, Ana; Pereira, Cristiana; Neves, Paula; Mendes, Diana; Teixeira, João Paulo

    2014-01-01

    Indoor air quality (IAQ) affects health particularly in susceptible individuals such as the elderly. It has been estimated that the older population spends approximately 19-20 h/d indoors, and the majority of the elderly spend all of their time indoors in elderly care centers (ECC). Older individuals may be particularly at risk of exposure to detrimental effects from pollutants, even at low concentrations, due to common and multiple underlying chronic diseases that increase susceptibility. This study, aimed to assess the impact of indoor biological agents in 22 ECC located in Porto, was conducted during summer and winter from November 2011 to August 2013 at a total of 141 areas within dining rooms, drawing rooms, medical offices, and bedrooms (including the bedridden). Air sampling was carried out with a microbiological air sampler (Merck MAS-100) and using tryptic soy agar for bacteria and malt extract agar for fungi. The results obtained were compared with the recently revised Portuguese standards. In winter, mean fungi concentration exceeded reference values, while bacteria concentrations were within the new standards in both seasons. The main fungi species found indoors were Cladosporium (73%) in summer and Penicillium (67%) in winter. Aspergillus fumigatus, Aspergillus niger, and Aspergillus flavus, known potential pathogenic/toxigenic species, were also identified. Although the overall rate and mean values of bacteria and fungi found in ECC indoor air met Portuguese legislation, some concern is raised by the presence of pathogenic microorganisms. Simple measures, like opening windows and doors to promote air exchange and renewal, may improve effectiveness in enhancing IAQ.

  2. [Continuity of care from the acute care hospital: Results].

    Science.gov (United States)

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

    2015-01-01

    To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  3. CARE FOR HEALTH AMONG ELDERLY PEOPLE: EXPERTS’ OPINION INTERPRETATION

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    Elena Viacheslavovna Chernyshkova

    2017-03-01

    Full Text Available The main objective of the paper is to determine the most important health preserving practices widely used among the elderly employees. Materials and methods: data were provided by sociological qualitative research method – semi-structured expert interview conducted in Saratov in 2015. The respondents included 10 doctors of Saratov polyclinics (7 women and 3 men of different specialties: therapists, neurologists, endocrinologists, cardiologist, allergist-immunologist, gerontologist. The survey’s key findings were discussed and analyzed. It is revealed that the majority of working pensioners do not apply for professional medical care. It is explained by the fact that the representatives of working elderly population predominantly focus on avoidance of unhealthy habits, rational labour and rest regimen, diminished conditions of work, adequate physical activity and health resort treatment. The aim of the research is also to stress that such practices as self-medication and mass media advertising for prescription drugs may worsen the health status of individuals of a sociogeriatric group.

  4. Diagnosing delirium in very elderly intensive care patients.

    Science.gov (United States)

    Heriot, Natalie R; Levinson, Michele R; Mills, Amber C; Khine, Thinn Thinn; Gellie, Anthea L; Sritharan, Gaya

    2017-02-01

    To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10). Retrospective study. An ICU in a large metropolitan private hospital in Melbourne, Australia. English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours. Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data. General patient characteristics, first onset of delirium symptoms, source of delirium information, administration of delirium medication, hospital and ICU length of stay, 90 day mortality were documented. Delirium was found in 11-29% of patients, the highest incidence identified by chart review. Patients diagnosed with delirium had higher 90 day mortality, and those meeting criteria for all three methods had longer hospital and ICU length of stay. ICU delirium in the elderly is often under-reported and strategies are needed to improve staff education and diagnosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. The effectiveness of preventive care at reducing curative care risk for the Taiwanese elderly under National Health Insurance.

    Science.gov (United States)

    Chen, Chin-Shyan; Peng, Yu-I; Lee, Ping-Chang; Liu, Tsai-Ching

    2015-06-01

    Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.

  6. The Israeli Long-Term Care Insurance Law: selected issues in providing home care services to the frail elderly.

    Science.gov (United States)

    Schmid, Hillel

    2005-05-01

    The paper describes and analyses selected issues related to the provision of home care services to frail elderly people following the Israeli Long-Term Care Insurance Law (1988). The goals and principles of the Law, which mandates the provision of home care services to frail elderly people, are presented. The paper also evaluates its contribution toward enhancing the well-being of elderly clients. Several major dilemmas that arose following implementation of the Law are analysed and evaluated in comparison with other countries that have enacted and implemented similar laws. These dilemmas are community vs institutional care; services in kind vs monetary allowances; service provision through contracting out with nongovernmental agencies; unstable and unskilled labour force; and service quality. Finally, policy implications are discussed, mainly in the following areas: investment in human resources as a condition for achieving high service quality, and the need for coordination between the agencies that provide long-term care services to elderly people.

  7. Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden.

    Science.gov (United States)

    Lundqvist, M; Davidson, T; Ordell, S; Sjöström, O; Zimmerman, M; Sjögren, P

    2015-03-01

    Dental care for elderly nursing home residents is traditionally provided at fixed dental clinics, but domiciliary dental care is an emerging alternative. Longer life expectancy accompanied with increased morbidity, and hospitalisation or dependence on the care of others will contribute to a risk for rapid deterioration of oral health so alternative methods for delivering oral health care to vulnerable individuals for whom access to fixed dental clinics is an obstacle should be considered. The aim was to analyse health economic consequences of domiciliary dental care for elderly nursing home residents in Sweden, compared to dentistry at a fixed clinic. A review of relevant literature was undertaken complemented by interviews with nursing home staff, officials at county councils, and academic experts in geriatric dentistry. Domiciliary dental care and fixed clinic care were compared in cost analyses and cost-effectiveness analyses. The mean societal cost of domiciliary dental care for elderly nursing home residents was lower than dental care at a fixed clinic, and it was also considered cost-effective. Lower cost of dental care at a fixed dental clinic was only achieved in a scenario where dental care could not be completed in a domiciliary setting. Domiciliary dental care for elderly nursing home residents has a lower societal cost and is cost-effective compared to dental care at fixed clinics. To meet current and predicted need for oral health care in the ageing population alternative methods to deliver dental care should be available.

  8. Rockall score in predicting outcomes of elderly patients with acute upper gastrointestinal bleeding

    Science.gov (United States)

    Wang, Chang-Yuan; Qin, Jian; Wang, Jing; Sun, Chang-Yi; Cao, Tao; Zhu, Dan-Dan

    2013-01-01

    AIM: To validate the clinical Rockall score in predicting outcomes (rebleeding, surgery and mortality) in elderly patients with acute upper gastrointestinal bleeding (AUGIB). METHODS: A retrospective analysis was undertaken in 341 patients admitted to the emergency room and Intensive Care Unit of Xuanwu Hospital of Capital Medical University with non-variceal upper gastrointestinal bleeding. The Rockall scores were calculated, and the association between clinical Rockall scores and patient outcomes (rebleeding, surgery and mortality) was assessed. Based on the Rockall scores, patients were divided into three risk categories: low risk ≤ 3, moderate risk 3-4, high risk ≥ 4, and the percentages of rebleeding/death/surgery in each risk category were compared. The area under the receiver operating characteristic (ROC) curve was calculated to assess the validity of the Rockall system in predicting rebleeding, surgery and mortality of patients with AUGIB. RESULTS: A positive linear correlation between clinical Rockall scores and patient outcomes in terms of rebleeding, surgery and mortality was observed (r = 0.962, 0.955 and 0.946, respectively, P = 0.001). High clinical Rockall scores > 3 were associated with adverse outcomes (rebleeding, surgery and death). There was a significant correlation between high Rockall scores and the occurrence of rebleeding, surgery and mortality in the entire patient population (χ2 = 49.29, 23.10 and 27.64, respectively, P = 0.001). For rebleeding, the area under the ROC curve was 0.788 (95%CI: 0.726-0.849, P = 0.001); For surgery, the area under the ROC curve was 0.752 (95%CI: 0.679-0.825, P = 0.001) and for mortality, the area under the ROC curve was 0.787 (95%CI: 0.716-0.859, P = 0.001). CONCLUSION: The Rockall score is clinically useful, rapid and accurate in predicting rebleeding, surgery and mortality outcomes in elderly patients with AUGIB. PMID:23801840

  9. [Factors influencing morale among the elderly in long-term care].

    Science.gov (United States)

    Lin, L C; Ou, M; Wu, S C

    1998-06-01

    The purpose of this research was to investigate the factors which influence morale among the elderly in long-term care. The sampling criteria for subjects were that they were (1) 65 years old or older and were residents or care recipients at a nursing home, day care or home care center which participated in the experimental project in Department of Health; (2) able to understand the Mandarin or Taiwanese language; (3) capable of verbal communication; and (4) family caregivers whose elder family met the above three requirements. A total sample of 174 subjects consisting of 87 elderly and 87 caregivers were chosen. Research findings revealed: the mean score for morale for elderly in this study was 11.71 out of range 2-19. Except for birthplace and caring models, there was no significant difference among the elderly. The elderly born in Taiwan had significantly higher morale than those born in Mainland China. The elderly in day care had significantly higher morale than those in home care and nursing homes. No significant difference was found among family caregivers, except for family caregivers who had changed their job due to the demands of caring for elderly relations. Elderly in this situation showed significantly lower morale in the elderly whose family caregivers did not change jobs. Correlation analysis showed a positive relationship between the elderly's level of daily activity and their morale level. Higher morale in the elderly was also found to be positively related to perceived higher levels of social support in family caregivers. In multiple regression, morale among the elderly was used as the criterion variable, while the variables of birth place, functional status, caregivers' perceived social support, home care, nursing home, changed job, never having had a job, caregivers' sex caregivers' educational level were used as predictors. The explanation variance achieved using the above research model was 30.78%. Recommendations derived from this study

  10. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

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    Franca, Manuela; Certo, Manuela; Varzim, Pedro [Centro Hospitalar do Porto, Radiology Department, Porto (Portugal); Silva, Donzilia [Centro Hospitalar do Porto, Surgery Department, Porto (Portugal); Peixoto, Carlos [Centro Hospitalar do Porto, Pathology Department, Porto (Portugal)

    2010-10-15

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  11. Can care of elderly be measured? A method for estimating the individual care of recipients in community health care

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    Nyberg Per

    2006-09-01

    Full Text Available Abstract Background Almost every country in the Western world has great difficulties allocating enough financial resources to meet the needs in the care of the increasing elderly population. The main problem is common to all countries and concerns the efforts to meet elderly persons' needs on an individual level while still maintaining society's responsibility for distributing justice. The aim of this study is to elaborate an instrument for measuring the quality of individual care and staff's working time in order to allocate public resources fairly. The present study gives an account of a new classification system named TiC (Time in Care, indicating how it can be used most effectively and also investigating the validity and reliability of the system. Methods All recipients in 13 sheltered homes for elderly care (n = 505 in a Swedish municipality were surveyed regarding the care they needed, in dimensions of General Care, Medical Care, Cognitive Dysfunction and Rehabilitation, and the time required. Construct validity was assessed by means of factor analysis. The inter-rater agreement of two raters concerning 79 recipients was measured using weighted Kappa. The stability of the instrument and its sensitivity to change were investigated through test-retest reliability measurements, conducted once a month during a six-month period. The content validity of the instrument was also assessed. Results Factor analysis resulted in a reduction of the number of items from 25 to 16 in three dimensions: General Care, Medical Care and Cognitive Dysfunction. The Kappa analysis showed satisfactory to excellent inter-rater agreement. The care need scores were basically stable but showed sensitivity to change in health status. Conclusion The instrument was found to be useful and reliable for assessing individual needs in community health care.

  12. Predictors of mortality among elderly dependent home care patients

    Science.gov (United States)

    2013-01-01

    Background The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. Results 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care. PMID:23947599

  13. Emotional geriatric care: a health worker development framework for advancing health care for the elderly

    Directory of Open Access Journals (Sweden)

    Nestor Asiamah

    2017-07-01

    Full Text Available The trend of population ageing is a critical global condition and is expected to impose dire socio-economic ramifications on populations in the near future. Its contribution to the global burden of disease is increasing, and the implications of this situation for the future are awe-inspiring. This paper draws from the researchers’ experience and relevant literature to recommend a framework that would guide the development and institutionalization of a specialized system of geriatric care, hereby called emotional geriatric care. The application of this framework by governments and health care organizations is expected to constantly improve care for the elderly as a way of gearing health care administration in response to ageing.

  14. Development of a Health Care Information System for the Elderly at Home

    Directory of Open Access Journals (Sweden)

    Wang Dong

    2016-01-01

    Full Text Available The growing population aging is a serious social problem in the world today. Accidental death at home is increasing because abnormal conditions can not be discovered in time, especially to the elderly who live alone. Besides, according to statistics, over 80 percent of the elderly need the service of home care in China. A health care information system for the elderly at home is developed to monitor the real–time state of the elderly remotely in this thesis. The system can show the current positions of the elderly in the house and judge whether they are in dangerous locations or have dangerous activities. In the case of emergency, the elderly can press the emergency button. The system also provides some help for the elderly’s daily life. The system offers the advantage for living at home more safely and more comfortably, and has better application prospect

  15. Work and Elder Care: Facts for Caregivers and Their Employers. Facts on Working Women No. 98-1.

    Science.gov (United States)

    Women's Bureau (DOL), Washington, DC.

    As the elderly population continues to grow, more elderly persons are requiring assistance with activities of daily living. Women are the traditional caregivers to the elderly, and the many women who also participate in the paid labor force must face the challenges of meeting both work and family obligations. Types of elder care assistance not…

  16. Pressure injuries in elderly with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Komici K

    2017-09-01

    Full Text Available Klara Komici,1 Dino F Vitale,2 Dario Leosco,1 Angela Mancini,1 Graziamaria Corbi,3 Leonardo Bencivenga,1 Alessandro Mezzani,4 Bruno Trimarco,5 Carmine Morisco,5 Nicola Ferrara,1,2 Giuseppe Rengo1,2 1Division of Geriatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; 2Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN, Telese Terme, Italy; 3Department of Medicine and Health Sciences, University of Molise Campobasso, Campobasso, Italy; 4Cardiac Rehabilitation Division, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy; 5Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy Objectives: To assess pressure injury (PI incidence among patients hospitalized for acute myocardial infarction (AMI in an intensive coronary care unit (ICCU and to detect the impact of specific risk factors on the development of PI in this clinical setting.Patients and methods: Prospective cohort study in ICCU setting. Patients admitted for AMI: patients mean age 67.5±11.5 years (n=165. Norton Scale, Mini Nutritional Assessment (MNA, demographic, clinical and biochemical data collected at the time of ICCU admission have been tested in a logistic model to assess the odds ratios (ORs of PI risk development. The jackknifed area under the receiver operating characteristic curve (AUC and the decision curve analysis have been employed to assess the additive predictive value of a factor.Results: Twenty-seven (16.3% patients developed PIs. An increased PI risk was associated with advanced age (OR =2.5 every 10-year increase; 95% CI =1.1–5.7, while probability of PI development was reduced in patients with higher left ventricular ejection fraction (LVEF (OR =0.4 every 5% increase; 95% CI =0.24–0.66, MNA score (OR =0.65 every unit change; 95% CI =0.44–0.95 and Norton Scale score

  17. Prevalence of depression among elderly on open care centers for older people

    OpenAIRE

    Vilma Karagianni; George Koulierakis; Christina Stylianopoulou; Fotoula Babatsikou; Charilaos Koutis

    2010-01-01

    Depression in the elderly is considered an important public health issue. Depression is the most common mental health problem among older people. It poses a critical impact on well-being and the quality of life of elderly and it is related with high expenses and great demand of health care services. Objective: To estimate the prevalence of depression among elderly in an urban area’s population and to investigate the aggravating and protective factors. Material and Method: The sample consisted...

  18. Determinants of life satisfaction among Japanese elderly women attending health care and welfare service facilities

    OpenAIRE

    Onishi, Chiemi; Yuasa, Kyoko; Sei, Masako; EWIS, ASHRAF; Nakano, Takuro; Munakata, Hokuma; Nakahori, Yutaka

    2010-01-01

    Prolonged life expectancy must be recognized as an excellent achievement of modern medicine, but not all the elderly people are satisfied with their lives. Life satisfaction is a multi-dimensional issue that depends on many objective and subjective characteristics. In this study, we aimed at investigating the factors affecting life satisfaction of 314 elderly Japanese women attending in 28 elderly-care and welfare facilities at Tokushima Prefecture, Japan. Our results indicated...

  19. Aripiprazole for acute mania in an elderly person

    Directory of Open Access Journals (Sweden)

    Balaji Bharadwaj

    2011-01-01

    Full Text Available New-onset bipolar disorder is rare in the elderly. Symptom profile is similar to that in young adults but the elderly are more likely to have neurological co-morbidities. There are no case reports of elderly mania being treated with aripiprazole, an atypical antipsychotic. A 78-year-old gentleman presented to us with symptoms suggestive of mania of 1 month′s duration. He had similar history 3 years ago and a family history of postpartum psychosis in his mother. There were no neurological signs on examination and work-up for an organic etiology was negative except for age-related cerebral atrophy. He improved with aripiprazole and tolerated the medications well. The use of psychotropic medications in the elderly is associated with side-effects of sedation, increased cardiovascular risk, and greater risk of extra-pyramidal side-effects. The use of partial dopaminergic antagonists like aripiprazole may be useful in the balancing of effects and side-effects.

  20. Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

    Science.gov (United States)

    McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.

    2009-01-01

    This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…

  1. The Influence of Skill Development Training Program for Spiritual Care of Elderly Individual on Elderly Care Technician Students' Perception of Spiritual Support.

    Science.gov (United States)

    Bulduk, Serap; Usta, Esra; Dinçer, Yeliz

    2017-06-01

    Spiritual care means helping an individual protect, maintain and gain all the dimensions of his/her existence. Elderly care technicians face numerous cases or crisis situations in which elderly individuals from different backgrounds question the meaning and value of life. Elderly care technicians must acknowledge that the spirituality is an important element in the way an elderly individual receives healthcare and they must be equipped for this matter. This study was conducted in order to examine the influence of "Skill Development Training Program for Spiritual Care of Elderly Individual," which was carried out with students from elderly care program, on the perception of spirituality support in a pretest-posttest quasi-experimental study design with control group. As the data collection form, "Spiritual Support Perception" (SSP) scale was used. The mean scores of the intervention group after the training and after one month are 50.39 ± 5.34 and 51.13 ± 4.98, respectively, and those of the control group are 43.16 ± 4.83 and 42.72 ± 4.48. A statistically significant difference was found between the mean scores of the intervention group from the pretest and the posttests immediately after the training and one month after the training (f = 94.247, p = 0.001). In the control group, however, there was no significant change in the SSP mean scores (f = 0.269, p = 0.77). As a result, this study pointed out the necessity of such training programs for healthcare professionals to make a distinction between their professional duties and their own personalities in order to offer spiritual care to the elderly individual.

  2. Critical care ultrasonography in acute respiratory failure.

    Science.gov (United States)

    Vignon, Philippe; Repessé, Xavier; Vieillard-Baron, Antoine; Maury, Eric

    2016-08-15

    Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.

  3. Licorice in leviathan: the medicalization of care for the Japanese elderly.

    Science.gov (United States)

    Lock, M

    1984-06-01

    Attitudes towards, and treatment of the elderly in Japan are discussed and the medicalization of their health care is examined. It is suggested that the ready availability of medical care will not eliminate the major problems that the elderly experience. The process by which traditional medicine has been incorporated systematically into the socialized health care system and its use in connection with the problems of elderly patients is documented. Modifications in the application of herbal medicine made by biomedical practitioners have been linked to cases of iatrogenesis in the elderly. In conclusion, the social construction of both traditional East Asian medicine and biomedicine in Japan is briefly examined; in both systems the somatic aspects of the problems of the elderly are emphasized while the social dimensions remain largely unquestioned.

  4. Care priorities- Registered Nurses' clinical daily work in municipal elderly care settings.

    Science.gov (United States)

    Norell, Margaretha; Ziegert, Kristina; Kihlgren, Annica

    2013-06-01

    Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation.

  5. Pediatric nuclear medicine in acute care.

    Science.gov (United States)

    Shammas, Amer; Vali, Reza; Charron, Martin

    2013-03-01

    Various radiopharmaceuticals are available for imaging pediatric patients in an acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. (99m)Tc pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. (99m)Tc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. Bone scintigraphy is a sensitive and noninvasive technique for the diagnosis of bone disorders such as osteomyelitis and fracture. Of recent, positron emission tomography imaging using (18)F-NaF has been introduced as an alternative to bone scintigraphy. (18)F-fluorodeoxyglucose-positron emission tomography has the potential to replace other imaging modalities, such as the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than gallium scan. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. The factors affecting the burden of care of informal caregivers of the elderly in Tehran

    Directory of Open Access Journals (Sweden)

    Hosein Rohani

    2015-03-01

    Full Text Available Background: Rapid growth of the elderly population followed by an increase in long term care will lead to a rise in the health costs of the elderly and the healthcare burden of their caregivers. This study was carried out to examine the factors affecting the burden of care for informal caregivers in order to design better interventional programs and to reduce this burden and unwanted consequences. Methods: This cross-sectional study was conducted in retirement associations of Tehran in 2012. The study population included 200 elderly and 200 caregivers. The instruments for data collection included two questionnaires about the elderly and their caregivers that were completed in a face-to-face interview. The data were analyzed by SPSS-16 software using multiple linear regression. Results: About 60% of the elderly and 34% of caregivers were female. Burden of care was low in 70%, moderate in 11.5%, and high in 18.5% of caregivers. Female caregivers were suffering 1.42 unit more burden of care than male caregivers (P= 0.027. Also, there was a significant association between the burden of care of untrained caregivers and instrumental activities of the daily living of the elderly (P< 0.001, daily activity of the elderly (P<0.001 and adequacy of wage (= 0.001. Conclusion: According to the results, being a female caregiver, daily physical activity of the elderly, instrumental activities of the daily living of the elderly, and adequacy of the wage were the most important factors in increasing the burden of care for caregivers of the elderly.

  7. Self-Regulation and Experience of Loneliness of Elderly People Who Live in Social Care Residences

    Science.gov (United States)

    Abitov, Ildar R.; Gorodetskaya, Inna M.

    2016-01-01

    The research addresses the peculiarities of self-regulation of loneliness experience of elderly people living in care homes. The population of the study consisted of 60 elderly people (65-80 years old). 30 of them live in families with spouses and children and 30 persons live in the State residential social service institution. It was found that…

  8. [The impact of frailty on the oral care behaviour and dental service use of elderly people

    NARCIS (Netherlands)

    Niesten, D.; Sanden, W.J.M. van der; Gerritsen, A.E.

    2015-01-01

    In order to explore how the level of frailty and various frailty factors affect the dental service use and oral self-care behaviour of frail elderly people, 51 frail elderly people were interviewed. Additional information on age, gender, living situation, prosthetic status, self-reported health and

  9. Reliable integrative assessment of health care needs in elderly persons : The INTERMED for the Elderly (IM-E)

    NARCIS (Netherlands)

    Wild, Beate; Lechner, Sabine; Maatouk, Imad; Wesche, Daniela; Raum, Elke; Mueller, Heiko; Brenner, Hermann; Slaets, Joris; Huyse, Frits; Soellner, Wolfgang; Herzog, W.

    2011-01-01

    Objective: With the increasing prevalence of multiple conditions in older age, the high prevalence of mental disorders, and the many social challenges facing elderly people, a high-risk patient group in need of interdisciplinary (biological, psychological, and social) care is emerging. The INTERMED

  10. Sarcopenia is predictive of nosocomial infection in care of the elderly.

    Science.gov (United States)

    Cosquéric, Gaëlle; Sebag, Aline; Ducolombier, Cyril; Thomas, Caroline; Piette, François; Weill-Engerer, Sébastien

    2006-11-01

    Protein-energy malnutrition and nosocomial infection (NI) are frequent in elderly patients, and a causal link between the two has often been suggested. The aim of the present study was to identify the nutritional parameters predictive of NI in elderly patients. We assessed on admission 101 patients (sixty-six women, thirty-five men, aged over 65 years) admitted to an acute care of the elderly department. Sarcopenia was detected by dual-energy X-ray absorptiometry, with appendicular skeletal muscle mass expressed with respect to body area. Weight, BMI, albuminaemia, serum transthyretin and C-reactive protein values were also determined on admission, and known risk factors, such as functional dependence and invasive biomedical material, were also evaluated. After up to 3 weeks of hospitalisation, patients were classified according to whether they had developed an NI. After 3 weeks of hospitalisation, we found that twenty-nine patients had suffered an NI, occurring after a mean of 16.1 d. Patients who were sarcopenic on admission had a significantly higher risk of contracting an NI (relative risk 2.1, 95 % CI 1.1, 3.8). None of the other morphometric or biological parameters differed significantly between the two groups of patients on admission. Patients who experienced an NI were also more likely, on admission, to have a medical device (P=0.02 to P=0.001 depending on the device), to have swallowing problems (P=0.002) or to have restricted autonomy (Prisk of NI during the first 3 weeks of hospitalisation.

  11. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly

    Science.gov (United States)

    Tohda, Gen; Ohtani, Masahiro; Dochin, Masaki

    2016-01-01

    AIM To investigate the efficacy and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with acute cholangitis. METHODS From June 2008 to May 2016, emergency ERCPs were performed in 207 cases of acute cholangitis at our institution. Patients were classified as elderly if they were aged 80 years and older (n = 102); controls were under the age of 80 years (n = 105). The patients’ medical records were retrospectively reviewed for comorbidities, laboratory data, etiology of cholangitis (presence of biliary stones, biliary stricture and malignancy), details of the ERCP (therapeutic approaches, technical success rates, procedure duration), ERCP-related complications and mortality. RESULTS The frequency of comorbidities was higher in the elderly group than the control group (91.2% vs 67.6%). Periampullary diverticulum was observed in the elderly group at a higher frequency than the control group (24.5% vs 13.3%). Between the groups, there was no significant difference in the technical success rates (95.1% vs 95.2%) or endoscopic procedure durations. With regard to the frequency of ERCP-related complications, there was no significant difference between the two groups (6.9% vs 6.7%), except for a lower rate of post-ERCP pancreatitis in the elderly group than in the control group (1.0% vs 3.8%). Neither angiographic nor surgical intervention was required in any of the cases with ERCP-related complications. There was no mortality during the observational periods. CONCLUSION Emergency ERCP for acute cholangitis can be performed safely even in elderly patients aged 80 years and older. PMID:27729744

  12. Hospital Medicine (Part 1): what is wrong with acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John

    2009-09-01

    Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.

  13. Rural-urban differences in the long-term care of the disabled elderly in China.

    Directory of Open Access Journals (Sweden)

    Mei Li

    Full Text Available BACKGROUND: In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. METHODS: This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. RESULTS: Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively, but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. CONCLUSIONS: The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  14. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

    Science.gov (United States)

    Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna

    2016-11-01

    Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

  15. Progress in Palliative Care Benefit of Elderly Patients with Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Shantong JIANG

    2015-07-01

    Full Text Available Lung cancer is the leading cause of death among all cancers in China. It also has the highest incidence when compared to other cancers. Almost half of all lung cancers occur over 70-year-old. Approximately 85% of all lung cancers are non-small cell lung cancer (NSCLC. The majority of patients are advanced lung cancer. Due to the unique alterations in physiology, elderly patients are at a greater risk of toxicity from chemotherapy. Palliative care as a special medical care is an important treatment for elderly patients with advanced NSCLC. Low-dose palliative radiotherapy can improve respiratory symptoms in elderly patients with NSCLC, with the tolerated side effects. Elderly patients with epidermal growth factor receptor (EGFR mutation can benefit from gefitinib and have a good tolerate of erlotiib. Cryocare Surgical System has an increasing trend of application in the treatment of elderly patients with NSCLC. Chinese medicine has effects in improving clinical symptoms and reducing side effects of chemotherapy, it can also improve the quality of life in these patients. Psychosocial support therapy can alleviate the burden of patients with NSCLC to some extent, but needs to improve its systematicness. Assessment and the time of palliative care are two important factors which determine the outcome of patients. We introduce the progress in palliative care benefit of elderly NSCLC, in order to provide the basis for palliative care of elderly NSCLC.

  16. A Conceptual Model for Episodes of Acute, Unscheduled Care.

    Science.gov (United States)

    Pines, Jesse M; Lotrecchiano, Gaetano R; Zocchi, Mark S; Lazar, Danielle; Leedekerken, Jacob B; Margolis, Gregg S; Carr, Brendan G

    2016-10-01

    We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care. In accordance with this information, we then drafted a preliminary conceptual model and collected stakeholder feedback, using online focus groups and concept mapping. Two technical expert panels reviewed the draft model, examined the stakeholder feedback, and discussed ways the model could be improved. After integrating the experts' comments, we solicited public comment on the model and made final revisions. The final conceptual model includes social and individual determinants of health that influence the incidence of acute illness and injury, factors that affect care-seeking decisions, specific delivery settings where acute care is provided, and outcomes and costs associated with the acute care system. We end with recommendations for how researchers, policymakers, payers, patients, and providers can use the model to identify and prioritize ways to improve acute care delivery.

  17. Construction of elderly identity within an education programme for care workers

    DEFF Research Database (Denmark)

    Jensen, Anne Winther

    , the paper focuses on how elderly identity is constructed within an adult basic education programme in the social and health care sector in Denmark. The programme being involved is for adults who would like to work in the social and health care sector at a basic level; the programme consists of theoretical......Elderly living in nursing homes or receiving home help in their private homes are often very dependent on the help provided by care workers. The paper deals with how the character of the provided help is influenced by the way the care workers perceive the elderly and their situation. In particular...... an educational research project; however as the programme being studied is withinThe Basic Social and Health Education Programmes in Denmark, Elderly Identity is an important subtheme....

  18. [Elderly human being with ostomy and environments of care: reflection on the perspective of complexity].

    Science.gov (United States)

    Barros, Edaiane Joana Lima; Santos, Silvana Sidney Costa; Lunardi, Valéria Lerch; Lunardi Filho, Wilson Danilo

    2012-01-01

    This is discussion about the relationship between elderly human beings with ostomy and their environments care, under the perspective of Complexity Edgar Morin. An axis holds the reflection: environments of care for elderly humans with ostomy. In this sense, we present three types of environment that surround the context of elderly humans with ostomy: home environment, group environment and hospital environment. This brings, as a social contribution, a new look about resizing caring of elderly humans with ostomy in their environment. It is considered that the environment hosting this human being contains a diversity of feelings, emotions, experiences; it binds multiple meanings, from the Complexity perspective, about the relationship between the environment and the caring process.

  19. Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

    Directory of Open Access Journals (Sweden)

    Li Li

    2010-06-01

    Conclusion: Based on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life.

  20. Systematic review of Kinect applications in elderly care and stroke rehabilitation

    National Research Council Canada - National Science Library

    Webster, David; Celik, Ozkan

    2014-01-01

    In this paper we present a review of the most current avenues of research into Kinect-based elderly care and stroke rehabilitation systems to provide an overview of the state of the art, limitations...

  1. Acute inflammation in horizontal incompletely impacted third molar with radiolucency in the elderly

    Science.gov (United States)

    Yamaoka, Minoru; Ono, Yusuke; Takahashi, Masahiro; Ishizuka, Masahide; Uchihashi, Takayuki; Yasuda, Kouichi; Uematsu, Takashi; Furusawa, Kiyofumi

    2009-01-01

    Although radiolucency has been shown as a risk of infection, the poorly understood effects of aging on radiolucency correlate with acute pericoronitis, which has a high risk of infection extending any complications. We reviewed the records of 346 consecutive patients aged more than 41 years to evaluate whether pericoronal radiolucency below the crown in mandibular horizontal incompletely impacted third molars is related to acute inflammation. The frequency of acute inflammation in teeth with pericoronal radiolucency below the crown was similar to that in teeth without; however, the odds ratio of acute inflammation exhibited in women aged more than 61 years compared to women aged 41–50 years was 9.77 (95% confidence interval [CI]: 1.67–57.29; P pericoronitis, including the severe forms of acute inflammation that result from pericoronitis, with pericoronal radiolucency below the crown in the elderly. PMID:19696898

  2. Elderly demand for family-based care and support: evidence from a social intervention strategy.

    Science.gov (United States)

    Aboagye, Emmanuel; Agyemang, Otuo Serebour; Tjerbo, Trond

    2013-12-06

    This paper examines the influence of the national health insurance scheme on elderly demand for family-based care and support. It contributes to the growing concern on the rapid increase in the elderly population globally using micro-level social theory to examine the influence the health insurance has on elderly demand for family support. A qualitative case study approach is applied to construct a comprehensive and thick description of how the national health insurance scheme influences the elderly in their demand for family support.Through focused interviews and direct observation of six selected cases, in-depth information on primary carers, living arrangement and the interaction between the health insurance as structure and elders as agents are analyzed. The study highlights that the interaction between the elderly and the national health insurance scheme has produced a new stratum of relationship between the elderly and their primary carers. Consequently, this has created equilibrium between the elderly demand for support and support made available by their primary carers. As the demand of the elderly for support is declining, supply of support by family members for the elderly is also on the decline.

  3. Caregiver Objective Burden and Assessments of Patient-Centered, Family-Focused Care for Frail Elderly Veterans

    Science.gov (United States)

    Rose, Julia Hannum; Bowman, Karen F.; O'Toole, Elizabeth E.; Abbott, Katherine; Love, Thomas E.; Thomas, Charles; Dawson, Neal V.

    2007-01-01

    Purpose: There is a growing consensus that quality of care for frail elders should include family and be evaluated in terms of patient-centered, family-focused care (PCFFC). Family caregivers are in a unique and sometimes sole position to evaluate such care. In the context of caring for physically frail elders, this study examined the extent to…

  4. Nursing practice models for acute and critical care: overview of care delivery models.

    Science.gov (United States)

    Shirey, Maria R

    2008-12-01

    This article provides a historical overview of nursing models of care for acute and critical care based on currently available literature. Models of care are defined and their advantages and disadvantages presented. The distinctive differences between care delivery models and professional practice models are explained. The historical overview of care delivery models provides a foundation for the introduction of best practice models that will shape the environment for acute and critical care in the future.

  5. Effect of combined anti-platelets drugs on platelet activation in the elderly patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    黄大海

    2012-01-01

    Objective To investigate the effect of combined anti-platelets drugs on platelet activation in the elderly patients with acute coronary syndrome(ACS).Methods Totally 72 elderly patients with ACS were divided randomly into two groups according to age ≤80 years and>80 years.

  6. Who Are the Clients?: Goal Displacement in an Adult Care Center for Elders with Dementia

    Science.gov (United States)

    Abramson, Corey M.

    2009-01-01

    This ethnographic study of "goal displacement" in an adult day care center explains how and why certain goals come to surpass others in the organizational practices of elder day care settings. Adult day care is often oriented towards providing family caregivers with respite rather than attempting to directly improve the lives of the elders…

  7. Caregiver Confidence: Does It Predict Changes in Disability among Elderly Home Care Recipients?

    Science.gov (United States)

    Li, Lydia W.; McLaughlin, Sara J.

    2012-01-01

    Purpose of the study: The primary aim of this investigation was to determine whether caregiver confidence in their care recipients' functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients. A secondary aim was to explore how caregiver confidence and care recipient functional…

  8. Technology acceptance for an Intelligent Comprehensive Interactive Care (ICIC) system for care of the elderly: a survey-questionnaire study.

    Science.gov (United States)

    Wong, Alice M K; Chang, Wei-Han; Ke, Pei-Chih; Huang, Chun-Kai; Tsai, Tsai-Hsuan; Chang, Hsien-Tsung; Shieh, Wann-Yun; Chan, Hsiao-Lung; Chen, Chih-Kuang; Pei, Yu-Cheng

    2012-01-01

    The key components of caring for the elderly are diet, living, transportation, education, and safety issues, and telemedical systems can offer great assistance. Through the integration of personal to community information technology platforms, we have developed a new Intelligent Comprehensive Interactive Care (ICIC) system to provide comprehensive services for elderly care. The ICIC system consists of six items, including medical care (physiological measuring system, Medication Reminder, and Dr. Ubiquitous), diet, living, transportation, education (Intelligent Watch), entertainment (Sharetouch), and safety (Fall Detection). In this study, we specifically evaluated the users' intention of using the Medication Reminder, Dr. Ubiquitous, Sharetouch, and Intelligent Watch using a modified technological acceptance model (TAM). A total of 121 elderly subjects (48 males and 73 females) were recruited. The modified TAM questionnaires were collected after they had used these products. For most of the ICIC units, the elderly subjects revealed great willingness and/or satisfaction in using this system. The elderly users of the Intelligent Watch showed the greatest willingness and satisfaction, while the elderly users of Dr. Ubiquitous revealed fair willingness in the dimension of perceived ease of use. The old-old age group revealed greater satisfaction in the dimension of result demonstrability for the users of the Medication Reminder as compared to the young-old and oldest-old age groups. The women revealed greater satisfaction in the dimension of perceived ease of use for the users of Dr. Ubiquitous as compared to the men. There were no statistically significant differences in terms of gender, age, and education level in the other dimensions. The modified TAM showed its effectiveness in evaluating the acceptance and characteristics of technologic products for the elderly user. The ICIC system offers a user-friendly solution in telemedical care and improves the quality of

  9. Prevalence of depression among elderly on open care centers for older people

    Directory of Open Access Journals (Sweden)

    Vilma Karagianni

    2010-10-01

    Full Text Available Depression in the elderly is considered an important public health issue. Depression is the most common mental health problem among older people. It poses a critical impact on well-being and the quality of life of elderly and it is related with high expenses and great demand of health care services. Objective: To estimate the prevalence of depression among elderly in an urban area’s population and to investigate the aggravating and protective factors. Material and Method: The sample consisted of 360 individuals, 218 women and 142 men, aged 60 years or older, members of the four Open Care Centres for Older People (KAPI of Agioi Anargyroi Municipality, in Attica. A questionnaire for demographics and phycho-social factors was used, whereas depression was probed through Geriatric Depression Scale, (Short Form - GDS-15, which has been standardized and adapted in a Greek elderly population. Results: 30,28% of the sample had depressive symptoms (22,22% moderate and 8,06% serious-clinical type depression. It was also shown that depression at women (70,6% appeared in a percentage over than the double against men (29,4%. The symptomatology of depression occurred widely among widower/widows, elderly being divorced or separated, people living alone, those with multiple pathologies and elderly informal family carers. Symptomatology of depression appeared in a lower rate among elderly who took care of their grandchildren or participated in social activities. Conclusions: The ascertainment high percentage of depressive symptoms in our sample of elderly population confirms the emergency of creating a strong psycho-social supporting network aimed to prevent depression among elderly and health promotion in the elderly in the context of Primary Health Care (PHC.

  10. Acute care in Tanzania: Epidemiology of acute care in a small community medical centre

    Directory of Open Access Journals (Sweden)

    Rachel M. Little

    2013-12-01

    Discussion: Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.

  11. Appropriateness of cardiovascular care in elderly adult cancer survivors.

    Science.gov (United States)

    Cheung, Winson Y; Levin, Raisa; Setoguchi, Soko

    2013-01-01

    Research suggests that the quality of non-cancer-related care among cancer survivors (CS) is suboptimal. Secondary disease prevention is an important component of survivorship care that has not been previously evaluated. Our aims were (1) to assess the utilization of and adherence to medications and treatments for the secondary prevention of myocardial infarction (MI) in CS versus non-cancer patients (NCP) and (2) to compare temporal trends in cardiovascular care between these two patient cohorts. Linking data from Medicare, pharmacy assistance programs, and cancer registries, we calculated the percentage of individuals receiving preventive medications (statins, β-blockers, angiotensin-converting enzyme inhibitors) and revascularization interventions (angioplasty, stent, bypass surgery) within 90 days after acute MI in CS and propensity score-matched NCP. We assessed trends over time and determined predictors of appropriate preventive care using modified Poisson regression. We identified 1,119 CS and 7,886 NCP. Compared to NCP, more survivors received statins (38 vs. 31 %) and β-blockers (67 vs. 59 %), but fewer underwent bypass surgery (1.5 vs. 2.8 %) after MI. From 1997 to 2004, both survivors and NCP were increasingly prescribed medications to prevent future coronary events. Over the same time period, receipt of bypass surgery was significantly lower among survivors. Co-morbidities, such as depression and lung disease, and demographic factors, such as advanced age and female, were associated with underuse of preventive care among survivors when compared to NCP. Use of preventive medications and procedures has generally improved, but uptake of bypass surgery among CS still lags behind NCP.

  12. Interventions for family members caring for an elder with dementia.

    Science.gov (United States)

    Acton, Gayle J; Winter, Mary A

    2002-01-01

    This chapter reviews 73 published and unpublished research reports of interventions for family members caring for an elder with dementia by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, Social Science Index, PsycINFO, ERIC, Social Work Abstracts, American Association of Retired Persons database, CRISP index of the National Institutes of Health, Cochrane Center database, and Dissertation Abstracts using the following search terms: caregiver, caregiving, dementia, Alzheimer's, intervention study, evaluation study, experimental, and quasi-experimental design. Additional keywords were used to narrow or expand the search as necessary. All nursing research was included in the review and nonnursing research was included if published between 1991 and 2001. Studies were included if they used a design that included a treatment and control group or a one-group, pretest-posttest design (ex post facto designs were included if they used a comparison group). Key findings show that approximately 32% of the study outcomes (e.g., burden, depression, knowledge) were changed after intervention in the desired direction. In addition, several problematic issues were identified including small, diverse samples; lack of intervention specificity; diversity in the length, duration, and intensity of the intervention strategies; and problematic outcome measures.

  13. CHANGING WRINKLES TO SMILES WITH PALLIATIVE CARE FOR THE ELDERLY!

    Directory of Open Access Journals (Sweden)

    S C Mohapatra

    2012-03-01

    Full Text Available Over the past years, the conscious and collaborative efforts of Peoples and Planners world-wide have shown a reduction in mortality and increase in the life expectancy at birth. Thus, the world will be over loaded with aged people one century ahead; on the other hand, we in India have cheated this particular group for last 65 years by not providing any special care package for them – the Elderly: presenting them the “geriatric care”! The then Director-General of the World Health Organization, Gro Harlem Brundtland in 1999 had said “Population ageing is, rst and foremost, a success story for public health policies as well as social and economic development”. Thus, the WHO has aptly chosen the theme “Ageing and health: Good health adds life to years” for 2012. The focus is how good health throughout life can help older men and women lead full and productive lives and be a resource for their families and communities.[1] It is predicted that within the next five years, the number of adults aged 65 years and over will outnumber children under the age of 5 and by 2050, all children under the age of 14. Between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11% to 22% with the most rapid and dramatic demographic changes being seen in low and middle income countries.[2

  14. Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks

    Directory of Open Access Journals (Sweden)

    Paulo Eduardo Vasques

    2011-01-01

    Full Text Available OBJECTIVE: The goal of this study was to assess the acute effect of physical exercise on the cognitive function of depressed elderly patients in a dual-task experiment. INTRODUCTION: Physical exercise has a positive effect on the brain and may even act as a treatment for major depressive disorder. However, the effects of acute cardiovascular exercise on cognitive function during and after one session of aerobic training in elderly depressive patients are not known. METHODS: Ten elderly subjects diagnosed with major depressive disorder performed neuropsychological tests during and after a moderate physical exercise session (65-75%HRmax. A Digit Span Test (Forward and Backward and a Stroop Color-Word Test were used to assess cognitive function. The elderly participants walked on an electric treadmill for 30 minutes and underwent the same cognitive testing before, during, immediately after, and 15 minutes after the exercise session. In the control session, the same cognitive testing was conducted, but without exercise training. RESULTS: The results of the Digit Span Test did not change between the control and the exercise sessions. The results of the Stroop Color-Word Test improved after physical exercise, indicating a positive effect of exercise on cognition. CONCLUSIONS: These data suggest that the cognitive functions of depressed elderly persons, especially attention and inhibitory control, are not impaired during and after an acute session of physical exercise. In contrast, the effect of dual-tasks showed beneficial results for these subjects, mainly after exercise. The dual-task may be a safe and useful tool for assessing cognitive function.

  15. Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks.

    Science.gov (United States)

    Vasques, Paulo Eduardo; Moraes, Helena; Silveira, Heitor; Deslandes, Andrea Camaz; Laks, Jerson

    2011-01-01

    The goal of this study was to assess the acute effect of physical exercise on the cognitive function of depressed elderly patients in a dual-task experiment. Physical exercise has a positive effect on the brain and may even act as a treatment for major depressive disorder. However, the effects of acute cardiovascular exercise on cognitive function during and after one session of aerobic training in elderly depressive patients are not known. Ten elderly subjects diagnosed with major depressive disorder performed neuropsychological tests during and after a moderate physical exercise session (65-75%HR(max)). A Digit Span Test (Forward and Backward) and a Stroop Color-Word Test were used to assess cognitive function. The elderly participants walked on an electric treadmill for 30 minutes and underwent the same cognitive testing before, during, immediately after, and 15 minutes after the exercise session. In the control session, the same cognitive testing was conducted, but without exercise training. The results of the Digit Span Test did not change between the control and the exercise sessions. The results of the Stroop Color-Word Test improved after physical exercise, indicating a positive effect of exercise on cognition. These data suggest that the cognitive functions of depressed elderly persons, especially attention and inhibitory control, are not impaired during and after an acute session of physical exercise. In contrast, the effect of dual-tasks showed beneficial results for these subjects, mainly after exercise. The dual-task may be a safe and useful tool for assessing cognitive function.

  16. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    NARCIS (Netherlands)

    W.M. Looman (Willemijn); I.N. Fabbricotti (Isabelle); R. Huijsman (Robbert)

    2014-01-01

    markdownabstract__Abstract__ Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty w

  17. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  18. Impact of anaemia on mortality and its causes in elderly patients with acute coronary syndromes.

    Science.gov (United States)

    Ariza-Solé, Albert; Formiga, Francesc; Salazar-Mendiguchía, Joel; Garay, Alberto; Lorente, Victòria; Sánchez-Salado, José C; Sánchez-Elvira, Guillermo; Gómez-Lara, Josep; Gómez-Hospital, Joan A; Cequier, Angel

    2015-06-01

    Prognostic impact of anaemia in the elderly with acute coronary syndromes has not been specifically analysed, and little information exists about causes of mortality in this setting. We prospectively included consecutive patients with acute coronary syndromes. Anaemia was defined as haemoglobin Anaemia was more common in the elderly (40.4% vs 19.5%, p Anaemia independently predicted overall mortality (HR 1.47, 95% CI 1.05-2.06), cardiac mortality (HR 1.76, 95% CI 1.06-2.94) and non-cardiac mortality (HR 1.59, 95% CI 1.03-2.45) in the overall cohort. In young patients the association between anaemia and mortality was significant only for non-cardiac causes. The association between anaemia and mortality was not significant in the elderly (HR 1.08, 95% CI 0.71-1.63, p 0.736). The impact of anaemia on cause specific of mortality seem to be different according to age subgroup. The association between anaemia and mortality was not observed in elderly patients from our series. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  19. Review of the treatment of acute coronary syndrome in elderly patients

    Directory of Open Access Journals (Sweden)

    Maan Jokhadar

    2009-11-01

    Full Text Available Maan Jokhadar, Nanette K WengerDivision of Cardiology Emory University School of Medicine Atlanta, GAAbstract: Advances in treatment and early revascularization have led to improved outcomes for patients with acute coronary syndrome (ACS. However, elderly ACS patients are less likely to receive evidence-based treatment, including revascularization therapy, due to uncertainty of the associated benefits and risks in this population. This article addresses key issues regarding medical and revascularization therapy in elderly ACS patients based on a review of the medical literature and in concordance with clinical practice guidelines from the American Heart Association (AHA and the American College of Cardiology (ACC.Keywords: acute coronary syndrome, revascularization, medical therapy

  20. Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    van Munster Barbara C

    2005-04-01

    Full Text Available Abstract Background Delirium is a neuropsychiatric syndrome frequently observed in elderly hospitalised patients and can be found in any medical condition. Due to the severe consequences, early recognition of delirium is important in order to start treatment in time. Despite the high incidence rate, the occurrence of delirium is not always identified as such. Knowledge of potential risk factors is important. The aim of the current study is to determine factors associated with the occurrence of a prevalent delirium among elderly patients acutely admitted to an internal medicine ward. Methods All consecutive patients of 65 years and over acutely admitted to the Department of Internal Medicine of the Academic Medical Centre, Amsterdam, a university hospital, were asked to participate. The presence of delirium was determined within 48 hrs after admission by an experienced geriatrician. Results In total, 126 patients were included, 29% had a prevalent delirium after acute admission. Compared to patients without delirium, patients with delirium were older, more often were cognitively and physically impaired, more often were admitted due to water and electrolyte disturbances, and were less often admitted due to malignancy or gastrointestinal bleeding. Independent risk factors for having a prevalent delirium after acute admission were premorbid cognitive impairment, functional impairment, an elevated urea nitrogen level, and the number of leucocytes. Conclusions In this study, the most important independent risk factors for a prevalent delirium after acute admission were cognitive and physical impairment, and a high serum urea nitrogen concentration. These observations might contribute to an earlier identification and treatment of delirium in acutely admitted elderly patients.

  1. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    Science.gov (United States)

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry.

  2. Determinants of life satisfaction among Japanese elderly women attending health care and welfare service facilities.

    Science.gov (United States)

    Onishi, Chiemi; Yuasa, Kyoko; Sei, Masako; Ewis, Ashraf A; Nakano, Takuro; Munakata, Hokuma; Nakahori, Yutaka

    2010-02-01

    Prolonged life expectancy must be recognized as an excellent achievement of modern medicine, but not all the elderly people are satisfied with their lives. Life satisfaction is a multi-dimensional issue that depends on many objective and subjective characteristics. In this study, we aimed at investigating the factors affecting life satisfaction of 314 elderly Japanese women attending in 28 elderly-care and welfare facilities at Tokushima Prefecture, Japan. Our results indicated that elderly subjects with depression tendencies always show significantly lower degrees of life satisfaction than others who are not depressed (pelderly women who shared decision for their living place and whose opinions were considered for daily life decisions reported significantly more life satisfaction levels than others. We conclude that elderly life satisfaction is affected by various determinants however, with different influencing weight. Life satisfaction of elderly people, with or without dementia, is greatly affected by their mood status and share in decision making. Avoiding elderly people depressive mood, sharing them in various daily decisions, considering their opinions, and allowing them to decide their elderly-care facility placement are crucial determinants for their life satisfaction and essential for their coping, adaptation, well-being and successful aging.

  3. Clinical analysis on 624 elderly patients with acute kidney injury

    Institute of Scientific and Technical Information of China (English)

    邹琴

    2012-01-01

    Objective To investigate the pathogens, clinical characteristic and therapeutic method of acute kidney injury(AKI).Methods The morbidity,composition of pathogeny,staging and prognosis of 624 cases with AKI recruited by our department from January 1999 to December 2009.

  4. Palliative care for the elderly - developing a curriculum for nursing and medical students

    Directory of Open Access Journals (Sweden)

    Bongartz Maren

    2010-09-01

    Full Text Available Abstract Background Delivering palliative care to elderly, dying patients is a present and future challenge. In Germany, this has been underlined by a 2009 legislation implementing palliative care as compulsory in the medical curriculum. While the number of elderly patients is increasing in many western countries multimorbidity, dementia and frailty complicate care. Teaching palliative care of the elderly to an interprofessional group of medical and nursing students can help to provide better care as acknowledged by the ministry of health and its expert panels. In this study we researched and created an interdisciplinary curriculum focussing on the palliative care needs of the elderly which will be presented in this paper. Methods In order to identify relevant learning goals and objectives for the curriculum, we proceeded in four subsequent stages. We searched international literature for existing undergraduate palliative care curricula focussing on the palliative care situation of elderly patients; we searched international literature for palliative care needs of the elderly. The searches were sensitive and limited in nature. Mesh terms were used where applicable. We then presented the results to a group of geriatrics and palliative care experts for critical appraisal. Finally, the findings were transformed into a curriculum, focussing on learning goals, using the literature found. Results The literature searches and expert feedback produced a primary body of results. The following deduction domains emerged: Geriatrics, Palliative Care, Communication & Patient Autonomy and Organisation & Social Networks. Based on these domains we developed our curriculum. Conclusions The curriculum was successfully implemented following the Kern approach for medical curricula. The process is documented in this paper. The information given may support curriculum developers in their search for learning goals and objectives.

  5. Primary percutaneous coronary intervention in elderly patients with ST-elevation acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2006-01-01

    @@ The elderly constitute a rapidly growing segment of our population and cardiovascular disease becomes more prevalent with increasing age,accounting for majority of their morbidity and mortality.1,2 ST-elevation acute myocardial infarction (STEMI) is the result of an abrupt cessation of blood supply caused by coronary occlusion, its process involving atherosclerotic plaque rupture or erosion,platelet aggregation and thrombus formation.

  6. [PECULIARITIES OF DIAGNOSIS AND TREATMENT OF AN ACUTE PANCREATITIS IN ELDERLY AND SENILE PATIENTS].

    Science.gov (United States)

    Osadchuk, D V; Chornomydz, A V

    2016-04-01

    Peculiarities of clinical course, diagnosis and treatment of elderly patients for an acute pancreatitis were analyzed. There was established, that the clinical course of an acute pancreatitis is atypical with obscure symptoms. Late admittance to hospital, presence of concomitant diseases, low reactivity of the organism defense systems, morpho-functional changes in pancreatic gland complicate the early diagnosis. While the abdominal pain occurrence in the patient it is necessary always to keep in mind the diagnosis of an acute pancreatitis and not to rely on the diagnosis with which the patient was delivered to hospital. Because of presence of several concomitant diseases in a patient with an acute pancreatitis the treatment must be multimodal with multidisciplinary approach, including surgeon, anesthesiologist and therapeutist. Operative intervention is mandatory only in presence of a life-threatening complications and in insufficiency of conservative therapy. Miniinvasive technologies constitute the first-line procedures.

  7. Employee effort - reward balance and first-level manager transformational leadership within elderly care.

    Science.gov (United States)

    Keisu, Britt-Inger; Öhman, Ann; Enberg, Birgit

    2017-08-29

    Negative aspects, staff dissatisfaction and problems related to internal organisational factors of working in elderly care are well-known and documented. Much less is known about positive aspects of working in elderly care, and therefore, this study focuses on such positive factors in Swedish elderly care. We combined two theoretical models, the effort-reward imbalance model and the Transformational Leadership Style model. The aim was to estimate the potential associations between employee-perceived transformational leadership style of their managers, and employees' ratings of effort and reward within elderly care work. The article is based on questionnaires distributed at on-site visits to registered nurses, occupational therapists, physiotherapists (high-level education) and assistant nurses (low-level education) in nine Swedish elderly care facilities. In order to grasp the positive factors of work in elderly care, we focused on balance at work, rather than imbalance. We found a significant association between employees' effort-reward balance at work and a transformational leadership style among managers. An association was also found between employees' level of education and their assessments of the first-level managers. We conclude that the first-level manager is an important actor for achieving a good workplace within elderly care, since she/he influences employees' psychosocial working environment. We also conclude that there are differences and inequalities, in terms of well-being, effort and reward at the work place, between those with academic training and those without, in that the former group to a higher degree evaluated their first-level manager to perform a transformational leadership style, which in turn is beneficial for their psychosocial work environment. Consequently, this (re)-produce inequalities in terms of well-being, effort and reward among the employees at the work place. © 2017 Nordic College of Caring Science.

  8. Oral health status and need for oral care of care-dependent indwelling elderly : from admission to death

    NARCIS (Netherlands)

    Hoeksema, Arie R; Peters, Lilian L; Raghoebar, Gerry M; Meijer, Henny J A; Vissink, Arjan; Visser, Anita

    2016-01-01

    OBJECTIVES: The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. MATERIALS AND METHODS: Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were asses

  9. Caring and Daring Discourses at Work: Doing Gender through Occupational Choices in Elderly Care and Police Work

    Science.gov (United States)

    Fejes, Andreas; Haake, Ulrika

    2013-01-01

    This paper aims to problematise how gender is being done--1. through occupational choices in two occupations that are traditionally gender divided, elderly care and police work, and 2. through the division of work assignments in police work. Interviews with care workers and police officers are analysed using a "doing gender" perspective, a…

  10. Oral health status and need for oral care of care-dependent indwelling elderly : from admission to death

    NARCIS (Netherlands)

    Hoeksema, Arie R; Peters, Lilian L; Raghoebar, Gerry M; Meijer, Henny J A; Vissink, Arjan; Visser, Anita

    The objective of this study is to assess oral health and oral status of elderly patients newly admitted to a nursing home from admission until death. Oral health, oral status, need for dental care, cooperation with dental treatment, and given dental care were assessed by two geriatric dentists in

  11. Nutritional Status Among Elderly in Ambulatory Care Setting

    Directory of Open Access Journals (Sweden)

    Karina Nurizky

    2017-06-01

    Full Text Available Background: Nutritional status is a final outcome from a balance between food intake and body’s needs of the nutrients. Elderly is people whose age more than 60 years old. In Indonesia, elderly population has increased. Its phenomena is also known as population aging. Population aging is related to malnutrition in elderly. Malnutrition is defined as the insufficient, excessive or imbalanced consumption of nutrients.The objective of this study was to describe the nutritional status among elderly outpatients in geriatrics clinic of Dr. Hasan Sadikin General Hospital Bandung. Methods: This study was a descriptive cross-sectional study that used primary data in geriatrics clinic Dr. Hasan Sadikin General Hospital Bandung from September 2013 to October 2013. The sampling method was convenience sampling. This study was done with  43 elderly ( women, n=27 and men, n=16 outpatients.The nutritional status was classified by the questionnaire of Mini Nutritional Assessment into malnourished, risk of malnutrition and without malnutrition (adequate. After collecting the data, it was analyzed by Microsoft Excel in presenting the proportion of the elderly nutritional status. Results: Among all the respondents, 27 (63% respondents had adequate nutrition and 16 (37% respondents had risk of malnutrition. There was no respondent who had malnutrition (undernutrition. Conclusions: Majority of elderly outpatients in geriatrics clinic Dr. Hasan Sadikin General Hospital had adequate nutrition.   DOI: 10.15850/amj.v4n2.1087

  12. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial.

    Science.gov (United States)

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    NCT02329873. Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10-30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all Pexercise tolerance significantly improved in the experimental group by the end of the fourth day (all Pexercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD.

  13. TAKING CARE OF THE SICK ELDER PEOPLE AT HOME IN THE SPEECH OF FAMILIAL CARE TAKER

    Directory of Open Access Journals (Sweden)

    Roceli Brum Cattani

    2004-08-01

    Full Text Available This investigation is about an exploratory, descriptive and in a qualitative approach study, which hadas its objective to know how the choice of the sick elderly people’s familial caretaker occurs and how the caretakerfeels in this role. The main caretaker was interviewed in home visits. The sample was constituted of nine familialcaretakers, mainly from the female sex: wives, daughters, daughters-in-law, granddaughters, and the husband. Forthe analysis of the data, the content analysis, following the methodological steps of Minayo, was used. Twoanalytical categories were elaborated: being a familial caretaker: is it an option or an obligation?, which shows thatthe choice of taking care is closely related to the feeling of obligation, but also to affection relations, gratitude andthe impossibility of choosing another caretaker, and being a sick elderly people’s familial caretaker that approachesfeelings of gratitude, resignation, inexperience in face of the care demands, physical and emotional tiredness, lossof freedom and solitude due to the activity in the caretaker.

  14. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    Science.gov (United States)

    Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

    2014-07-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

  15. End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice

    Science.gov (United States)

    Sorensen, Ros; Iedema, Rick

    2011-01-01

    The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be…

  16. Care of Acute Gastrointestinal Conditions in the Observation Unit.

    Science.gov (United States)

    Ham, Jason J; Ordonez, Edgar; Wilkerson, R Gentry

    2017-08-01

    The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Gender (inequality among employees in elder care: implications for health

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    Elwér Sofia

    2012-01-01

    Full Text Available Abstract Introduction Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (inequality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences. Methods All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups. Results We identified two themes. "Advocating gender equality in principle" showed how gender (inequality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender. Conclusion The health experience of the participants was affected by gender (inequality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.

  18. Actual Situations and Problems of Postoperative Nursing Care for the Elderly who Underwent Neurosurgical Operation

    OpenAIRE

    2014-01-01

    The objective of the study is to identify nursing care and related problems involved in extending the daily life and supporting self-care of the elderly who underwent neurosurgical operation, and to determine the direction of nursing care. Subjects were six nurses who had been working in anacute-phase department for five years or longer. Collected data was analyzed by the qualitative synthesis method (KJ method). The results clarified [nursing care to enhance the treatment effect of neurosurg...

  19. Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly.

    Science.gov (United States)

    Charatcharoenwitthaya, Phunchai; Pausawasdi, Nonthalee; Laosanguaneak, Nuttiya; Bubthamala, Jakkrapan; Tanwandee, Tawesak; Leelakusolvong, Somchai

    2011-08-28

    To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged endoscopy data-base of 526 consecutive patients with overt UGIB ad-mitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained. A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality. Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.

  20. Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly

    Institute of Scientific and Technical Information of China (English)

    Phunchai Charatcharoenwitthaya; Nonthalee Pausawasdi; Nuttiya Laosanguaneak; Jakkrapan Bubthamala; Tawesak Tanwandee; Somchai Leelakusolvong

    2011-01-01

    AIM: To characterize the effects of age on clinical pre-sentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years.METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB ad-mitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after en-doscopy were obtained.RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comor-bidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respec-tively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly as-sociated with 30-d mortality.CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.

  1. Health conditions of elderly in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Cenir Gonçalves Tier

    2014-10-01

    Full Text Available This study aimed to identify the health conditions and environmental factors that influence the activities of daily living of elderly people. Cross-sectional epidemiological research conducted with 167 elderly in a municipality of Rio Grande do Sul, Brazil, from May to July 2013, using a structured instrument. Data were grouped for statistical/descriptive treatment. Circulatory diseases were the most frequent. The commonly used drug was aspirin, and falls were prevalent in 65 elderly. There was a significant difference in eating in age group older than 80 years (p=0,002. Dressing had significance in the age group above 80 years old (p=0.010, but was not significant when associated architecture with age. It was concluded that knowledge of the socio-demographic and health characteristics of the elderly enables the implementation of specific actions by health professionals, besides helping managers to formulate health indicators.

  2. Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics

    Science.gov (United States)

    Dotta, Thiago de Angelis Guerra; Bonadio, Marcelo Batista; Furlaneto, Maria Elisabet; Silva, Jorge dos Santos; Leme, Luiz Eugênio Garcez

    2014-01-01

    OBJECTIVE: To make an analysis of the care of elderly in an Emergency Department of Orthopedics with the primary objective to know the percentage of elderly treated, their conditions of origin and level of accidental conditions, and examine possible comorbidities, evolution and mortality rate. METHODS: Retrospective observational epidemiological study based on survey records of a tertiary hospital during one year (January to December 2006) RESULTS: In the year 2006 (January to December) 12,916 calls to patients older than 60 were performed. CONCLUSION: Massive attendance of the elderly population was observed, however, the vast majority related to chronic problems that do not require urgent attention. Patients requiring urgent attention suffer from trauma related to falls and are between the seventh and ninth decades of life, mostly female and requiring hospitalization for longer periods. Level of Evidence VI, Cases Series. PMID:24868189

  3. Acute delirium in an elderly woman following zoledronate administration

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    Mohammad Nasiruddin

    2014-01-01

    Full Text Available Zoledronate is a third-generation bisphosphonate having distinctive profile of high potency as well as prolonged duration of action. Intravenous zoledronate is the recently approved bisphosphonate for the treatment of osteoporosis and has an attractive once-yearly regimen for the treatment of osteoporosis. Here we report, for the first time, a case of acute delirium following zoledronate administration for osteoporosis. An 86-year-old female patient presented to orthopedics out-patient department (OPD with complaints of pain and unable to bear weight on left thigh with history of fall from bed 2 months back. She was diagnosed as fracture neck of femur with severe osteoporosis and treated conservatively. She was given zoledronate IV 5 mg infusion over 30 min. After 10-12 h of zoledronate infusion, patient became confused, disorientated, and agitated. A septic work-up was negative. Electrolyte disturbances were excluded with normal sodium, potassium, calcium, and magnesium levels. Computed tomography of the brain was unremarkable. A metabolic cause could not be found for the change in her mental state. Patient was referred to medicine department where she was diagnosed as drug-induced acute delirium probably due to zoledronate. Patient was advised injections haloperidol and torsemide. In the following 48 h, her confusion got cleared and mental status was improved. According to the Naranjo′s scale, the effect of zoledronate in our patient was scored 6 indicating a probable likelihood of causing delirium. It was a probable cause of acute delirium according to World Health Organization (WHO causality scale.

  4. Long-term care for elder women in Spain: advances and limitations.

    Science.gov (United States)

    Vara, María-Jesús

    2014-01-01

    In Spain, elder women are the largest group in need of long-term care. Significant improvements in this issue took place between 2007 and 2011, thanks to the Dependency Law (2006). But severe limitations showed the difficulty of overcoming the historical backwardness of Spanish social policy. This article describes the situation of Spanish people with dependency in activities of daily living. It analyzes changes driven by this law, especially in their impacts on elder women. It assesses the extent to which those changes can alter the traditional model of care. There are three major findings: First, measures promoted by the law have improved the previous situation but are incapable of developing a new model. Care for elders still relies on family, with lack of professionalism, little socialization, and expanding commodification. Second, the current care model is fundamentally detrimental to older women and women caregivers. Third, this kind of model hinders the overcoming of gender inequalities in intrafamily, generational, and social relations.

  5. TV-Based Caring Videophone System for the Elderly in the Smart Home Environment

    Directory of Open Access Journals (Sweden)

    Jingshuang Shen

    2013-01-01

    Full Text Available A novel videophone system for the elderly-care application is proposed. Based on the detailed analysis of the elderly’s physical and psychological characteristics, a TV-based caring videophone system for the elderly is developed: an embedded multimedia device is designed to implement the interactive video and audio processing and IP-based communication, in which TV is adopted as the display terminal to achieve a low-cost but high-quality service. Considering the user’s convenience, many personalized designs, such as photo-based address book, photo-click-dialing, and touch pad based remote controller, are developed to make the proposed videophone system more intuitive and easy to use for the elderly. Based on Support Vector Machine (SVM algorithms, an evaluation model is also developed with the data collected from the embedded multimedia device. It is useful to evaluate the physical and psychological health of the elderly.

  6. Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

    Science.gov (United States)

    Meret-Hanke, Louise A.

    2011-01-01

    Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

  7. Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

    Science.gov (United States)

    Meret-Hanke, Louise A.

    2011-01-01

    Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

  8. Chinese Caregiving Burden and the Future Burden of Elder Care in Life-Course Perspective

    Science.gov (United States)

    Zhan, Heying Jenny

    2002-01-01

    This article uses the life course perspective to combine micro- and macro-levels of analysis of caregiving burdens experienced by Chinese baby-boom cohort and then explores their elder care prospects. Based on survey interviews during 1997 and 1998 with 110 caregivers providing care to dependent parents or parents-in-law, this study finds that…

  9. Attitudes of Health Care Providers toward Elderly Patients with Normal Aging and Disease-Related Symptoms.

    Science.gov (United States)

    Baker, Rodney R.

    1984-01-01

    Examined preferences of 275 health care providers for working with elderly patients exhibiting symptoms of normal aging or diseases. In comparing descriptions of two hospitalized patients, physicians, nurses and social workers expressed a preference for working with patients with disease symptoms, raising concerns about geriatric care. (JAC)

  10. Acute Heart Failure in the Elderly : Differences in Clinical Characteristics, Outcomes, and Prognostic Factors in the VERITAS Study

    NARCIS (Netherlands)

    Metra, Marco; Cotter, Gad; El-Khorazaty, Jill; Davison, Beth A.; Milo, Olga; Carubelli, Valentina; Bourge, Robert C.; Cleland, John G.; Jondeau, Guillaume; Krum, Henry; O'Connor, Christopher M.; Parker, John D.; Torre-Amione, Guillermo; van Veldhuisen, Dirk J.; Rainisio, Maurizio; Kobrin, Isaac; Mcmurray, John J.; Teerlink, John R.

    2015-01-01

    Background: Acute heart failure (HF) is common in the elderly, but the association of age with clinical outcomes and prognostic factors has not been examined thoroughly. Methods and Results: We analyzed the clinical and laboratory characteristics and the outcomes of 1,347 patients with acute HF enro

  11. A high-protein diet during hospitalization is associated with an accelerated decrease in soluble urokinase plasminogen activator receptor levels in acutely ill elderly medical patients with SIRS.

    Science.gov (United States)

    Tavenier, Juliette; Haupt, Thomas H; Andersen, Aino L; Buhl, Sussi F; Langkilde, Anne; Andersen, Jens R; Jensen, Jens-Erik B; Pedersen, Mette M; Petersen, Janne; Andersen, Ove

    2017-05-01

    Acute illness and hospitalization in elderly individuals are often accompanied by the systemic inflammatory response syndrome (SIRS) and malnutrition, both associated with wasting and mortality. Nutritional support and resistance training were shown to increase muscle anabolism and reduce inflammation in healthy elderly. We hypothesized that nutritional support and resistance training would accelerate the resolution of inflammation in hospitalized elderly patients with SIRS. Acutely admitted patients aged >65 years with SIRS were randomized to an intervention consisting of a high-protein diet (1.7 g/kg per day) during hospitalization, and daily protein supplement (18.8 g) and 3 weekly resistance training sessions for 12 weeks after discharge (Intervention, n=14), or to standard-care (Control, n=15). Plasma levels of the inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR), interleukin-6, C-reactive protein (CRP), and albumin were measured at admission, discharge, and 4 and 13 weeks after discharge. The Intervention group had an earlier decrease in suPAR levels than the Control group: -15.4% vs. +14.5%, P=.007 during hospitalization, and -2.4% vs. -28.6%, P=.007 between discharge and 4 weeks. There were no significant effects of the intervention on the other biomarkers. All biomarkers improved significantly between admission and 13 weeks, although with different kinetics (suPAR: -22%, interleukin-6: -86%, CRP: -89%, albumin: +11%). Nutritional support during hospitalization was associated with an accelerated decrease in suPAR levels, whereas the combined nutrition and resistance training intervention after discharge did not appear to affect the inflammatory state. Our results indicate that improved nutritional care during hospitalization may accelerate recovery in acutely ill elderly medical patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Elder mistreatment in U.S. residential care facilities: the scope of the problem.

    Science.gov (United States)

    Phillips, Linda R; Guo, Guifang; Kim, Haesook

    2013-01-01

    Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.

  13. Self-care to elderly after cerebrovascular accident: caregiver and academics experiences

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    Márcia Gabriela Gomes Nascimento

    2015-11-01

    Full Text Available Objective: understand the experiences of the caregiver and multidisciplinary health academics toward the developmentof self-care at home for elderly after cerebrovascular accident. Methods: qualitative study with the use of semi-structuredinterviews with six caregivers and eight academics whose data were analyzed in the light of the Phenomenology. Results:three categories emerged: living with the challenges and limitations imposed on the caregiver and on the person being cared;the professional being and the technic conservatism; the multidisciplinary team at home: experiences with the caregiver andthe person being cared. Conclusion: caregivers of elderly who went through cerebrovascular accident need more supportand guidance for conducting home care, they need a plan of care to facilitate and encourage self-care, minimizing the burdenincurred to the caregiver. Multidisciplinary academics displayed a technical view. This demonstrates the need for change inacademic education with more focus on a holistic and humanistic view of care.

  14. Care Transitions in Long-term Care and Acute Care: Health Information Exchange and Readmission Rates.

    Science.gov (United States)

    Yeaman, Brian; Ko, Kelly J; Alvarez del Castillo, Rodolfo

    2015-09-30

    Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind other settings in adoption of health information technologies (HIT). In this article, we provide some brief background information about care transitions in LTC and concerns related to technology. We describe a pilot project using HIT and secure messaging in LTC to facilitate electronic information exchange during care transitions. Five LTC facilities were included, all located within Oklahoma and serviced by the same regional health system. The study duration was 20 months. Both inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We provide discussion of positive outcomes, lessons learned, and limitations. Finally, we offer implications for practice and research for implementation of HIT and information exchange across care settings that may contribute to reduction in readmission rates in acute care and ED settings.

  15. Ethical challenges related to elder care. High level decision-makers' experiences

    Directory of Open Access Journals (Sweden)

    Kihlgren Mona

    2007-04-01

    Full Text Available Abstract Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to

  16. The elderly and a remote home care: The case of Slovenia

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    Kerbler Boštjan

    2013-01-01

    Full Text Available Due to increasing ageing, western countries are facing an increase in financial needs to provide suitable healthcare, social care and housing for the elderly. One of society’s responses to these issues is the idea of moving elder-care activities to their living environments. This can be achieved with the help of information and communication technologies (ICT by which home care could be provided remotely. However, the findings of various authors suggest that elderly people have mostly negative attitudes towards a remote home care. In order to determine the views of the elderly towards this service in Slovenia, a survey was conducted, the results of which are discussed in this article. Contrary to our assumption, it turned out that elderly people have positive attitudes towards remote home care. This was attributed to effectively informing respondents and increasing their understanding of the operation and usability of the service. Raising the awareness of potential users is therefore crucial for its acceptance in a society.

  17. [Is ageism a relevant concept for health care practice in the elderly?].

    Science.gov (United States)

    Masse, Marie; Meire, Philippe

    2012-09-01

    With the demographic aging, the older adults' needs for assistance and care will inevitably increase. Therefore, it is important to explore the beliefs and attitudes of the health care professionals toward the elderly. This paper discusses the notion of ageism and its paradoxes in health care practices for the elderly. First, the concept of ageism is defined through its cognitive, affective and behavioral components. Second, on the basis of the literature review, different "age biases" induced by ageism are described, which can influence the assessment of health condition of the elderly, the treatment decisions, but also the attitudes of the health care workers with out-patients as with institutionalized subjects. Third, the potential negative effects of ageist stereotypes on the health status and psychological well-being of the elderly are examined. Finally, some propositions are made to oppose ageism in health care practices for the elderly, including continuing education, better knowledge of the diversity of aging processes, reflexion on professionals' own prejudices, values and beliefs, promotion of relational attitudes which sustain autonomy.

  18. Deferasirox and vitamin D improves overall survival in elderly patients with acute myeloid leukemia after demethylating agents failure.

    Directory of Open Access Journals (Sweden)

    Etienne Paubelle

    Full Text Available The prognosis of acute myeloid leukemia (AML in elderly (≥65 years patients is poor and treatment remains non-consensual especially for those who are not eligible for intensive therapies. Our group has shown that in vitro the iron chelator deferasirox (DFX synergizes with vitamin D (VD to promote monocyte differentiation in primary AML cells. Herein, we present results from a retrospective case-control study in which the association of DFX (1-2 g/d and 25-hydroxycholecalciferol (100,000 IU/week (DFX/VD was proposed to patients following demethylating agents failure. Median survival of patients treated with DFX/VD combination (n = 17 was significantly increased in comparison with matched patients receiving best supportive care (BSC alone (n = 13 (10.4 versus 4 months respectively. In addition, the only factor associated to an increased overall survival in DFX/VD-treated patients was serum VD levels. We conclude that DFX/VD treatment correlated with increased overall survival of AML patients in this retrospective cohort of elderly patients.

  19. Deferasirox and Vitamin D Improves Overall Survival in Elderly Patients with Acute Myeloid Leukemia after Demethylating Agents Failure

    Science.gov (United States)

    Suarez, Felipe; Callens, Céline; Dussiot, Michaël; Isnard, Françoise; Rubio, Marie-Thérèse; Damaj, Gandhi; Gorin, Norbert-Claude; Marolleau, Jean-Pierre; Monteiro, Renato C.; Moura, Ivan C.; Hermine, Olivier

    2013-01-01

    The prognosis of acute myeloid leukemia (AML) in elderly (≥65 years) patients is poor and treatment remains non-consensual especially for those who are not eligible for intensive therapies. Our group has shown that in vitro the iron chelator deferasirox (DFX) synergizes with vitamin D (VD) to promote monocyte differentiation in primary AML cells. Herein, we present results from a retrospective case-control study in which the association of DFX (1–2 g/d) and 25-hydroxycholecalciferol (100,000 IU/week) (DFX/VD) was proposed to patients following demethylating agents failure. Median survival of patients treated with DFX/VD combination (n = 17) was significantly increased in comparison with matched patients receiving best supportive care (BSC) alone (n = 13) (10.4 versus 4 months respectively). In addition, the only factor associated to an increased overall survival in DFX/VD-treated patients was serum VD levels. We conclude that DFX/VD treatment correlated with increased overall survival of AML patients in this retrospective cohort of elderly patients. PMID:23840388

  20. Acute eccentric resistance exercise decreases matrix metalloproteinase activity in obese elderly women.

    Science.gov (United States)

    Nascimento, Dahan da Cunha; Navalta, James Wilfred; Durigan, João Luiz Quagliotti; Marqueti, Rita de Cassia; Tibana, Ramires Alsamir; Luiz Franco, Octavio; de Almeida, Jesser Alves; Camarço, Nathalia Ferreira; Neto, Ivo Vieira de Sousa; Prestes, Jonato

    2016-03-01

    The association of ageing with obesity commits elderly women and has been correlated with multiple degenerative processes, which could be occasioned by an enhancing in levels of matrix metalloproteinase-2 and metalloproteinase-9 (MMPs) as well by an cytokine unbalance that included an enhancing on interleukin-6 (IL-6). Furthermore, other factors could be also related to degenerative process, as they could be reduced by eccentric resistance exercise (ERE), which seems particularly important to initiate resistance training in obese older adults. In this view, this study aims to determinate the effects of an acute ERE session on serum MMP-2, MMP-9 and IL-6 in elderly obese women. Ten elderly obese women participated in this study and completed a 10 repetitions maximum test (10 RM) utilizing leg extension exercise. Subjects then completed an acute ERE session consisting of seven sets of 10 repetitions at 110% of 10 RM with a rest of 3 min between sets. Blood samples were collected before, immediately after, 3, 24 and 48 h following the ERE session. Zymograms were utilized to measure the MMP-2 and MMP-9 enzymes from all individuals. Moreover, IL-6 concentration was also determinated. After ERE session, MMP-2 and MMP-9 decreased, remaining significantly below baseline values after 48 h (Pelderly obese women, possibly indicating a transient protection against the low grade inflammation present in this specific population.

  1. [Acute confusional syndrome in elderly patients hospitalized due to medical condition].

    Science.gov (United States)

    Formiga, F; Marcos, E; Sole, A; Valencia, E; Lora-Tamayo, J; Pujol, R

    2005-10-01

    Delirium or acute confusional syndrome (ACS) is a frequent problem during hospitalization of elderly patients. We study the appearance of delirium and its characteristics in patients admitted to an internal medicine service. Prospective study of 148 patients over 64 years admitted due to medical condition (non-surgical) in the internal medicine service of the University Hospital of Bellvitge. Functionality was quantified with the Barthel index (BI) and comorbidity with the Charlson index (CI). The Confusional Assessment Method was used for the diagnosis of the ACS. Seventy-seven (77) (52%) of the 148 patients were women, with a mean age of 78.5 years. The CI was 2.2. Mean of previous BI was 81.7. Mortality during admission was 8% (12 patients). A total of 42.5% of the patients (63) had ACS (30% prevalent). It was hyperactive in 68%, hypoactive in 16% and mixed in 16%. In 38% of the patients, the ACS had morning predominance and 62% it appeared after the evening. Advanced age was the only significant differences between patients with or without ACS (p patients who survived or who died (p = 0.36). Frequency of appearance of the confusional picture is high in patients admitted to acute hospitals, it being more frequent in the elderly. Measures to prevent the confusional picture in elderly patients who are hospitalized should be increased.

  2. Medicare Post-Acute Care Episodes and Payment Bundling

    Data.gov (United States)

    U.S. Department of Health & Human Services — Published in Volume 4, Issue 1, of Medicare and Medicaid Research Review, this paper provides an overview of results examining alternative Medicare post-acute care...

  3. Acute stroke: postprocedural care and management of complications.

    Science.gov (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  4. Identifying and managing patients with delirium in acute care settings.

    Science.gov (United States)

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  5. Comparison of long-term care in an acute care institution and in a long-term care institution.

    Science.gov (United States)

    Friedman, R; Kalant, N

    1998-11-03

    Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p cost per patient-year was $7580 higher at the acute care hospital, attributable to the higher cost of drugs ($42), the greater use of laboratory tests ($189) and, primarily, the higher cost of nursing ($7349). For patients requiring 3.00 nursing hours/day, the acute care

  6. The Study on the Subjective Life Satisfaction That the Elderly Perceives in Long-term Care Facility and on the Influence Factors

    OpenAIRE

    Cho, Chu- yong; Jung, Yun-Tae

    2014-01-01

    The objectives of this study are to evaluate influences of environmental factors in elderly long-term care facility on life satisfaction of the elderly who live in the facility; to derive major determinants that affect level of life satisfaction; and thus to provide fundamental information for use in improving life satisfaction of the elderly in currently operating long-term care facilities as well as newly constructed elderly long-term care facilities. This study targeted at 252 of the elder...

  7. ACUTE UNDIFFERENTIATED FEVER IN INTENSIVE CARE UNITS

    Directory of Open Access Journals (Sweden)

    Srikanth Ram Mohan

    2014-03-01

    Full Text Available Acute undifferentiated fever (AUF is common in tropical regions of the developing world, its specific etiology is often unknown. It’s common causes include malaria, dengue fever, enteric fever, leptospirosis, rickettsial infection. AUF is defined as fever without any localised source of infection, of 14 days or less in duration. The objective of the study was to focus on identifying the causes of AUF in patients admitted to Intensive care units & to determine importance of clinical examination in identifying the cause. It was a prospective study done in our Medical college Hospital at Kolar, Karnataka between 1-11-2010 to 30-11-2011. Cases presenting to hospital aged >18 years with complaints of Fever & admitted in Intensive care units were included in study. A total of 558 cases were enrolled. The clinical findings were noted and subsequent Investigations required were asked for. The study compromised of approximately equal number of Male & Female patients & age varied from 18 – 100 years. There was a clear seasonal variation – More no of cases were admitted between April & November. Majority presented with Fever of Short duration (1-3 days. Certain well defined syndromes were identified like:  Fever with Thrombocytopenia – the most common of all the syndromes.  Fever with Myalgia & Arthralgia,  Fever with Hepatorenal dysfunction,  Fever with Encephalopathy,  Fever with Pulmonary - Renal dysfunction and  Fever with Multiorgan dysfunction (MODS. Out of 558 cases AUF was noted in 339 cases (60.86%. An etiological diagnosis could be made for 218 cases (39.06%. Leptospirosis was the commonest cause with 72 cases (12.9%. The no of cases with Dengue were 48(8.6%, Malaria –25 (4.4%, Viral fever –35 (6.2%, Mixed infections – 12 (2.1%, Pulmonary Tuberculosis -25 ( 4.4% and one case of Rickettsial Infection. MODS was the most common presentation in AUF patients, seen in 108 cases (31.8% and 40 cases expired. A study of AUF

  8. Physical and mental health aspects of elderly in social care in Poland

    Directory of Open Access Journals (Sweden)

    Dobrzyn-Matusiak D

    2014-10-01

    Full Text Available Dorota Dobrzyn-Matusiak,1 Czeslaw Marcisz,2 Ewelina Bąk,3 Halina Kulik,1 Ewa Marcisz4 1Department of Nursing Propaedeutics, 2Department of Gerontology and Geriatric Nursing, School of Health Care, Medical University of Silesia, Katowice, Poland; 3Faculty of Health Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland; 4Department of Anxiety Disorders, Hospital of Ministry of Internal Affairs, Katowice, Poland Background: The objective of the study was to evaluate health aspects in elderly individuals in social, institutional, and home care in Poland.Methods: A total of 300 elderly individuals in care in Poland were included in the study. The subjects were divided into three groups: residents of long-term care institutions (group I, residents of adult day-care homes (group II, and community-dwelling subjects (group III. Each group consisted of 100 subjects. Questionnaires evaluating the following physical and mental dimensions of health were used: SF-36 Health Survey, basic activities of daily living, instrumental activities of daily living, Geriatric Depression Scale, and Mini–mental state examination.Results: It was found that the health aspects of the elderly varied depending on whether care was provided in an institutionalized or a home environment, and the lowest health status was found in the elderly receiving in-home care. Furthermore, home-based elderly indicated significant limitations in performing basic activities of daily living and instrumental activities of daily living, as well as a higher prevalence of depression and cognitive impairment.Conclusion: The elderly in long-term institutionalized care, both in a residential home and adult day-care homes, were characterized by a better physical and mental health status than those receiving in-home care. It seemed that worse health status, including the more frequent depression occurrence and cognitive function disorders in the elderly using the nursing care at their homes

  9. A council of elders: creating a multi-voiced dialogue in a community of care.

    Science.gov (United States)

    Katz, A M; Conant, L; Inui, T S; Baron, D; Bor, D

    2000-03-01

    In an era of 'medical care delivery systems', there is an increasing need for the patient's voice to be heard, for it to be invited, listened to, and taken seriously. This challenge is particularly evident in geriatrics education, a domain of clinical training in which educators and clinicians alike must struggle to overcome adverse attitudes towards the elderly ('ageism'). In this paper we introduce a 'Council of Elders' as an educational innovation in which we invited community elders to function as our 'Senior Faculty', to whom medical residents present their challenging and heartfelt dilemmas in caring for elder patients. In the conversations that ensue, the elders come to function not simply as teachers, but collaborators in a process in which doctors, researchers, and elders together create a community of resources, capable of identifying novel ways to overcome health-related difficulties which might not have been apparent to either group separately. Using the first meeting of the Council as an exemplar, we describe and discuss the special nature of such meetings and also the special preparations required to build a dialogic relationship between participants from very different worlds--different generations, different cultures (including the professional culture and the world of lived experience). Meetings with the council have become a required part of the primary care residency program--a very different kind of 'challenging case conference' in which moral dilemmas can be presented, discussed and reflected upon. It is not so much that elders give good advice in their responses--although they often do--as that they provide life world and value orientation as young residents gain a better sense of the elder's experience and what matters most to them. This project has been particularly worthwhile in addressing the problem of ageism--a way to render visible stereotypes and adverse physician values, with implications for decision-making with the patient, not for

  10. Building a transdisciplinary approach to palliative care in an acute care setting.

    Science.gov (United States)

    Daly, Donnelle; Matzel, Stephen Chavez

    2013-01-01

    A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.

  11. Discrimination of elderly patients in the health care system of Lithuania

    Directory of Open Access Journals (Sweden)

    Kristina Selli

    2016-07-01

    Full Text Available Aim: This study aimed to explore and describe the barriers that elderly Lithuanians experience with respect to going to court or other institutions to defend their right not to be discriminated regarding medical care. Methods: We used a mixed methods approach due to the scarcity of information in Lithuania. First, the review of laws was done using the e-tar database and court cases were searched using the e-teismai database followed by policy analysis. Additional sources of information were identified searching Google Scholar and PubMed, as well as Google for grey literature. The keywords used were: ageism in patient care, discrimination against elderly, elderly and health (English and Lithuanian: 2000-2015. Secondly, we conducted in-depth individual interviews with 27 clients of newly-established integrated home care services: 13 elderly patients, and 14 informal caregivers. Results:  This study identified five groups of barriers explaining why Lithuanian elderly are hesitant to fight discrimination in the health system. The results of the study disclose the following barriers that the elderly in Lithuania face: i the lack of recognition of the phenomenon of discrimination against the elderly in patient care; ii the lack of information for complaining and the fear of consequences of complaining; iii the deficiencies and uncertainties of laws and regulations devoted to discrimination; iv the high level of burden of proof in court cases and lack of good practices; v the lack of a patient (human rights-based approach in all policies and in education as well as the lack of intersectoral work. Conclusions:  This study disclosed the need to: encourage training of legists and lawyers in expanding knowledge and skills in human rights in patient care;  encourage training of health care professionals – the burden of leadership for this has to be assumed by universities and public health professionals; incorporate a new article in the ‘Law on the

  12. Accessibility of health care for elderly mexicans living in ciudad juarez, Mexico.

    Science.gov (United States)

    Sizemore, M H

    1992-01-01

    The issue of access to health care for the elderly and the quality of that care is of growing importance not only in the United States but also in less developed nations such as Mexico. An area of special interest is the U.S.-Mexico border region, where an increasing number of people are relocating to seek jobs they believe will open up as the North American Free Trade Agreement (NAFTA) loosens trade barriers. Workers flocking to the border often bring their families, including elderly relatives. This study examines a sample of lower-middle and mid-middle class Mexicans aged sixty to eighty-nine who reside in the border city of Ciudad Juárez, focusing on the principal ailments which affect these individuals and available treatment. A concluding section makes brief comparative remarks on access to health care for the elderly in Mexico and in the United States.

  13. Percutaneous coronary intervention for acute myocardial infarction in elderly patients with renal dysfunction: results from the Korea Acute Myocardial Infarction Registry.

    Science.gov (United States)

    Lim, Sang Yup; Bae, Eun Hui; Choi, Joon Seok; Kim, Chang Seong; Ma, Seong Kwon; Ahn, Youngkeun; Jeong, Myung Ho; Kim, Weon; Woo, Jong Shin; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Kim, Soo Wan

    2013-07-01

    This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFRrenal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.

  14. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

    Directory of Open Access Journals (Sweden)

    Marjan Askari

    Full Text Available BACKGROUND: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE quality indicators (QIs were developed to assess and improve the care of elderly patients. OBJECTIVES: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. METHODS: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. RESULTS: Seventeen studies were included with 278 QIs (original, adapted or newly developed. The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR: 11%-35%, depression (IQR: 27%-41%, osteoporosis (IQR: 34%-43% and osteoarthritis (IQR: 29-41% were notably low. Medication management and use (range: 81%-90%, hearing loss (77%-79% and continuity of care (76%-80% scored higher than other conditions. Out of the 278 QIs, 141 (50% had mean pass rates below 50% and 121 QIs (44% had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. CONCLUSIONS: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

  15. Frailty and quality of life in elderly patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Lisiak M

    2016-05-01

    Full Text Available Magdalena Lisiak,1 Izabella Uchmanowicz,1 Radosław Wontor2 1Department of Clinical Nursing, Wroclaw Medical University, 2Department of Cardiology, T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland Background: Frail elderly people are at risk of developing adverse health outcomes such as disability, hospitalization, and mortality. In recent years, the literature has drawn attention to the role of frailty syndrome (FS in acute coronary syndrome (ACS. There are few studies regarding the relationship between two multidimensional variables such as FS and quality of life (QoL.Objective: The aim of the study was to investigate the relationship between FS and early QoL of elderly patients with ACS (≥65 years old.Methods: The study was conducted among 91 patients aged 65 years and over with ACS. The MacNew questionnaire was used to evaluate QoL and the Tilburg frailty indicator to evaluate frailty.Results: FS was present in 82.4% of patients. The average Tilburg frailty indicator score was 7.43±2.57. A negative correlation between the global values of FS and QoL was shown (r=−0.549, P<0.05. The vulnerability factors that negatively affected early QoL were: FS, marital status, conservative therapy, and hypertension. In multivariate analysis, FS was found to be the independent predictor of worse QoL (β ± standard error −0.277±0.122, P=0.026.Conclusion: The presence of FS has a negative impact on early QoL in patients with ACS. The study suggests that in elderly patients with ACS, there is a need to identify frailty in order to implement additional therapeutic and nursing strategies in ACS. Keywords: frailty syndrome, aging, frail elderly, assessment, quality of life, acute coronary syndrome

  16. Educational Support Group in Changing Caregivers' Psychological Elder Abuse Behavior toward Caring for Institutionalized Elders

    Science.gov (United States)

    Hsieh, Hsiu-Fang; Wang, Jing-Jy; Yen, Maiofen; Liu, Tzu-Ti

    2009-01-01

    Institutionalized elderly who are frail and dependent are vulnerable to be abused by overwhelmed caregivers especially caregiver psychological abusive behavior is a growing but hidden problem with few evidence-based interventions. The purpose of this study was to examine the effectiveness of an educational support group in alleviating caregiver's…

  17. Acute-care surgical service: a change in culture.

    Science.gov (United States)

    Parasyn, Andrew D; Truskett, Philip G; Bennett, Michael; Lum, Sharon; Barry, Jennie; Haghighi, Koroush; Crowe, Philip J

    2009-01-01

    The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute-care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on-site service from 08.00 to 18.00 hours Monday to Friday and on-call service in after-hours for a 79-week period. An acute-care ward of four beds and an operating theatre were placed under the control of the rostered acute-care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52-week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute-care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On-site consultant-driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.

  18. "We prefer greeting rather than eating:" life in an elder care center in Ethiopia.

    Science.gov (United States)

    Teka, Alemnesh; Adamek, Margaret E

    2014-12-01

    In Ethiopia where family care is a centuries-long tradition, living in an elder care institution invariably brings social devaluation. Accordingly, this study explored the psychosocial needs of older adults in a residential elder care center in Ethiopia from the perspective of both staff and residents. Three focus group discussions of 24 residents and interviews with 5 staff persons revealed that elders were living a subsistence lifestyle, eating the same meal every day, mostly cutoff from the surrounding community, and lacking basic amenities. Despite the absence of basic amenities, residents yearned even more so for meaningful social interaction. Psychosocial support was both undervalued and underutilized by staff members, and thus, residents' psychosocial well-being appeared to be at risk. The addition of social workers in institutional care in Ethiopia may help to promote improved living standards. Advocacy is needed on behalf of residents to establish and implement guidelines on care and support of residents in old age homes. As elders in developing countries are living longer--a growing number with disabilities--at the same time that informal supports are waning, the need for developing long term care policies is becoming critical.

  19. Relationship of cerebral microbleeds with hematoma growth in elderly patients with acute hypertensive intracerebral hemorrhage

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    Shou-feng LIU

    2015-01-01

    Full Text Available Objective To investigate whether cerebral microbleeds (CMBs can predict hematoma growth in elderly patients with acute hypertensive intracerebral hemorrhage.  Methods The clinical records of 98 elderly patients with acute hypertensive intracerebral hemorrhage who underwent initial CT within 6 h and repeated CT and susceptibility-weighted imaging (SWI within 24 h of onset were analyzed. Based on the performance of SWI, patients were divided into microbleeds group and non-microbleeds group. Forward multivariate Logistic regression analysis was used to evaluate the predicting value of CMBs on the growth of intracerebral hematoma.  Results Among 98 patients, hematoma growth was found in 25 cases in the second CT scan. The ratio in microbleeds group was significantly higher than that in non-microbleeds group (43.75% vs 16.67%; χ2 = 8.319, P = 0.004. Multivariate Logistic regression showed that CMBs was independent risk factor for intracerebral hematoma (OR = 0.241, 95%CI: 0.065-0.861; P = 0.017.  Conclusions CMBs in patients with acute intracerebral hematoma can predict high risk of hemotoma growth, and effective treatment should be taken to improve the prognosis of patients. DOI: 10.3969/j.issn.1672-6731.2015.01.012

  20. Influenza vaccination and the endurance against air pollution among elderly with acute coronary syndrome.

    Science.gov (United States)

    Huang, Ching-Hui; Chao, Day-Yu; Wu, Chao-Chun; Hsu, Shu-Yun; Soon, Maw-Soan; Chang, Chia-Chu; Kor, Chew-Teng; Chang, Wan-Tzu; Lian, Ie-Bin

    2016-12-07

    Air pollution, weather condition and influenza are known risk factors of acute coronary syndrome (ACS) among elderly people. The influenza vaccine (IV) has been shown to reduce major cardiovascular events. The purpose of this study was to compare resistance to air pollution and weather factors causing ACS between vaccinated and less-vaccinated elderly people. A case-crossover design was applied to 1835 elderly ACS patients who were obtained from the 1-million sample of Taiwan National Health Insurance Research Data with inclusion criteria: (1) the first diagnosis of ACS was in cold season and at age 68 or more, (2) had received the free IV program at least once during the period 3years before the ACS. They were stratified into two groups: 707 had received flu vaccinations for all the 3years and the remaining 1128 had not. The measurements of air pollutants, temperature, and humidity corresponding to each of the 3days prior to the ACS diagnosis date were retrieved from the data banks of the Taiwan Environmental Protection Administration and Central Weather Bureau. Increases in air pollution concentrations of CO, NO2, PM10 or PM2.5 and decreases in temperature significantly influenced the risk of ACS for the non-continuously vaccinated elderly population; however, less significant effects were observed for the continuously vaccinated population. Consecutive influenza vaccination may potentially offer resistance against the detrimental effects of air pollution and changes in temperature in frail elderly adults with ACS. Future studies are needed to directly assess the interaction effect between the vaccination and environmental factors on ACS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients.

    Science.gov (United States)

    Chao, Chia-Ter; Tsai, Hung-Bin; Wu, Chia-Yi; Lin, Yu-Feng; Hsu, Nin-Chieh; Chen, Jin-Shin; Hung, Kuan-Yu

    2015-08-01

    Polypharmacy is common in the elderly due to multimorbidity and interventions. However, the temporal association between polypharmacy and renal outcomes is rarely addressed and recognized. We investigated the association between cardiovascular (CV) polypharmacy and the risk of acute kidney injury (AKI) in elderly patients.We used the Taiwan National Health Insurance PharmaCloud system to investigate the relationship between cumulative CV medications in the 3 months before admission and risk of AKI in the elderly at their admission to general medical wards in a single center. Community-dwelling elderly patients (>60 years) were prospectively enrolled and classified according to the number of preadmission CV medications. CV polypharmacy was defined as use of 2 or more CV medications.We enrolled 152 patients, 48% with AKI (based upon Kidney Disease Improving Global Outcomes [KDIGO] classification) and 64% with CV polypharmacy. The incidence of AKI was higher in patients taking more CV medications (0 drugs: 33%; 1 drug: 50%; 2 drugs: 57%; 3 or more drugs: 60%; P = 0.05) before admission. Patients with higher KDIGO grades also took more preadmission CV medications (P = 0.04). Multiple regression analysis showed that patients who used 1 or more CV medications before admission had increased risk of AKI at admission (1 drug: odds ratio [OR] = 1.63, P = 0.2; 2 drugs: OR = 4.74, P = 0.03; 3 or more drugs: OR = 5.92, P = 0.02), and that CV polypharmacy is associated with higher risk of AKI (OR 2.58; P = 0.02). Each additional CV medication increased the risk for AKI by 30%.We found that elderly patients taking more CV medications are associated with risk of adverse renal events. Further study to evaluate whether interventions that reduce polypharmacy could reduce the incidence of geriatric AKI is urgently needed.

  2. Frailty and geriatric syndromes in elderly assisted in primary health care

    Directory of Open Access Journals (Sweden)

    Vera Elizabeth Closs

    2016-06-01

    Full Text Available The aim of this study was to describe the association between frailty and geriatric syndromes (GS [cognitive impairment (CI; postural instability (PI; urinary/fecal incontinence (UFI; polypharmacy (PP; and immobility (IM] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS were evaluated. Sociodemographic data, identification of frailty (Fried phenotype and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, self-perception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0-5 was two geriatric syndromes (26.87%. The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI - PI - PP.

  3. Long-term care of dependent elderly and quality of life their carers

    OpenAIRE

    Macková, Marie

    2013-01-01

    This article focuses on the issue of long-term care of dependent elderly and quality of life of their carers. Elderly care has an impact on the quality of life of family members. The research was carried out through a questionnaire and interview. The quality of life was measured using the WHOQOL instrument. The research aimed to identify the current levels of family members’ quality of life and the factors influencing the quality of life thereof. The research findings showed a lower quality o...

  4. COMBINING WORK WITH CARING FOR ELDERLY FAMILY MEMBER IN POLAND (CHOSEN ISSUES

    Directory of Open Access Journals (Sweden)

    Lukasz Jurek

    2016-07-01

    Full Text Available The problem of combining work with caring for elderly family members is becoming an increasingly important matter due to demographic (population ageing and social (increasing economic activity of women changes that are currently in progress. The aim of the article is to present selected issues related to the professional situation of people taking care for their elderly family members. The primary focus of the study is reasons for not working of non-working caregivers, and professional problems of working caregivers

  5. The problem of care of the elderly in terms of moral theory

    Directory of Open Access Journals (Sweden)

    Grażyna Kowalik

    2015-07-01

    Full Text Available Currently there are around 630 million 60-year-olds living in the world. According to WHO estimates, in 2050 the number will exceed 2,000,000,000. Care of this group of people is gaining a new meaning. It is generally believed that people should treat others in a moral manner, which should also apply to the elderly. Morality imposes certain restrictions on the actions taken to satisfy selfish desires. It identifies a number of objectives to be followed in life. This work is an attempt to determine more precisely what a moral action means in relation to care of the elderly in light of different ethical approaches.

  6. Assistive social robots in elderly care: a review

    NARCIS (Netherlands)

    Broekens, J.; Heerink, M.; Rosendal, H.

    2009-01-01

    Assistive social robots, a particular type of assistive robotics designed for social interaction with humans, could play an important role with respect to the health and psychological well-being of the elderly. Objectives: Assistive social robots are believed to be useful in eldercare for two reason

  7. 447 Clothing for Elderly Persons: Management and Caring Strategies

    African Journals Online (AJOL)

    FIRST LADY

    2011-01-18

    Jan 18, 2011 ... so, the need and desire for food, and probably for fashion. The taste and choice of clothing among the elderly is believed to be tied with the individual .... other factors, this disease could cause a person to become so insensitive to ... location of older people and the role of consumer culture in age identities.

  8. Assistive social robots in elderly care: a review

    NARCIS (Netherlands)

    Broekens, J.; Heerink, M.; Rosendal, H.

    2009-01-01

    Assistive social robots, a particular type of assistive robotics designed for social interaction with humans, could play an important role with respect to the health and psychological well-being of the elderly. Objectives: Assistive social robots are believed to be useful in eldercare for two

  9. Recognition and perception of elder abuse by prehospital and hospital-based care providers.

    Science.gov (United States)

    Rinker, Austin G

    2009-01-01

    The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers

  10. [A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

    Science.gov (United States)

    Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

    2015-12-01

    Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

  11. Significance and Costs of Complex Biopsychosocial Health Care Needs in Elderly People : Results of a Population-Based Study

    NARCIS (Netherlands)

    Wild, Beate; Heider, Dirk; Maatouk, Imad; Slaets, Joris; Koenig, Hans-Helmut; Niehoff, Dorothea; Saum, Kai-Uwe; Brenner, Hermann; Soellner, Wolfgang; Herzog, Wolfgang

    2014-01-01

    Objective: To improve health care for the elderly, a consideration of biopsychosocial health care needs may be of particular importance-especially because of the prevalence of multiple conditions, mental disorders, and social challenges facing elderly people. The aim of the study was to investigate

  12. An Integrated Curriculum of Nursing, Nutrition, Exercise, and Drugs for Health Care Providers of the Elderly (Project NNED).

    Science.gov (United States)

    Summit-Portage Area Health Education Network, Akron, OH.

    This document is intended to give health care providers interdisciplinary information concerning drugs, nutrition, and exercise to help them enhance health maintenance of the elderly. Prepared as part of Project NNED, (Nursing, Nutrition, Exercise, and Drugs), an integrated curriculum for health care providers of the elderly, the document includes…

  13. Norms and Care Relationships in Transnational Families: The Case of Elderly Parents Left Behind in Lithuania

    Directory of Open Access Journals (Sweden)

    Gedvilaitė-Kordušienė Margarita

    2015-10-01

    Full Text Available In the context of high migration rates and limited formal care support for the elderly the paper deals with normative expectations and actual flows of support in Lithuanian transnational families. The study is based on a representative survey of elderly parents who have at least one migrant child (N=305. The data analysis revealed predominance of familistic attitudes towards filial responsibilities in transnational families. We did not find any significant differences in filial expectations between the two types of transnational families (elderly parents having only migrant children and those with both migrant and non-migrant children. High expectations of elderly parents are not being met in regards to face-to-face and virtual contacts with migrant adult children. The differences in provided/ received emotional support between migrant and non-migrant children were insignificant. However, the data revealed significant differences in provided/received financial support between migrant and non-migrant children.

  14. Receptive Vocabulary and Cognition of Elderly People in Institutional Care.

    Science.gov (United States)

    Ibrahimagic, Amela; Zunic, Lejla Junuzovic; Ibrahimagic, Omer C; Smajlovic, Dzevdet; Rasidovic, Mirsada

    2017-06-01

    Basic cognitive functions such as: alertness, working memory, long term memory and perception, as well as higher levels of cognitive functions like: speech and language, decision-making and executive functions are affected by aging processes. Relations between the receptive vocabulary and cognitive functioning, and the manifestation of differences between populations of elderly people based on the primary disease is in the focus of this study. To examine receptive vocabulary and cognition of elderly people with: verified stroke, dementia, verified stroke and dementia, and without the manifested brain disease. The sample consisted of 120 participants older than 65 years, living in an institution. A total of 26 variables was analyzed and classified into three groups: case history/anamnestic, receptive vocabulary assessment, and cognitive assessments. The interview with social workers, nurses and caregivers, as well as medical files were used to determine the anamnestic data. A Montreal Cognitive Assessment Scale (MoCA) was used for the assessment of cognition. In order to estimate the receptive vocabulary, Peabody Picture Vocabulary Test was used. Mean raw score of receptive vocabulary is 161.58 (+-21:58 points). The best results for cognitive assessment subjects achieved on subscales of orientation, naming, serial subtraction, and delayed recall. Discriminative analysis showed the significant difference in the development of receptive vocabulary and cognitive functioning in relation to the primary disease of elderly people. The biggest difference was between subjects without manifested brain disease (centroid = 1.900) and subjects with dementia (centroid = -1754). There is a significant difference between elderly with stroke; dementia; stroke and dementia, and elderly people without manifested disease of the brain in the domain of receptive vocabulary and cognitive functioning. Variables of serial subtraction, standardized test results of receptive vocabulary

  15. Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder.

    Science.gov (United States)

    Okada, Akira

    2014-05-16

    Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued. 2014 BMJ Publishing Group Ltd.

  16. Effect of social networks and well-being on acute care needs.

    Science.gov (United States)

    Sintonen, Sanna; Pehkonen, Aini

    2014-01-01

    The effect of social surroundings has been noted as an important component of the well-being of elderly people. A strong social network and strong and steady relationships are necessary for coping when illness or functional limitations occur in later life. Vulnerability can affect well-being and functioning particularly when sudden life changes occur. The objective of this study was to analyse how the determinants of social well-being affect individual acute care needs when sudden life changes occur. Empirical evidence was collected using a cross-sectional mail survey in Finland in January 2011 among individuals aged 55-79 years. The age-stratified random sample covered 3000 individuals, and the eventual response rate was 56% (1680). Complete responses were received from 1282 respondents (42.7%). The study focuses on the compactness of social networks, social disability, the stability of social relationships and the fear of loneliness as well as how these factors influence acute care needs. The measurement was based on a latent factor structure, and the key concepts were measured using two ordinal items. The results of the structural model suggest that the need for care is directly affected by social disability and the fear of loneliness. In addition, social disability is a determinant of the fear of loneliness and therefore plays an important role if sudden life changes occur. The compactness of social networks decreases social disability and partly diminishes the fear of loneliness and therefore has an indirect effect on the need for care. The stability of social relationships was influenced by the social networks and disability, but was an insignificant predictor of care needs. To conclude, social networks and well-being can decrease care needs, and supportive actions should be targeted to avoid loneliness and social isolation so that the informal network could be applied as an aspect of care-giving when acute life changes occur.

  17. Acute inflammation in horizontal incompletely impacted third molar with radiolucency in the elderly

    Directory of Open Access Journals (Sweden)

    Minoru Yamaoka

    2009-07-01

    Full Text Available Minoru Yamaoka, Yusuke Ono, Masahiro Takahashi, Masahide Ishizuka, Takayuki Uchihashi, Kouichi Yasuda, Takashi Uematsu, Kiyofumi FurusawaMatsumoto Dental University, Oral and Maxillofacial Surgery, Shiojiri, Nagano, JapanAbstract: Although radiolucency has been shown as a risk of infection, the poorly understood effects of aging on radiolucency correlate with acute pericoronitis, which has a high risk of infection extending any complications. We reviewed the records of 346 consecutive patients aged more than 41 years to evaluate whether pericoronal radiolucency below the crown in mandibular horizontal incompletely impacted third molars is related to acute inflammation. The frequency of acute inflammation in teeth with pericoronal radiolucency below the crown was similar to that in teeth without; however, the odds ratio of acute inflammation exhibited in women aged more than 61 years compared to women aged 41–50 years was 9.77 (95% confidence interval [CI]: 1.67–57.29; P <<0.05, and in women aged more than 61 years compared to women aged 51–60 years was 26.25 (95% CI: 2.94–234.38; P < 0.01. The odds ratio of severe acute inflammation exhibited in men aged more than 61 years compared to men aged 41–50 years was 16.67 (95% CI: 1.76–158.27; P < 0.01. These odds ratios indicate an association of acute pericoronitis, including the severe forms of acute inflammation that result from pericoronitis, with pericoronal radiolucency below the crown in the elderly.Keywords: radiolucency, mandible, third molar, acute inflammation, aging

  18. Use of social commitment robots in the care of elderly people with dementia: a literature review.

    Science.gov (United States)

    Mordoch, Elaine; Osterreicher, Angela; Guse, Lorna; Roger, Kerstin; Thompson, Genevieve

    2013-01-01

    Globally, the population of elderly people is rising with an increasing number of people living with dementias. This trend is coupled with a prevailing need for compassionate caretakers. A key challenge in dementia care is to assist the person to sustain communication and connection to family, caregivers and the environment. The use of social commitment robots in the care of people with dementia has intriguing possibilities to address some of these care needs. This paper discusses the literature on the use of social commitment robots in the care of elderly people with dementia; the contributions to care that social commitment robots potentially can make and the cautions around their use. Future directions for programs of research are identified to further the development of the evidence-based knowledge in this area.

  19. Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients

    DEFF Research Database (Denmark)

    Olesen, Charlotte; Harbig, Philipp; Buus, Kirsten Marie;

    2014-01-01

    Background Elderly polypharmacy patients may be more at risk of not adhering to medication. If so, the underlying reasons may be more readily disclosed during private discussions with patients. Hence pharmaceutical care discussions at home might improve treatment adherence. Objective The aim...... of this study was to investigate the impact of pharmaceutical care on medication adherence, hospitalisation and mortality in elderly patients prescribed polypharmacy. Setting Pharmaceutical care discussed at home. Methods A randomised controlled trial with two arms; pharmaceutical care (n = 315) and controls (n...... by a pill-count. Patients were categorised as non-adherent if their mean adherence rate for all drugs consumed was pharmaceutical care on non-adherence and hospitalisation was analysed by 2 × 2 tables, and mortality by Cox regression. Main outcome measure Medication adherence...

  20. Focused Acute Medicine Ultrasound (FAMUS) - point of care ultrasound for the Acute Medical Unit.

    Science.gov (United States)

    Smallwood, Nicholas; Dachsel, Martin; Matsa, Ramprasad; Tabiowo, Eugene; Walden, Andrew

    2016-01-01

    Point of care ultrasound (POCU) is becoming increasingly popular as an extension to clinical examination techniques. Specific POCU training pathways have been developed in specialties such as Emergency and Intensive Care Medicine (CORE Emergency Ultrasound and Core UltraSound Intensive Care, for example), but until this time there has not been a curriculum for the acutely unwell medical patient outside of Critical Care. We describe the development of Focused Acute Medicine Ultrasound (FAMUS), a curriculum designed specifically for the Acute Physician to learn ultrasound techniques to aid in the management of the unwell adult patient. We detail both the outline of the curriculum and the process involved for a candidate to achieve FAMUS accreditation. It is anticipated this will appeal to both Acute Medical Unit (AMU) clinicians and general physicians who deal with the unwell or deteriorating medical or surgical patient. In time, the aspiration is for FAMUS to become a core part of the AIM curriculum.

  1. Voices from the Gila: health care issues for rural elders in south-western New Mexico.

    Science.gov (United States)

    Averill, Jennifer B

    2002-12-01

    A goal of the Healthy People 2010 initiative is to reduce or eliminate health disparities in vulnerable populations, including populations from rural and minority ethnic backgrounds. Rural communities, including elderly populations, experience lower rates of personal income, educational attainment, health-insurance coverage, access to emergency and specialty care services, and reported health status than do urban communities. A need exists to address identified research priorities, such as the perceptions of rural elders, their family members, and health care providers. The purposes of this study were to explore the health care perceptions, needs, and definitions of health for multicultural rural elders in one county of south-western New Mexico, and to consider practice implications. Informed consent procedures followed the University of New Mexico Health Sciences Center Human Research Review Committee guidelines. Research methods. This critical ethnography incorporated ethnographic interviews, ethnographic participant observation, photography, review of pertinent documents, and analysis of contextual factors. The sample consisted of 22 participants. Definitions of health varied with socioeconomic status, encompassing avoidance of contact with the health care system, obtaining needed medications, remaining independent, a sense of spiritual belonging, eating wisely, and exercising moderately. Three major concerns emerged from the analysis: the escalating cost of prescription drugs, access-to-care issues, and social isolation. The primary limitation was the small sample size. Although the researcher's position as an outsider to local communities may also have affected the outcome, it provided fresh insight to regional problems. The study addressed national research priorities for a vulnerable group of rural elders. Nursing implications include the need for expanded knowledge and educational preparation regarding elder issues and community-level services, inclusion of

  2. Attitudes towards older people among Swedish health care students and health care professionals working in elder care

    Directory of Open Access Journals (Sweden)

    Gabriella Engström

    2011-05-01

    Full Text Available The proportion of older people in the general population has increased and will continue to increase during the coming decade. Therefore, a positive attitude towards older people is important. The aim of the study was to gain knowledge about attitudes towards older people among health care students and health care staff in Swedish elder care settings. The study includes a convenience sample of 928 respondents comprised of health care students and three groups of professional caregivers [registered nurses (RNs with university degrees, certified nursing assistants (CNAs, nurses] in a variety of health care settings in Sweden. The participants completed the Kogan’s Old People (KOPS Scale with 17 positive (OP+ and 17 negative (OP– statements. The statements score ranged from 17 to 85 respectively. A significant (P<0.05 difference in both positive and negative scores was observed among the three professional caregiver groups. RNs had the highest positive score (OP+:64 as well as the lowest negative score (OP–:36. Health care students in semester one had the most unfavourable attitude toward older people (OP–:41 while students in semester two had the most favourable attitude toward older people (OP+:62. RNs reported both a higher positive score as well as lower negative score compared to nurses without an academic degree and CNAs. In addition, we found that progression in one’s health care education contributes to reduce unfavourable attitudes toward older people. Health care professionals need to have the right skills to manage a more demanding role in the future in order to offer effective services for older people. A skilled workforce of health professionals is therefore very necessary.

  3. [Diagnosis of acute heart failure and relevance of biomarkers in elderly patients].

    Science.gov (United States)

    Ruiz Ortega, Raúl Antonio; Manzano, Luis; Montero-Pérez-Barquero, Manuel

    2014-03-01

    Diagnosis of acute heart failure (HF) is difficult in elderly patients with multiple comorbidities. Risk scales and classification criteria based exclusively on clinical manifestations, such as the Framingham scales, lack sufficient specificity. In addition to clinical manifestations, diagnosis should be based on two key factors: natriuretic peptides and echocardiographic study. When there is clinical suspicion of acute HF, a normal natriuretic peptide level will rule out this process. When a consistent clinical suspicion is present, an echocardiographic study should also be performed. Diagnosis of HF with preserved ejection fraction (HF/pEF) requires detection of an enlarged left atrium or the presence of parameters of diastolic dysfunction. Elevation of cardiac biomarkers seems to be due to myocardial injury and the compensatory mechanisms of the body against this injury (hormone and inflammatory response and repair mechanisms). Elevation of markers of cardiac damage (troponins and natriuretic peptides) have been shown to be useful both in the diagnosis of acute HF and in prediction of outcome. MMP-2 could be useful in the diagnosis of HF/pEF. In addition to biomarkers with diagnostic value, other biomarkers are helpful in prognosis in the acute phase of HF, such as biomarkers of renal failure (eGFR, cystatin and urea), inflammation (cytokines and CRP), and the cell regeneration marker, galectin-3. A promising idea that is under investigation is the use of panels of biomarkers, which could allow more accurate diagnosis and prognosis of acute HF.

  4. Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

    Directory of Open Access Journals (Sweden)

    Patricia Steinert

    2016-08-01

    Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

  5. Ageing and Non-Formal Care for Elderly Persons in Croatia

    Directory of Open Access Journals (Sweden)

    Sonja Podgorelec

    2007-06-01

    Full Text Available Ageing and depopulation are the fundamental demographic processes in the development of the population of Croatia. In the total population in 2001 the age group encompassing persons 65 years of age and older made up 15.7% of the total population. The age structure of the population is one of the essential determinants of the quality of lives of individuals, especially within the family. Based on an analysis of demographic indicators (the population structure, the ratio of females, the ageing index, the age coefficient, average age, age-dependency ratios, marital status, and a brief review of migration history in the second half of the 20th century, the goal of this paper is to evaluate the quality of non-formal care of the elderly in relation to potential care providers. Due to ageing in the total population of Croatia, due to a reduction in the number of children per family and separate residences of adult children and their elderly parents, the circle of main care providers for the elderly has diminished. With the decrease in the number of family members, increasingly frequent forms of single-parent families and the employment of women, who were traditionally the most important providers of all forms of non-formal care, insufficient care for the elderly within families has become a problem. Despite changes in the way of life, the family is still the basic source of emotional, informational and instrumental support for elderly people. The help and support that the elderly receive from friends is roughly equal in the city and in villages, although neighbourly help is somewhat greater in non-urban areas (for example in Istria and on the islands. However, researches confirm that the social network of support and help among the rural population has changed since the nineties of the last century. To a certain extent the support of friends and neighbours may substitute the lack of care by children, but a weaker network of homes for the elderly and

  6. iCare: A Mobile Health Monitoring System for the Elderly

    CERN Document Server

    Lv, Ziyu; Wu, Guowei; Yao, Lin; Chen, Zhikui

    2010-01-01

    This paper describes a mobile health monitoring system called iCare for the elderly. We use wireless body sensors and smart phones to monitor the wellbeing of the elderly. It can offer remote monitoring for the elderly anytime anywhere and provide tailored services for each person based on their personal health condition. When detecting an emergency, the smart phone will automatically alert pre-assigned people who could be the old people's family and friends, and call the ambulance of the emergency centre. It also acts as the personal health information system and the medical guidance which offers one communication platform and the medical knowledge database so that the family and friends of the served people can cooperate with doctors to take care of him/her. The system also features some unique functions that cater to the living demands of the elderly, including regular reminder, quick alarm, medical guidance, etc. iCare is not only a real-time health monitoring system for the elderly, but also a living ass...

  7. Key informants' perceptions of health care for elders at the U.S.-Mexico border.

    Science.gov (United States)

    Guo, Guifang; Phillips, Linda

    2006-01-01

    This study was part of a systematic assessment to gain an understanding of aging in a rural community along the U.S.-Mexico border in Arizona. It used a participatory action research design. Interviews were conducted among key informants (n = 29), including health and social services providers and community leaders. Content analysis focused on identifying common themes and concerns related to elders. Major themes identified were (1) social infrastructure issues, (2) community awareness of health problems, (3) socioeconomic problems, (4) cultural influences on health beliefs, practice, and use of services, (5) image of aging, (6) border issues, and (7) educational needs for service providers. Elders living at the border are a particularly vulnerable population with strong cultural affiliations and health disparities. Although the population of elders has been growing at the border, the traditional focus on the health care needs of youth and children has contributed to the neglect of issues facing elders. This study provided community key informants' perspective of aging to community members, policy makers, service agencies, and health care providers for community development. A conceptual framework was developed for educational programs and research projects for health professionals who care for elders at the border.

  8. Assessing the link between health care utilisation in general practice and morbidity patterns in the elderly in the Nordic countries

    DEFF Research Database (Denmark)

    Halling, Anders; Kristensen, Troels; Ranstad, Karin

    important areas of healthcare utilisation in general practice in the Nordic countries. In the future, this demand for healthcare services among the elderly is expected to increase. For instance, it is likely that people live longer and advanced technologies continue to be developed, affecting demand...... and individual level patient morbidity and socioeconomic characteristics among older people with extensive and complex care needs. Background: In the Nordic countries municipalities and regions are using a significant amount of resources on care for the elderly. Elderly care is one of the largest and most...... and healthcare costs. Developments in the functional level of the elderly mean that we have a growing group of well-functioning elderly. This group can do without or with little care, but at the same time there is a growing group of older people with extensive and complex care needs (e.g., dementia, COPD...

  9. Quality in transitional care of the elderly: Key challenges and relevant improvement measures

    Directory of Open Access Journals (Sweden)

    Marianne Storm

    2014-05-01

    Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment.Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

  10. A high-protein diet during hospitalization is associated with an accelerated decrease in soluble urokinase plasminogen activator receptor levels in acutely ill elderly medical patients with SIRS

    DEFF Research Database (Denmark)

    Tavenier, Juliette; Haupt, Thomas Huneck; Andersen, Aino L

    2017-01-01

    Acute illness and hospitalization in elderly individuals are often accompanied by the systemic inflammatory response syndrome (SIRS) and malnutrition, both associated with wasting and mortality. Nutritional support and resistance training were shown to increase muscle anabolism and reduce...... inflammation in healthy elderly. We hypothesized that nutritional support and resistance training would accelerate the resolution of inflammation in hospitalized elderly patients with SIRS. Acutely admitted patients aged >65 years with SIRS were randomized to an intervention consisting of a high-protein diet...... accelerate recovery in acutely ill elderly medical patients....

  11. [Burnout syndrome in elderly care takers working in social care homes].

    Science.gov (United States)

    González-Losa, María Del Refugio; Vázquez-García, Carlos; Esperón, Ramón

    2013-01-01

    To identify the presence and characteristics of Burnout syndrome in subjects dedicated to the care of older adults in homes for seniors. A descriptive study was done, 46 workers of 10 homes in Mérida, Yucatán, were included. Subjects older than 18 years and who have direct interaction with adults were included. To evaluate the presence of Burnout syndrome the Spanish version of the Maslach Burnout Inventory was used. Sixty-five percent of the population studied was female and 35% male, the average age was 38 years, with a range of 19-60 years. 87% of the studied population had some level of Burnout syndrome. In 60% of homes all the workers were affected. Regard gender 90% of the women has some grade of Burnout syndrome and 81% of males. Respect areas affected, 30% had emotional exhaustion, 46% depersonalization and 95% lack of realization. According the number of affected areas 45% were affected in one area, 30% in two and 25% in three, the latter representing 22% of the study population. There is a high frequency of Burnout syndrome among subjects who are dedicated to caring for the elderly. Personal accomplishment was the most affected area. Subjects with lowest salary present higher frequency of Burnout syndrome.

  12. Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway.

    Science.gov (United States)

    Tsiompanou, Eleni; Lucas, Caroline; Stroud, Mike

    2013-06-01

    This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.

  13. [Risks of drug-nutrient interaction for the elderly in long-term care institutions].

    Science.gov (United States)

    Peixoto, Jessica Sereno; Salci, Maria Aparecida; Radovanovic, Cremilde Aparecida Trindade; Salci, Tania Pereira; Torres, Maricy Morbin; Carreira, Lígia

    2012-09-01

    This study was aimed at verifying the risks of drug-nutrient interactions in the elderly residents of a long-term care institution. Descriptive study of quantitative approach, performed in 73 elderly people. Data collection occurred in 2008 through analysis of medical records, diet history and evaluation of the BMI. Data evidenced that the drugs more frequently used were the ones for nervous and cardiovascular systems, totaling approximately 66% of the prescriptions; among the 375 drugs prescribed 166 make some type of interaction, 32.0% reduce the effect of drug absorption when there is use with caffeine and 14.3% reduce the B12 vitamin absorption. Taking several drugs of continuous use may cause damage to the absorption of nutrients. The action of the health team becomes vital, through careful evaluation of the administered drugs, diet and interaction between them, to benefit the elderly with a better use of the therapeutics and improvement of the nutritional conditions.

  14. Independence, Security, and the intergenerational social contract: home-helper services and elder care in rural Japan.

    Science.gov (United States)

    Traphagan, John W

    2003-01-01

    For several years, demographic trends and changing ideas about responsibilities for elder care in Japan have contributed to the desire, or need, for families to seek out new care approaches. This article focuses on one alternative to traditional approaches to caring for elder family members--the home-helper program that is available through the Japanese long-term care insurance program. Using ethnographic data collected in northern Japan, it will be argued that the home-helper program forms a compensatory elder care system that is intended to augment family-provided care and social support, rather than to promote independent living. This compensatory approach to elder care is based upon an intergenerational social contract in which it is assumed that some degree of dependence on family members is both an expected and preferred outcome of growing old.

  15. Outcomes of Cardiac Arrest in Residential Care Homes for the Elderly in Hong Kong.

    Science.gov (United States)

    Fan, Kit Ling; Leung, Ling Pong

    2017-05-03

    Studies done in the 1990's suggested nursing home residents with cardiac arrest had minimal chance of survival and resuscitation was not recommended. More recent studies showed opposing results. In Hong Kong, the proportion of elderly living in the residential care homes for the elderly is increasing. There is no study of out-of-hospital cardiac arrest outcomes in this population. This study aimed at evaluating the prognosis of out-of-hospital cardiac arrest occurring in the residential care homes for the elderly. It is hoped that the findings may inform the local emergency medical service concerning the issue of futility of resuscitating the residents with cardiac arrest in the residential care homes. This study was a retrospective analysis of a database of all patients aged 65 years or above with atraumatic out-of-hospital cardiac arrest and who were attended by the emergency medical service in a 12-month period. Data in the database were prospectively collected by the emergency medical service. The characteristics of patients and cardiac arrests, timeliness of the emergency medical service, and survival were analyzed. Comparison was made between elderly living in and not living in the residential care homes. Predictors of survival were evaluated with logistic regression. 3919 patients aged ≥ 65 years were analyzed. There were 1506 cases of cardiac arrest occurring in the residential care homes for the elderly. Resuscitation was discontinued at the emergency department in over 70% of these cases. The survival to hospital admission rate and the 30-day survival rate were 9.6% and 0.3% respectively. Both were lower than patients not residing in the residential care homes. Younger age, witnessed arrest, bystander defibrillation, and shorter call to ED interval were associated with higher chance of surviving to hospital admission. Elderly suffering from cardiac arrest in residential care homes had a poor chance of survival. Except age, witnessed arrest, bystander

  16. Forecasting the use of elderly care: a static micro-simulation model.

    Science.gov (United States)

    Eggink, Evelien; Woittiez, Isolde; Ras, Michiel

    2016-07-01

    This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).

  17. Nurses' perceptions of multidisciplinary team work in acute health-care.

    Science.gov (United States)

    Atwal, Anita; Caldwell, Kay

    2006-12-01

    Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one's own role but also the role of other professionals. The aim of this study was to explore nurses' perceptions of multidisciplinary teamwork in acute health-care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health-care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team-playing skills is an integral part of continued professional development.

  18. [Assessment of the association between nursing care services, hypertension, and Alzheimer's disease in elderly patients with late-stage diabetes].

    Science.gov (United States)

    Kondo, Seiji; Kondo, Yasuko; Kitagawa, Chihiro; Katsuta, Sayaka

    2013-12-01

    In an aging society with fewer children, diabetes self-control is difficult for elderly patients. Under these circumstances, it is expected that living in care homes for the elderly and institutions where nursing care services could be provided will help improve the prognosis of diabetic patients. Therefore, we assessed whether HbA(1c). levels (National Glycohemoglobin Standardization Program : NGSP) in 121 elderly patients with late-stage diabetes receiving home medical care in our clinic from March 2008 to March 2013 improved with nursing care services.

  19. Hyperintense acute reperfusion marker on FLAIR is not associated with early haemorrhagic transformation in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Rozanski, Michal [Charite, Universitaetsmedizin Berlin, Department of Neurology, Center for Stroke Research Berlin-CSB, Berlin (Germany); Charite Campus Mitte, Department of Neurology, Berlin (Germany); Ebinger, Martin; Schmidt, Wolf U.; Hotter, Benjamin; Pittl, Sandra; Heuschmann, Peter U.; Jungehuelsing, Jan G.; Fiebach, Jochen B. [Charite, Universitaetsmedizin Berlin, Department of Neurology, Center for Stroke Research Berlin-CSB, Berlin (Germany)

    2010-12-15

    The hyperintense acute reperfusion marker (HARM) has been described as a predictor for haemorrhagic transformation (HT) in acute ischaemic stroke. We hypothesised that this phenomenon is not present in the elderly. It was possible to assess 47/84 consecutive patients aged 80 and over with diagnosed ischaemic stroke or transient ischaemic attack (TIA). MRI was performed within 24 h of onset of symptoms with follow-up MRI within a further 48 h. Of 47 included patients, 19 showed HARM; it was only seen on follow-up examination. Ten of the 47 patients underwent thrombolysis with recombinant tissue plasminogen activator (rt-PA); 4 of them showed HARM, and 1 of those showed HT. HARM was found in three out of eight patients with haemorrhagic transformation on baseline and/or follow-up MRI. We did not observe an association between HARM and early HT either in the whole group or in the patients who received thrombolysis. HARM was not associated with HT in the elderly after ischaemic stroke, independent of treatment. While it may indicate dysfunction of the blood-brain barrier (BBB), it does not necessarily amount to HT. (orig.)

  20. Viral etiology among the elderly presenting acute respiratory infection during the influenza season

    Directory of Open Access Journals (Sweden)

    Aripuanã Sakurada Aranha Watanabe

    2011-02-01

    Full Text Available INTRODUCTION: Acute respiratory tract infections are the most common illness in all individuals. Rhinoviruses have been reported as the etiology of more than 50% of respiratory tract infections worldwide. The study prospectively evaluated 47 elderly individuals from a group of 384 randomly assigned for acute respiratory viral infections (cold or flu and assessed the occurrence of human rhinovirus (HRV, influenza A and B, respiratory syncytial virus and metapneumovirus (hMPV in Botucatu, State of São Paulo, Brazil. METHODS: Forty-nine nasal swabs collected from 47 elderly individuals following inclusion visits from 2002 to 2003 were tested by GenScan RT-PCR. HRV-positive samples were sequenced for phylogenetic analysis. RESULTS: No sample was positive for influenza A/B or RSV. HRV was detected in 28.6% (14/47 and hMPV in 2% (1/47. Of 14 positive samples, 9 isolates were successfully sequenced, showing the follow group distribution: 6 group A, 1 group B and 2 group C HRVs. CONCLUSIONS: The high incidence of HRV during the months of the influenza season requires further study regarding HRV infection impact on respiratory complications among this population. Infection caused by HRV is very frequent and may contribute to increasing the already high demand for healthcare during the influenza season.

  1. The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Xiong HUANG; Xuebin CAO; Gang ZHANG

    2008-01-01

    It is challenging to undo early percutaneous intervention (PCI) in the elderly with acute coronary syndrome (ACS). Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4, 2004 to December 12, 2005. All the patients had early percutaneous coronary intervention and were followed up for 6-12 months by telephone or in the out-patient department. Nine of the 15 patients exhibited acute myocardial infarction (AMI). Six exhib-ited unstable angina (UA). All the patients had early PCI. The average door-to-balloon time was 78 minutes (40-110 minutes). The average PCI time was 99 minutes (68-120 minutes). Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total. All the procedures were considered successful. Neither deaths nor recurrent angina occurred in the 6-12 months of follow-up. It was shown that early PCI might be an effective and safe method to treat eld-erly patients with ACS.

  2. Learning from Errors at Work: A Replication Study in Elder Care Nursing

    Science.gov (United States)

    Leicher, Veronika; Mulder, Regina H.; Bauer, Johannes

    2013-01-01

    Learning from errors is an important way of learning at work. In this article, we analyse conditions under which elder care nurses use errors as a starting point for the engagement in social learning activities (ESLA) in the form of joint reflection with colleagues on potential causes of errors and ways to prevent them in future. The goal of our…

  3. [Training in emergency procedures and care and management of elderly people].

    Science.gov (United States)

    Dahr, Amaël

    2013-01-01

    Since the introduction of skills-based training reference frameworks for the training of nursing assistants and student nurses, certification in training in emergency procedures and care is an integral part of the initial training of future healthcare professionals. The elderly person is a great example for learning rightgestures.

  4. Attitudes of Medical Students and Residents toward Care of the Elderly

    Science.gov (United States)

    Muangpaisan, Weerasak; Intalapapron, Somboon; Assantachai, Prasert

    2008-01-01

    The research reported in this article examined attitudes toward the care of the elderly between and among medical students and residents in training. Data were collected with a 16-item attitude questionnaire. Participants were medical students in their introduction period (prior to clinical experience) and residents of the Department of Internal…

  5. The Impact of Elderly Care Competence and Quality Improvement Programme in Four Swedish Municipalities

    Science.gov (United States)

    Westerberg, Kristina; Hjelte, Jan

    2013-01-01

    During a number of years Swedish municipalities have work with improvement of competence and long-term quality in elderly care. The overall aim of the present study was to compare different learning activities (workplace improvement and/or courses), and to relate these activities to learning climate, learning strategies, and perception of care…

  6. Attitudes of Medical Students and Residents toward Care of the Elderly

    Science.gov (United States)

    Muangpaisan, Weerasak; Intalapapron, Somboon; Assantachai, Prasert

    2008-01-01

    The research reported in this article examined attitudes toward the care of the elderly between and among medical students and residents in training. Data were collected with a 16-item attitude questionnaire. Participants were medical students in their introduction period (prior to clinical experience) and residents of the Department of Internal…

  7. The Elderly Population with Chronic Functional Disability: Implications for Home Care Eligibility.

    Science.gov (United States)

    Stone, Robyn I.; Murtaugh, Christopher M.

    1990-01-01

    Assessed effect of changes in minimum number of activities of daily living (ALD) and instrumental activities of daily living (IADL) limitations, types of help, and duration of disability required on size of population potentially eligible for home care benefits. Only 411,000 elders met restrictive disability criteria; over 4 million would qualify…

  8. [The availability of particular types of medical social care to persons of elderly and senile age].

    Science.gov (United States)

    Shigabutdinov, A F

    2012-01-01

    The article presents the results of sociological survey of respondents of elderly and senile age living with their families or in senior centers. The comparative analysis was applied to availability of particular types of medical social care of contingent of interest depending on place of its residence. The age and ability of self-support of respondents were taken into account.

  9. Tracing Error-Related Knowledge in Interview Data: Negative Knowledge in Elder Care Nursing

    Science.gov (United States)

    Gartmeier, Martin; Gruber, Hans; Heid, Helmut

    2010-01-01

    This paper empirically investigates elder care nurses' negative knowledge. This form of experiential knowledge is defined as the outcome of error-related learning processes, focused on how something is not, on what not to do in certain situations or on deficits in one's knowledge or skills. Besides this definition, we presume the existence of…

  10. Elder Disability as an Explanation for Racial Differences in Informal Home Care

    Science.gov (United States)

    Li, Lydia W.; Fries, Brant E.

    2005-01-01

    Purpose: Adjusting for sociodemographic characteristics and disability levels, this study examines whether differences exist in the structure and function of community-dwelling Black and White frail elders' informal care networks. Design and Methods: Data from in-person assessments of Michigan's Home and Community-Based Medicaid Waiver applicants…

  11. Geriatrician Training in the Care of Elders with Intellectual and Other Developmental Disabilities

    Science.gov (United States)

    Tyler, Carl V., Jr.; Rader, Erin; Campbell, James W.; Zyzanski, Stephen J.; Panaite, Vanessa

    2009-01-01

    Adults with intellectual and other developmental disabilities (IDD) are now living to late life. Whether geriatricians are being trained to provide care for this clinically complex subpopulation of elders has not been examined. Two thirds of all geriatric fellowship directors in the United States responded to a Web-based survey of curriculum and…

  12. Systematic review of Kinect applications in elderly care and stroke rehabilitation.

    Science.gov (United States)

    Webster, David; Celik, Ozkan

    2014-07-03

    In this paper we present a review of the most current avenues of research into Kinect-based elderly care and stroke rehabilitation systems to provide an overview of the state of the art, limitations, and issues of concern as well as suggestions for future work in this direction. The central purpose of this review was to collect all relevant study information into one place in order to support and guide current research as well as inform researchers planning to embark on similar studies or applications. The paper is structured into three main sections, each one presenting a review of the literature for a specific topic. Elderly Care section is comprised of two subsections: Fall detection and Fall risk reduction. Stroke Rehabilitation section contains studies grouped under Evaluation of Kinect's spatial accuracy, and Kinect-based rehabilitation methods. The third section, Serious and exercise games, contains studies that are indirectly related to the first two sections and present a complete system for elderly care or stroke rehabilitation in a Kinect-based game format. Each of the three main sections conclude with a discussion of limitations of Kinect in its respective applications. The paper concludes with overall remarks regarding use of Kinect in elderly care and stroke rehabilitation applications and suggestions for future work. A concise summary with significant findings and subject demographics (when applicable) of each study included in the review is also provided in table format.

  13. Malnutrition in the elderly residing in long-term care facilities: a cross ...

    African Journals Online (AJOL)

    Subjects: Sixty-two elderly residing in a long-term care facility from both the higher and lower socio-economic areas ... symptoms of depression are recognised risk factors for ... In view of the impact of malnutrition on health and quality of life,.

  14. An activity monitoring system for elderly care using generative and discriminative models

    NARCIS (Netherlands)

    van Kasteren, T.L.M.; Englebienne, G.; Kröse, B.J.A.

    2010-01-01

    An activity monitoring system allows many applications to assist in care giving for elderly in their homes. In this paper we present a wireless sensor network for unintrusive observations in the home and show the potential of generative and discriminative models for recognizing activities from such

  15. The Impact of Elderly Care Competence and Quality Improvement Programme in Four Swedish Municipalities

    Science.gov (United States)

    Westerberg, Kristina; Hjelte, Jan

    2013-01-01

    During a number of years Swedish municipalities have work with improvement of competence and long-term quality in elderly care. The overall aim of the present study was to compare different learning activities (workplace improvement and/or courses), and to relate these activities to learning climate, learning strategies, and perception of care…

  16. Care staff training in detection of depression in residential homes for the elderly - Randomised trial

    NARCIS (Netherlands)

    Eisses, AMH; Kluiter, H; Jongenelis, K; Beekman, ATF; Ormel, J

    2005-01-01

    Background. Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected. Aims. To determine the effects of staff training on the detection, treatment and outcome of depression in residents often homes. Method. We conducte

  17. Nurses' knowledge of universal health coverage for inclusive and sustainable elderly care services

    Directory of Open Access Journals (Sweden)

    Fabian Ling Ngai Tung

    2016-01-01

    Full Text Available Objectives: to explore nurses' knowledge of universal health coverage (UHC for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN or registered nurses (RN was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs. Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services.

  18. AmI in good care? Developing design principles for ambient intelligent domotics for elderly

    NARCIS (Netherlands)

    Meulendijk, Michiel; van de Wijngaert, Lidwien; Brinkkemper, Sjaak; Leenstra, Herbert

    2011-01-01

    The combination of ambient intelligence (AmI) and domotics has the potential to respond to elderly people's desire to live independent from extensive forms of care. Their slow adoption of technological aids shows reluctance, though. This article investigates their motivations to adopt ambient

  19. Social justice, health disparities, and culture in the care of the elderly.

    Science.gov (United States)

    Dilworth-Anderson, Peggye; Pierre, Geraldine; Hilliard, Tandrea S

    2012-01-01

    Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The "conundrum of health disparities" refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans.

  20. The prevalence of depression among elderly warded in a tertiary care centre in Wilayah Persekutuan.

    Science.gov (United States)

    Sherina, M S; Rampal, L; Hanim, M Arfah; Thong, P L

    2006-03-01

    Depression is characterized by symptoms like disturbance in behavior, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the orthopaedic, surgical, gynaecology and medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.022), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p= 0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.000), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.

  1. Future of long-term care financing for the elderly in Korea.

    Science.gov (United States)

    Kwon, Soonman

    2008-01-01

    With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly longterm care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.

  2. Acute changes in pulse pressure in relation to constituents of particulate air pollution in elderly persons

    Energy Technology Data Exchange (ETDEWEB)

    Jacobs, Lotte [Occupational and Environmental Medicine, Unit of Lung Toxicology, K.U.Leuven, Leuven (Belgium); Buczynska, Anna [Departement of Chemistry, UA, Wilrijk (Belgium); Walgraeve, Christophe [Research group EnVOC, Department of Sustainable Organic Chemistry and Technology, UGent, Gent (Belgium); Delcloo, Andy [Royal Meteorological Institute, Brussels (Belgium); Potgieter-Vermaak, Sanja [Departement of Chemistry, UA, Wilrijk (Belgium); Molecular Science Institute, School of Chemistry, University of Witwatersrand, Johannesburg (South Africa); Division of Chemistry and Environmental Science, Manchester Metropolitan University, Manchester (United Kingdom); Van Grieken, Rene [Departement of Chemistry, UA, Wilrijk (Belgium); Demeestere, Kristof; Dewulf, Jo; Van Langenhove, Herman [Research group EnVOC, Department of Sustainable Organic Chemistry and Technology, UGent, Gent (Belgium); De Backer, Hugo [Royal Meteorological Institute, Brussels (Belgium); Nemery, Benoit, E-mail: ben.nemery@med.kuleuven.be [Occupational and Environmental Medicine, Unit of Lung Toxicology, K.U.Leuven, Leuven (Belgium); Nawrot, Tim S. [Occupational and Environmental Medicine, Unit of Lung Toxicology, K.U.Leuven, Leuven (Belgium); Centre for Environmental Sciences, Hasselt University, Diepenbeek (Belgium)

    2012-08-15

    An increased pulse pressure (difference between systolic and diastolic blood pressure) suggests aortic stiffening. The objective of this study was to examine the acute effects of both particulate matter (PM) mass and composition on blood pressure, among elderly persons. We carried out a panel study in persons living in elderly homes in Antwerp, Belgium. We recruited 88 non-smoking persons, 70% women with a mean age of 83 years (standard deviation: 5.2). Blood pressure was measured and a blood sample was collected on two time points, which were chosen so that there was an exposure contrast in ambient PM exposure. The elemental content of the collected indoor and outdoor PM{sub 2.5} (particulate matter with an aerodynamic diameter <2.5 {mu}m) mass concentration was measured. Oxygenated polycyclic aromatic hydrocarbons (oxy-PAHs) on outdoor PM{sub 10} (particulate matter with an aerodynamic diameter <10 {mu}m) were measured. Each interquartile range increase of 20.8 {mu}g/m Superscript-Three in 24-h mean outdoor PM{sub 2.5} was associated with an increase in pulse pressure of 4.0 mmHg (95% confidence interval: 1.8-6.2), in persons taking antihypertensive medication (n=57), but not in persons not using antihypertensive medication (n=31) (p for interaction: 0.02). Vanadium, iron and nickel contents of PM{sub 2.5} were significantly associated with systolic blood pressure and pulse pressure, among persons on antihypertensive medication. Similar results were found for indoor concentrations. Of the oxy-PAHs, chrysene-5,6-dione and benzo[a]pyrene-3,6-dione were significantly associated with increases in systolic blood pressure and pulse pressure. In elderly, pulse pressure was positively associated with acute increases in outdoor and indoor air pollution, among persons taking antihypertensive medication. These results might form a mechanistic pathway linking air pollution as a trigger of cardiovascular events.

  3. Elderly people's perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden.

    Science.gov (United States)

    Harrefors, Christina; Sävenstedt, Stefan; Axelsson, Karin

    2009-06-01

    Many countries encounter a demographic change where the number of elderly people will increase. As a result, the number of very old people needing care, services and medical assistance will increase. Care in the private home is often described as providing the best alternative for many elderly people. The aim of this study was to describe elderly people's perceptions of how they wanted to be cared for, from a perspective of becoming in need of assistance with personal care, in the future. Twelve couples of healthy elderly people living in a couple hood participated in an interview study. They were all 70 years and older and received no kind of professional care or social support. Open individual semi-structured interviews were conducted with the support of written vignettes. The vignettes were formed as scenarios that described three levels of caring needs where the elderly people would become ill. A qualitative content analysis was used to analyse the interviews. The findings were interpreted in one main theme: maintaining the self and being cared for with dignity to the end. The theme was built from three categories: at home as long as possible, professional care at nursing home when advanced care is needed and fear of being abandoned. The categories reflect the perception that when minimum help was needed, care and support by the partner and nursing staff were preferred. As the scenarios changed to being totally dependent on care, they preferred care in a nursing home. There was a pervading concern of the risk of not being seen as an individual person and becoming a nobody with no meaningful relations. Thus, there must be a singular goal to support old people, in all stages of their lives, through the recognition and affirmation of self, and providing care with dignity to the end.

  4. Viewpoints of the members of the workers' retirement centers in Tehran about elderly day care centers (2012

    Directory of Open Access Journals (Sweden)

    Hosein Rohani

    2014-02-01

    Full Text Available Background: There is no documented evidence regarding elderly day care centers in Iran. This needs analysis study was conducted to investigate the demand for elderly day care centers in Tehran. Methods: This cross-sectional study was conducted recruiting 210 participants aged over 60 who were members of the elderly retirement centers in Tehran in 2012. Data were gathered by Kansas state university questionnaire and analyzed using Mann-Whitney and Kruskal-Wallis tests. Results: About 80% of participants were men with the mean age of 67.5±5.23 years. Results showed that male (P<0.001, married (P=0.01 and literate elderly (P<0.001, and those living in rental homes (P<0.001 expressed a greater need for elderly day care centers. There was no statistically significant relationship between the lifestyle (P=0.051 and income (P=0.08 of the participants and demand for elderly day care centers. Conclusion: Given the rising population of the elderly and their high demand for day care centers, it is necessary to establish well-equipped day care centers for this group of people. Also, these centers may reduce the burden of care for the aged people on public services and family care givers.

  5. The secure base script and the task of caring for elderly parents: implications for attachment theory and clinical practice.

    Science.gov (United States)

    Chen, Cory K; Waters, Harriet Salatas; Hartman, Marilyn; Zimmerman, Sheryl; Miklowitz, David J; Waters, Everett

    2013-01-01

    This study explores links between adults' attachment representations and the task of caring for elderly parents with dementia. Participants were 87 adults serving as primary caregivers of a parent or parent-in-law with dementia. Waters and Waters' ( 2006 ) Attachment Script Assessment was adapted to assess script-like attachment representation in the context of caring for their elderly parent. The quality of adult-elderly parent interactions was assessed using the Level of Expressed Emotions Scale (Cole & Kazarian, 1988 ) and self-report measures of caregivers' perception of caregiving as difficult. Caregivers' secure base script knowledge predicted lower levels of negative expressed emotion. This effect was moderated by the extent to which participants experienced caring for elderly parents as difficult. Attachment representations played a greater role in caregiving when caregiving tasks were perceived as more difficult. These results support the hypothesis that attachment representations influence the quality of care that adults provide their elderly parents. Clinical implications are discussed.

  6. Predictors of Self-care among the Elderly with Diabetes Type 2: Using Social Cognitive Theory.

    Science.gov (United States)

    Borhaninejad, Vahidreza; Iranpour, Abedin; Shati, Mohsen; Tahami, Ahmad Naghibzadeh; Yousefzadeh, Gholamrezan; Fadayevatan, Reza

    Diabetes is one of the most common chronic diseases among the elderly and is also a very serious health problem. Adopting theory-based self-care behaviors is an effective means in managing such diseases. This study aimed to determine the predictors of diabetes self-care in the elderly in Kerman based on a social cognitive theory. In this cross-sectional study, 384 elderly diabetic patients who had referred to health screening centers in Kerman were chosen via cluster sampling. To collect information about self-care and its predictors, Toobert Glasgow's diabetes self-efficacy scale as well as a questionnaire was used which was based on social cognitive theory constructs. The validity and reliability of the questionnaire was confirmed. The data were analyzed using Pearson correlation and linear regression analysis in SPSS software 17. Among the subjects, 67.37% (252) had poor self-care ability; 29.14% (109) had average ability, and 3.40% (13) enjoyed a proper level of self- care ability. There was a significant relationship between the constructs of the social cognitive theory (knowledge, self- efficacy, social support, outcome expectations, outcome expectancy and self-regulation) and the self-care score. Furthermore, the mentioned constructs could predict 0.47% of the variance of the self-care behaviors. self-care behaviors in this study were poor. Therefore, it is necessary to develop an educational intervention based on cognitive theory constructs with the goal of properly managing diabetes in the elderly patients. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  7. Acute Ankle Sprains in Primary Care

    NARCIS (Netherlands)

    R.M. van Rijn (Rogier)

    2010-01-01

    textabstractOf all injuries of the musculoskeletal system, 25% are acute lateral ankle sprains.1 In the USA and the UK there are about 23,000 and 5000 ankle sprains, respectively, each day. In the Netherlands approximately 600,000 people sustain an ankle injury each year, of those 120,000 occur duri

  8. A Comparative Study on the Effects of Self-Care Program Education Run by Health Volunteers and Health Care Staff on the Elderly\\'s Quality of Life

    Directory of Open Access Journals (Sweden)

    Fazlollah Ghofranipour

    2016-06-01

    Full Text Available Introduction: The diseases and problems due to ageing can affect the quality of life (QoL in the elderly. The aim of this study was to compare the effects of self-care program education run by health volunteers and healthcare staff on the QoL in the elderly. Methods: In this experimental, field trial study, 150 elderly people living in Mashhad were enrolled by multistage sampling in 2014. The participants were randomly assigned to three groups of 50 individuals in each; group A was educated by healthcare staff at healthcare centers, group B by health volunteers at the elderly's homes, and group C was control. The intervention groups (A and B attended two independent self-care education programs for one month. The data were gathered by the SF-36 questionnaire administered before and one month after the completion of the program. Data analysis was done by descriptive statistics [mean (standard deviation] and analytical statistics (independent samples t-test and Kruskal-Wallis H-test. Results: QoL score of the groups A, B, and C was derived 45.44±23.87, 45.36±23.81, and 45.38±23.83 before the intervention and 48.79±22.09, 63.15±19.03, and 46.08±22.67 after the intervention, respectively. The QoL score of the group B was significantly higher than the other two groups (P<0.05 after the intervention. Besides that, after the intervention, the mean scores of QoL and physical function, role-physical, role-emotional, social function, bodily pain, and general health increased significantly more markedly in the group B compared with the other two groups. Conclusion: Self-care education by the health volunteers was much more effective than that by healthcare staff. In addition, implementing the self-care education program contributed to improving QoL and therefore life satisfaction in the elderly.

  9. Elderly patients’ participation in emergency medical services when offered an alternative care pathway

    Directory of Open Access Journals (Sweden)

    Birgitta Wireklint Sundström

    2013-02-01

    Full Text Available As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as “There was a ray of hope about a caring encounter and about being treated like a unique human being”. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified.

  10. Trauma in elderly people: access to the health system through pre-hospital care

    Directory of Open Access Journals (Sweden)

    Hilderjane Carla da Silva

    2016-01-01

    Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.

  11. Social support and self-care activities among the elderly patients with diabetes in Kelantan.

    Science.gov (United States)

    Ahmad Sharoni, S K; Shdaifat, E A; Mohd Abd Majid, H A; Shohor, N A; Ahmad, F; Zakaria, Z

    2015-01-01

    Diabetes is common among the elderly and can significantly affect their lives including the issues related with social support and diabetic self-care activities. The objective of this study was to examine the social support and self-care activities among the elderly patients with diabetes. A survey involving 200 patients was conducted from March 2013 to May 2013 in three hospitals in Kelantan. Data were obtained through self-administered questionnaires and clinical characteristics were acquired from the patients' records. The scores for social support (mean = 19.26; SD = 2.63) and self-care activities (mean = 14.83; SD = 4.92) were moderate. Higher social support was associated with high levels of glycated haemoglobin (HbA1c), fasting blood sugar (FBS) level, the duration of diabetes and a decrease in body mass index (BMI) (p<0.05). It was observed that the patients with low educational, Hb1Ac and FBS level, with other chronic diseases and who have had diabetes for some time had low self-care activities (p<0.05). There was a significant negative relationship between an increase in social support and decrease in self-care activity (p<0.05). Healthcare providers, family and friends have to strengthen their relationship with the elderly patients with diabetes to provide more social support and promote the compliance with diabetic self-care activities to improve clinical outcomes.

  12. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

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    Surekha Kishore

    2015-06-01

    Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely   gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly.  Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of   provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.

  13. Tailoring teaching to the elderly in home care.

    Science.gov (United States)

    Worcester, M I

    1990-01-01

    This paper provides a brief overview of teaching and learning principles common to all adult learners and then discusses the latest research findings and their implications for adapting teaching materials and methods for the elderly. Sensory abilities, cognitive abilities, motor dexterity, developmental tasks, cohort influences, and the current situation in which the older person exists are included. Summary tables of key information are provided throughout the text for easy reference. Guides for assessment of the older adult, aids for evaluating educational materials, and a list of resources for teaching the older adult are provided in the appendix.

  14. Continuity of Care for Elderly Patients with Diabetes Mellitus, Hypertension, Asthma, and Chronic Obstructive Pulmonary Disease in Korea

    OpenAIRE

    2010-01-01

    We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD...

  15. Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants

    Science.gov (United States)

    2010-01-01

    Background Few studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them. Method Eighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for both the elder care budget and quality of care. Qualitative method was used for the data analysis. Results Two themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants. Conclusion New knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and discomfort and distrust when

  16. Malnutrition in elder care: qualitative analysis of ethical perceptions of politicians and civil servants

    Directory of Open Access Journals (Sweden)

    Kihlgren Mona

    2010-06-01

    Full Text Available Abstract Background Few studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them. Method Eighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for both the elder care budget and quality of care. Qualitative method was used for the data analysis. Results Two themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants. Conclusion New knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and

  17. Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana

    OpenAIRE

    Clausen, F.; SANDBERG, E.; Ingstad, B.; Hjortdahl, P.

    2000-01-01

    OBJECTIVE—To evaluate the health status among the elderly in a village in Botswana and their pattern of health care utilisation.
DESIGN—A descriptive study where all persons 60 years and older were invited to participate, including a medical examination, laboratory testing and a questionnaire aiming at gathering sociodemographic data.
SETTING—Mmankgodi village of Botswana.
SUBJECTS—419 persons were identified as elderly in the village, out of which 337 were included.
MAIN OUTCOME MEASURES—The...

  18. Life Experiences of Abused Elderly in Geriatric Care in Iasi, Romania. A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Aliona DRONIC

    2016-06-01

    Full Text Available This qualitative study focused on the life experiences of abused elderly in geriatric care in a Iasi hospital, in Romania. A total of 13 (9 women and 4 men patients were involved in a complimentary, multidisciplinary psycho-social service after been screened for abuse using EASI © (Yaffe et al., 2008. Through thematic network analysis, the texts from the interviews revealed three global themes: 1 the abuse undermines the dignity, 2 the need to find meaning to the lived experience and, 3 the strategies of maintaining dignity. This is the first qualitative study of hospitalized elderly having an experience of abuse in Romania.

  19. Puerto Rican elders' knowledge and use of community-based long-term care services.

    Science.gov (United States)

    Guzzardo, Mariana T; Sheehan, Nancy W

    2013-01-01

    We conducted 3 focus groups with 28 Spanish-speaking Puerto Rican elders to explore their knowledge and use of community-based long-term care services, including an exploration of whether their residential setting influences access to services. Analysis revealed themes relating to participants' difficulties and frustrations with formal services. A major theme was a reliance on formal services, given a lack of reliable familial help. Elders living in Latino senior housing reported the greatest access to services, with availability of Spanish-speaking housing staff and informal support from neighbors serving as critical components of their social networks. Practice and policy recommendations are provided.

  20. Community Health Care for the Elderly and Nursing care%社区老年人的保健与护理

    Institute of Scientific and Technical Information of China (English)

    付敏

    2013-01-01

    Objective:To explore community; health care for the elderly and nursing methods. Methods:since 2010 my community for people over 60 years old in 80 cases and nursing care data analysis. Results: Through community care and nursing work effectively prevent senile body function decline, maintain elderly normal activities, improve the elderly population health, delaying senility. Conclusion: The community nursing staff skilled in related professional knowledge, keen observation and accurate judgment, can be found in elderly patients with health problems and a variety of subtle changes, take effective measures, as soon as possible to restore the health of the elderly.%  目的:探讨社区老年人的保健及护理方法。方法:选取2010年以来我社区60岁以上老年人80例保健及护理资料进行分析。结果:通过社区保健及护理工作有效地预防老年人机体功能减退、维持老年人正常的生活活动能力,提高老年群体健康,延缓衰老。结论:社区护理人员熟练地掌握相关的专业知识,具备敏锐的观察能力和准确的判断能力,能够及时发现老年患者的健康问题及各种细微的变化,及早采取正确有效的措施,尽快恢复老人健康。

  1. GUI system for Elders/Patients in Intensive Care

    OpenAIRE

    Raheja, J. L.; Dhiraj; Gopinath, D.; Chaudhary, Ankit

    2014-01-01

    In the old age, few people need special care if they are suffering from specific diseases as they can get stroke while they are in normal life routine. Also patients of any age, who are not able to walk, need to be taken care of personally but for this, either they have to be in hospital or someone like nurse should be with them for better care. This is costly in terms of money and man power. A person is needed for 24x7 care of these people. To help in this aspect we purposes a vision based s...

  2. [Review of functional impairment associated with acute illness in the elderly].

    Science.gov (United States)

    Osuna-Pozo, Carmen María; Ortiz-Alonso, Javier; Vidán, Maite; Ferreira, Guillermo; Serra-Rexach, José Antonio

    2014-01-01

    Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  3. Assessing the quality of care for the elderly in services from public primary health care in Porto Alegre, Brazil

    Directory of Open Access Journals (Sweden)

    Elise Botteselle de Oliveira

    2013-09-01

    Full Text Available Introduction: The aging population creates a greater demand creates a greater demand for health services and becomes a challenge for the health care system. Primary Health Care (PHC plays a fundamental role in promoting healthy aging and controlling multi-morbidity. Objective: To assess the quality of care provided to elderly patients in public PHC in Porto Alegre, Rio Grande do Sul state, Brazil. Methods: A cross-sectional population-based study carried out in 2007, with interviews conducted with 212 elderly patients from four types of municipal public services: Primary Health Centers, Family Health Strategy teams, the “Conceição” Hospital Community Health Service (CH/CHS, and the “Murialdo” School Health Center. Results: There were significant differences between the centers investigated regarding the following attributes: Access-utilization, Longitudinality, Care coordination and information systems, and Family and community orientation. The CH/CHS showed prevalence of 55.8% (p<0.001 for the overall PHC high score - higher figures in comparison with the other services. The overall score of preventive practices showed a significant association with the services to the overall PHC score, with an average of 3.9 (CI 95%=3.60-4.32 among the elderly who presented low scores and 5.9 (CI 95%=5.3-6.5 among those presenting high scores. Discussion: The results show low scores in all types of services. The services with a high overall PHC score present higher preventive practice prevalence. Conclusions: PHC-oriented services are more effective and offer greater quality of preventive care recommended for the elderly.

  4. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial

    Science.gov (United States)

    Liao, Lin-Yu; Chen, Kuei-Min; Chung, Wei-Sheng; Chien, Jung-Yien

    2015-01-01

    Clinical trials identifier NCT02329873 Background Acute exacerbation (AE) of COPD is characterized by a sudden worsening of COPD symptoms. Previous studies have explored the effectiveness of respiratory rehabilitation for patients with COPD; however, no training program specific to acute exacerbation in elderly patients or unstable periods during hospitalization has been developed. Objective To evaluate the effects of a respiratory rehabilitation exercise training package on dyspnea, cough, exercise tolerance, and sputum expectoration among hospitalized elderly patients with AECOPD. Methods A randomized control trial was conducted. Pretest and posttest evaluations of 61 elderly inpatients with AECOPD (experimental group n=30; control group n=31) were performed. The experimental group received respiratory rehabilitation exercise training twice a day, 10–30 minutes per session for 4 days. The clinical parameters (dyspnea, cough, exercise tolerance, and sputum expectoration) were assessed at the baseline and at the end of the fourth day. Results All participants (median age =70 years, male =60.70%, and peak expiratory flow 140 L) completed the study. In the patients of the experimental group, dyspnea and cough decreased and exercise tolerance and sputum expectoration increased significantly compared with those of the patients in the control group (all P<0.05). Within-group comparisons revealed that the dyspnea, cough, and exercise tolerance significantly improved in the experimental group by the end of the fourth day (all P<0.05). Conclusion Results of this study suggest that the respiratory rehabilitation exercise training package reduced symptoms and enhanced the effectiveness of the care of elderly inpatients with AECOPD. PMID:26345529

  5. Elderly who take care of elderly: a study on the Frailty Syndrome.

    Science.gov (United States)

    Santos-Orlandi, Ariene Angelini Dos; Brito, Tábatta Renata Pereira de; Ottaviani, Ana Carolina; Rossetti, Estefani Serafim; Zazzetta, Marisa Silvana; Pavarini, Sofia Cristina Iost

    2017-01-01

    Identifying prevalence of frailty in elderly caregivers inserted in a high social vulnerability context and its correlation with sociodemographic and health aspects. Descriptive, correlational and cross-sectional study. Forty elderly caregivers were evaluated with: questionnaire for caregiver characterization, Mini Mental State Examination, Katz Index, Lawton instrumental activities of daily living scale, Geriatric Depression Scale and the frailty phenotype proposed by Fried. Interviews were conducted at their residences and scheduled in advance. All ethical precautions were observed. Data were analyzed with the Stata statistical program version 11.0. 10% of elderly caregivers were frail. There was a significant correlation between frailty and sex, instrumental activities of daily living and cognition. Female caregivers, partially dependent individuals regarding instrumental activities of daily living and with worse cognitive state deserve a special attention from health services. Identificar a prevalência de fragilidade em cuidadores idosos inseridos em contexto de alta vulnerabilidade social e sua correlação com aspectos sociodemográficos e de saúde. Estudo descritivo, correlacional, transversal. Foram avaliados 40 cuidadores idosos utilizando-se: questionário para caracterização do cuidador, Mini Exame do Estado Mental, Índice de Katz, Escala de atividades instrumentais de vida diária de Lawton, Escala de Depressão Geriátrica e o fenótipo de fragilidade proposto por Fried. As entrevistas foram realizadas no domicílio, sendo previamente agendadas. Todos os cuidados éticos foram observados. Os dados foram analisados com apoio do pacote estatístico Stata versão 11.0. 10,0% dos cuidadores idosos eram frágeis. Houve correlação significativa entre fragilidade e: sexo, atividades instrumentais de vida diária e cognição. Conclusão: Cuidadoras do sexo feminino, indivíduos parcialmente dependentes em relação às atividades instrumentais de vida

  6. Care ‘going market’: Finnish elderly-care policies in transition

    Directory of Open Access Journals (Sweden)

    Anneli Anttonen

    2011-06-01

    -ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} The article evaluates marketization and its effects on elderly-care policies in Finland, where the welfare state has been the most important mechanism in mitigating failures caused by the functioning of market. In addition, since the 1960s the public sector has been regarded as the guarantee for citizens' social rights and the common good. Therefore, marketization, denoting to market logics intervened with social-care practices that construct care as a commodity and the individual in need of care as a consumer, is a critical juncture for an evaluation of the underlying pattern change. To evaluate the change this article employs a framework of institutional policy analysis. By focusing on institutional framing of care policies, institutionalized responsibilities, policy discourses, and policy outcomes and by using textual and statistical data, this article aims to reach a detailed but comprehensive picture on marketization and its influence in the Finnish social-care regime. All institutional aspects analysed in the study show a clear transition from universal social policies based on public responsibility to market-friendly policies and the marketization of social care. However, they also imply that marketization is regulated by public authorities. On the basis of these results, we argue that Finnish elderly-care policies is going through a profound change, in magnitude similar to what occurred 30-40 years ago when the politics of universalism was breaking through. The new direction points to the market and a deep-going reform of social-care service provision is taking place, and the earlier state-centred welfare production mode is at least partly withering away. In this respect the pattern of social-care service

  7. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette

    2015-01-01

    disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged...

  8. Affective Responses to Acute Exercise in Elderly Impaired Males: The Moderating Effects of Self-Efficacy and Age.

    Science.gov (United States)

    McAuley, Edward; And Others

    1995-01-01

    Examined relationships between perceptions of personal efficacy and affective responsibility to acute exercise in elderly male inpatients and outpatients at a Veterans Administration Medical Center. A significant change in feelings of fatigue was revealed over time but exercise effects on affect were shown to be moderated by perceptions of…

  9. Old news: why the 90-year crisis in medical elder care?

    Science.gov (United States)

    Diachun, Laura L; Charise, Andrea; Lingard, Lorelei

    2012-07-01

    North American and European demographic projections indicate that by 2030, persons aged 65 and older will outnumber those younger than 15 by a ratio of 2:1. Curiously, principles of geriatric care have not taken strong hold among nongeriatric specialties, even as we approach the time of greatest need. To explore historical precedents for the current crisis in elder care, this article revisits the prescriptions of G. Stanley Hall's Senescence: The Last Half of Life (1922), a text widely recognized as one of the founding texts in the medicalized study of aging. It presents in brief three of Hall's major concerns-paucity of knowledge of nongeriatric specialists, the need for individualized care of elderly adults, and the prevalence of attitudinal obstacles in medical professionals caring for older persons-to demonstrate how little the language and content of modern appraisals have evolved since 1922. This disconcerting sense of paralysis is presented as an opportunity to advance important questions aimed at stimulating a more-comprehensive research agenda for addressing the future of medical elder care.

  10. Elder-clowning in long-term dementia care: Results of a pilot study

    Science.gov (United States)

    Kontos, Pia; Miller, Karen-Lee; Colobong, Romeo; Lazgare, Luis Ivan Palma; Binns, Malcolm; Low, Lee-Fay; Surr, Claire; Naglie, Gary

    2016-01-01

    Objectives To assess the effects of elder-clowning on moderate to severe behavioral and psychological symptoms of dementia (BPSD) in nursing home residents with dementia, primarily of the Alzheimer’s type. Design Before-after study. Setting Nursing home. Participants Twenty-three nursing home residents with moderate to severe BPSD defined by the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score of ≥10, and their care aides. Intervention A pair of elder-clowns visited all residents twice weekly (approximately 10 minutes per visit) for 12 weeks. They utilized improvisation, humor and empathy, as well as expressive modalities such as song, musical instruments, and dance to individualize resident engagement. Measurements Primary outcomes were BPSD measured by the NPI-NH, quality of life measured by Dementia Care Mapping (DCM), and nursing burden of care measured by the Modified Nursing Care Assessment Scale (M-NCAS). Secondary outcomes included occupational disruptiveness measured by the NPI-NH, agitation measured by the Cohen Mansfield Agitation Inventory (CMAI), and psychiatric medication use. Results Over 12 weeks, NPI-NH scores significantly declined (t22 = −2.68, p = 0.01) and DCM quality of life scores significantly improved (F1,50 = 23.09, p clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer’s type. Elder-clowning is a promising intervention that may improve Alzheimer’s dementia care for nursing home residents. PMID:26889843

  11. Medical Problems Referred to a Care of the Elderly Physician: Insight for Future Geriatrics CME.

    Science.gov (United States)

    Lam, Robert; Gallinaro, Anna; Adleman, Jenna

    2013-01-01

    Family physicians provide the majority of elderly patient care in Canada. Many experience significant challenges in serving this cohort. This study aimed to examine the medical problems of patients referred to a care of the elderly physician, to better understand the geriatric continuing medical education (CME) needs of family doctors. A retrospective chart review of patients assessed at an urban outpatient seniors' clinic between 2003 and 2008 was conducted. Data from 104 charts were analyzed and survey follow-up with 28 of the referring family physicians was undertaken. Main outcomes include the type and frequency of medical problems actually referred to a care of the elderly physician. Clarification of future geriatric CME topics of need was also assessed. Preventive care issues were addressed with 67 patients. Twenty-four required discussion of advance directives. The most common medical problems encountered were osteoarthritis (42), hypertension (34), osteoporosis (32), and depression or anxiety (23). Other common problems encountered that have not been highly cited as being a target of CME included musculoskeletal and joint pain (41), diabetes (23), neck and back pain (20), obesity (11), insomnia (11), and neuropathic, fibromyalgia and "leg cramps" pain (10). The referring family physicians surveyed agreed that these were topics of need for future CME. The findings support geriatric CME for the common medical problems encountered. Chronic pain, diabetes, obesity and insomnia continue to be important unresolved issues previously unacknowledged by physicians as CME topics of need. Future CME focusing more on process of geriatric care may also be relevant.

  12. Health related quality of life and care dependency among elderly hospital patients: an international comparison.

    Science.gov (United States)

    Dijkstra, Ate; Hakverdioğlu, Gülendam; Muszalik, Marta; Andela, Richtsje; Korhan, Esra Akın; Kędziora-Kornatowska, Kornelia

    2015-01-01

    Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries.

  13. Ethics support in institutional elderly care: a review of the literature.

    Science.gov (United States)

    van der Dam, Sandra; Molewijk, Bert; Widdershoven, Guy A M; Abma, Tineke A

    2014-09-01

    Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases (Pubmed, CINAHL/PsycINFO, Ethxweb). Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: 'institutional bodies' (ethics committee and consultation team); 'frameworks' (analytical tools to assist care professionals); 'educational programmes and moral case deliberation'; and 'written documents and policies'. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation.

  14. Who will be caring for Europe's dependent elders in 2030?

    NARCIS (Netherlands)

    Gaymu, J.; Ekamper, P.; Beets, G.C.N.

    2007-01-01

    As the population of Europe grows older, the problem of dependence is becoming an important issue. Can we predict the care needs of dependent older adults over the medium and long term? And, in particular, how will the burden of care be shared between family and professional carers? In this article,

  15. Who will be caring for Europe's dependent elders in 2030?

    NARCIS (Netherlands)

    Gaymu, J.; Ekamper, P.; Beets, G.C.N.

    2007-01-01

    As the population of Europe grows older, the problem of dependence is becoming an important issue. Can we predict the care needs of dependent older adults over the medium and long term? And, in particular, how will the burden of care be shared between family and professional carers? In this article,

  16. Trajectories and Determinants of Elder Care in Rural China During an 8-Year Period: Why Having Sons Makes a Difference.

    Science.gov (United States)

    Guo, Man; Chi, Iris; Silverstein, Merril

    2016-07-01

    Using 8-year panel data for 1,355 older adults in rural Anhui province, China, this study examined the trajectories and determinants of elder care provided by adult children to their older parents. The results of two-level latent variable growth models showed that trajectories of elder care differed by the gender of children, with an increase in care from sons but a decrease in care from daughters over time. Children's life stages influenced their care provision but differed by gender. Functional impairment of parents and care provided by siblings in the family also affected the care provided by each child. The findings reflect the patrilineal nature of Chinese family systems and demonstrate the linkages between critical life events and caregiving behaviors of adult children. Findings of this study can inform the formulation of elder care policies that meet the needs of families with different structures and at different life stages.

  17. The hidden curriculum of the medical care for elderly patients in medical education: a qualitative study.

    Science.gov (United States)

    Meiboom, Ariadne; Diedrich, Chantal; Vries, Henk De; Hertogh, Cees; Scheele, Fedde

    2015-01-01

    Despite more attention being given to geriatrics in medical curricula, few new physicians are seeking training in this field. So far, there has been no exploration of factors in the hidden curriculum that could potentially influence the persisting lack of interest in this field of medicine. To study this hidden curriculum in medical education in relation to medical care of elderly patients, the authors used a qualitative research design including participant observations on two internal medicine wards in a teaching hospital and semistructured interviews. The results showed that elderly patients with multiple problems are seen as frustrating and not interesting. Medical students were not stimulated to go into the totality of medical problems of elderly patients. They picked up a lot of disparaging remarks about these patients. The mainly negative attitudes demonstrated by role models, in particular the residents, may potentially influence the development of future doctors and their choice of career.

  18. Gastroenteritis and food-borne disease in elderly people living in long-term care.

    Science.gov (United States)

    Kirk, Martyn D; Veitch, Mark G; Hall, Gillian V

    2010-02-01

    Elderly people in long-term care facilities (LTCFs) may be more vulnerable to infectious gastroenteritis and food-borne disease and more likely to experience serious outcomes. We review the epidemiology of gastroenteritis and food-borne diseases in elderly residents of LTCFs to inform measures aimed at preventing sporadic disease and outbreaks. Gastroenteritis in elderly people is primarily acquired from other infected persons and contaminated foods, although infections may also be acquired when residents have poor personal hygiene, have contaminated living environments or water, or have contact with infected pets. Early recognition of outbreaks and implementation of control measures is critical to reduce the effects on LTCF residents and staff members. Although outbreaks among LTCF residents are common, they are challenging to investigate, and there are still major gaps in our knowledge, particularly in regards to controlling noroviruses, the incidence and causes of specific infections, and sources of food-borne disease.

  19. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required

  20. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  1. Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

    OpenAIRE

    Risa Fukuda; Yasuko Shimizu; Natsuko Seto

    2015-01-01

    Objective: Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods: This was a qualitative study using focus group interviews (FGIs). The setti...

  2. Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

    Directory of Open Access Journals (Sweden)

    Gilberto Luís Camanho

    2008-09-01

    Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

  3. 老年人急性腹痛病因分析及诊治体会%Etiology Study and Diagnosis of Acute Abdominal Pain in Elderly People

    Institute of Scientific and Technical Information of China (English)

    闻静; 邵明; 贾增玲

    2011-01-01

    . Conclusion The cause of elderly patients with acute abdominal pain are multiple ,in order to make corresponding and effective treatment,we should carefully analyze the characteristics of their pain,combined with careful physical examination and inspection aids can help us to make accurate diagnosis. Acute abdominal pain is one of the most common acute illness in order not to misdiagnosis,we should carefully ask about the history of illness,make full use of auxiliary examination to the patients lack of typical symptoms and physical characteristics, take close observation of them, make clear diagnose early and give them opportunely treatments.

  4. Professional Caregivers' Oral Care Practices and Beliefs for Elderly Clients Aging In Place.

    Science.gov (United States)

    Delgado, Ashley M; Prihoda, Thomas; Nguyen, Carol; Hicks, Beatriz; Smiley, Lynn; Taverna, Melanie

    2016-08-01

    As recently as the 1990s long-term care facilities (LTCFs) were the main housing option for semi- or fully-dependent elders. Today, 90% of those 65 and older want to "age in place." The growth of the elderly population that want to "age in place" will require increasing numbers of professional caregivers to assist in oral care practices. The purpose of this study was to address the gap in the knowledge about the oral care practices and beliefs of professional caregivers who work for non-medical in-home care companies charged in the care of "aging in place" elders. The Nursing Dental Coping Belief Scale was used in a descriptive cross-sectional study. Professional caregivers (n=67) employed by 3 non-medical in-home care companies in South Texas completed the survey. The survey gathered demographic information, oral care practice questions and oral health belief questions. Statistics used for data analysis included chi-square contingency table analysis. The level of significance was set at phome care companies are not mandated by law to provide training, yet professional caregivers wanted more training in brushing and flossing (85%). A majority (60%) reported being trained. Most (85%) looked inside their client's mouth yet nearly 18% did not floss their client's teeth and only 31% knew if their clients wore dentures. While this was a small study, it provides preliminary information that professional caregivers, who serve clients aging in place, want more oral care training. Professional caregivers would be better served if there were more thorough and frequent training provided with managerial oversight. Copyright © 2016 The American Dental Hygienists’ Association.

  5. Assessment of cancer care in Indian elderly cancer patients: A single center study

    Science.gov (United States)

    Sarkar, Anindya; Shahi, UP

    2013-01-01

    Background and purpose: This prospective study aimed to assess the profiles of elderly cancer patient to optimize cancer care in Indian setup. The profiles have been compared with that of younger patients in terms of epidemiological, clinical data, co-morbidity, treatment, toxicity, clinical outcome, and survival pattern. Materials and Methods: The study comprised cancer patients attending radiotherapy outdoor (November 2005 to June 2006). There were 104 patients of age ≥60 years (elderly group) and 121 patients of 45-59 years (younger group). Results: Elderly group had median age 65 years (60-88 years) with M:F = 1:1. The younger group had median age 50 years (45-59 years) with M:F = 1:2. Elderly had higher proportion of gastrointestinal and genito-urinary tract malignancies. Younger group had higher proportion of breast, lymphoma, and brain tumor. 13% had co-morbidity, 50% received treatment, 27% were treated with radiotherapy with or without surgery, and two-third of these cases belong to elderly group. Majority tolerated treatment well. 10% had significant grade of toxicity. 57% of elderly patients did not accept and one-fourth of all cases did not complete the prescribed treatment. 88% cases were responders of which 70% showed complete response. There were no differences between two groups. At 12 months 35% of treated patients came for follow-up. At first 12 months, 60-70% were alive without disease. Conclusion: There were differences between two groups in terms of performance status, treatment acceptance, and treatment modality prescribed. Elderly patients deserve same opportunity as younger patients for treatment and survival options from the oncologist. PMID:24455630

  6. Assessment of cancer care in Indian elderly cancer patients: A single center study

    Directory of Open Access Journals (Sweden)

    Anindya Sarkar

    2013-01-01

    Full Text Available Background and purpose: This prospective study aimed to assess the profiles of elderly cancer patient to optimize cancer care in Indian setup. The profiles have been compared with that of younger patients in terms of epidemiological, clinical data, co-morbidity, treatment, toxicity, clinical outcome, and survival pattern. Materials and Methods: The study comprised cancer patients attending radiotherapy outdoor (November 2005 to June 2006. There were 104 patients of age ≥60 years (elderly group and 121 patients of 45-59 years (younger group. Results: Elderly group had median age 65 years (60-88 years with M:F = 1:1. The younger group had median age 50 years (45-59 years with M:F = 1:2. Elderly had higher proportion of gastrointestinal and genito-urinary tract malignancies. Younger group had higher proportion of breast, lymphoma, and brain tumor. 13% had co-morbidity, 50% received treatment, 27% were treated with radiotherapy with or without surgery, and two-third of these cases belong to elderly group. Majority tolerated treatment well. 10% had significant grade of toxicity. 57% of elderly patients did not accept and one-fourth of all cases did not complete the prescribed treatment. 88% cases were responders of which 70% showed complete response. There were no differences between two groups. At 12 months 35% of treated patients came for follow-up. At first 12 months, 60-70% were alive without disease. Conclusion: There were differences between two groups in terms of performance status, treatment acceptance, and treatment modality prescribed. Elderly patients deserve same opportunity as younger patients for treatment and survival options from the oncologist.

  7. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial.

    Science.gov (United States)

    Ha, Lisa; Hauge, Truls; Spenning, Anne Bente; Iversen, Per Ole

    2010-10-01

    Undernutrition after an acute stroke increases the risk of poor outcome. We wanted to examine the effect of individualized, nutritional support on weight loss and functional outcomes in stroke patients. Acute stroke patients at nutritional risk were randomized to either individualized, nutritional care or routine care while in hospital. Patients in the intervention group received an individualized treatment plan aiming to prevent weight loss. In accordance with routine care, the controls did not have such a treatment plan. Patients were reviewed at follow-up after three months. Primary outcome measure was the percentage of patients with weight loss ≥5%. Secondary outcomes measures were quality of life (QoL), handgrip strength and length of hospital stay. This trial is registered with ClinicalTrials.gov, number NCT00163007. At follow-up, 20.7% of the intervention group (n = 58) lost ≥5% weight compared with 36.4% in the control group (n = 66) (P = 0.055). The intervention group had a significantly higher increase in QoL score (P = 0.009) and in handgrip strength (P = 0.002). There was no difference in length of hospital stay. Individualized, nutritional treatment strategy can prevent clinically significant weight loss and improve QoL in elderly acute stroke patients at nutritional risk. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  8. A framework for understanding outcomes of integrated care programs for the hospitalized elderly

    Directory of Open Access Journals (Sweden)

    Jacqueline M. Hartgerink

    2013-11-01

    Full Text Available Introduction: Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes.Theory and methods: Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration.Results: Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals’ cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information.Conclusion: We expect that insight into the cognitive and behavioural mechanisms will contribute to the understanding of integrated care programmes. The framework can be used to identify the underlying mechanisms of integrated care responsible for producing favourable outcomes, allowing comparisons across programmes.

  9. An apocalyptic vision of ageing in China: Old age care for the largest elderly population in the world.

    Science.gov (United States)

    Liu, Tao; Sun, Li

    2015-06-01

    According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13% of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual family's responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the state's formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized "Beveridge" models (e.g. as in Sweden).

  10. Challenges in managing elderly people with diabetes in primary care settings in Norway.

    Science.gov (United States)

    Graue, Marit; Dunning, Trisha; Hausken, Marie Fjelde; Rokne, Berit

    2013-12-01

    To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Focus-group interviews. Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32-59 years with clinical experience ranging from 1.5 to 38 years. Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

  11. Paediatric emergency and acute care in resource poor settings.

    Science.gov (United States)

    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.

  12. Impairment and Abuse of Elderly by Staff in Long-Term Care in Michigan: Evidence from Structural Equation Modeling

    Science.gov (United States)

    Conner, Tom; Prokhorov, Artem; Page, Connie; Fang, Yu; Xiao, Yimin; Post, Lori A.

    2011-01-01

    Elder abuse in long-term care has become a very important public health concern. Recent estimates of elder abuse prevalence are in the range of 2% to 10% (Lachs & Pillemer, 2004), and current changes in population structure indicate a potential for an upward trend in prevalence (Malley-Morrison, Nolido, & Chawla, 2006; Post et al., 2006). More…

  13. Rural Community-Dwelling Elders' Reports of Access to Care: Are There Hispanic versus Non-Hispanic White Disparities?

    Science.gov (United States)

    Borders, Tyrone F.

    2004-01-01

    Consumer reports can provide useful information about the dimensions of access in need of improvement for particular population subgroups. To determine if there are Hispanic versus non- Hispanic white disparities in rural elders' reports of their health care access. A telephone survey was conducted among 2,097 rural community-dwelling elders in…

  14. Acute blood pressure response in hypertensive elderly women immediately after water aerobics exercise: A crossover study.

    Science.gov (United States)

    Cunha, Raphael Martins; Vilaça-Alves, José; Noleto, Marcelo Vasconcelos; Silva, Juliana Sá; Costa, Andressa Moura; Silva, Christoffer Novais Farias; Póvoa, Thaís Inácio Rolim; Lehnen, Alexandre Machado

    2017-01-01

    Water aerobics exercise is widely recommended for elderly people. However, little is known about the acute effects on hemodynamic variables. Thus, we assessed the effects of a water aerobic session on blood pressure in hypertensive elderly women. Fifty hypertensive elderly women aged 67.8 ± 4.1 years, 1.5 ± 0.6 m high and BMI 28.6 ± 3.9 kg/m(2), participated in a crossover clinical trial. The experiment consisted of a 45-minute water aerobics session (70%-75% HRmax adjusted for the aquatic environment) (ES) and a control session (no exercise for 45 minutes) (CS). Heart rate was monitored using a heart rate monitor and systolic blood pressure (SBP) and diastolic (DBP) measurements were taken using a semi-automatic monitor before and immediately after the sessions, and at 10, 20 and 30 minutes thereafter. It was using a generalized estimating equation (GEE) with Bonferroni's post-hoc test (p exercise, BP declined in ES by a greater magnitude than in CS (SBP 7.5 mmHg, 6.2%, p = 0.005 and DBP 3.8 mmHg, 5.5%, p = 0.013). At 20 minutes after exercise and thereafter, SBP and DBP were similar in both ES and CS. In conclusion, BP returned to control levels within 10-20 minutes remaining unchanged until 30 minutes after exercise, and post-exercise hypotension was not observed. Besides, BP changed after exercise was a safe rise of small magnitude for hypertensive people.

  15. BENEFICIAL EFFECTS OF CAPTOPRIL ON PROGNOSIS IN ELDERLY PATIENTSWITH ACUTE MYOCARDIAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    蔡煦; 沈卫峰; 李明洲; 龚兰生

    1998-01-01

    This study sought to investigate the effects of early and long-term intervention with angiotensin-converting enzyme(ACE) inhibitor captopril on the elderly patients with acute myocardial infarction(AMI), and observe its in-hospitsl and post-hospital outcomes during serial follow-up of 54 months. Methods. 631 elderly patients(60~75 years old) with AMI and without cardioganie shock were hospitalized within 72 hours of symptoms and were randondy allocated to captopril (n= 361; treatment group) and conventional treatment (n=270,contro1 group), The survival and cardiac events(congestive heart failure, reinfarction, severe arthythmias and cardiac death)of each group were determined during hospitalization and follow-up. Results. During hospitalization, the survival was higher in treatment group than in control group(P<0. 0001). On the other hand, in treatment group lower mortality was true for patients with anterior myocardial infarction(P= 0. 001 ) or with anterior+inferior myocardial infarction(P= 0. 026), but not statistically significant in ones with inferior myocardial infarction(P= 0. 061). During follow-up, the occurrence of cardiae death, heart failure, reinfaretion and severe arrhythmiss were lower in treatment group(P=0.0001, P=0.05, P=0. 0004 and P=0.027). So higher survival(P= 0.005) and lower total cardiac events(P=0. 0008) could be seen in treatment group over this period. Conclusions. Early and long-term treatment with captopril in the elderly patients with AMI has beneficial outcomes in both in-hospital and follow-up periods,

  16. The Role of Invasive Therapies in Elderly Patients with Acute Myocardial Infarction

    Science.gov (United States)

    Nicolau, José C.; Lemos, Pedro A.; Wajngarten, Maurício; Giraldez, Roberto R.; Serrano, Carlos V.; Martinez, Eulógio E.; Baracioli, Luciano M.; Kalil, Roberto; Jatene, Fábio B.; Dallan, Luis A.; Puig, Luis B.; Stolf, Noedir A.

    2009-01-01

    INTRODUCTION: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies - IT), especially in the context of long-term outcomes after hospital discharge. METHODS: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years. In this population, 548 patients were ≥70 years old (elderly group - EG), and 1040 were <70 years of age (younger group - YG); 1088 underwent IT during hospitalization, and the remaining 500 were treated medically (conservative therapy - CT). Patients were monitored either by visit or by phone at least once a year. A standard questionnaire was administered to all patients. The impact of IT was analyzed with both non-adjusted and adjusted models. RESULTS: By the end of the follow-up period, the survival rates for the IT and CT groups were, respectively, 71.9% versus 47.2% in the global population (hazard ratio=0.55, P<0.001), 81.5% versus 66.6% in the YG (hazard ratio=0.68, P=0.018) and 48.8% versus 20.3% in the EG (hazard ratio=0.58, P<0.001). In the adjusted models, the hazard ratios were 0.62 (P<0.001) in the global population, 0.74 in the YG (P=0.073) and 0.64 (P=0.001) in the EG. CONCLUSION: Long-term follow-up of patients with myocardial infarction revealed that IT during the in-hospital phase was at least as effective in elderly patients as in younger patients. PMID:19578659

  17. Invisible Elderly in Danish and Swedish Residential Care Home Architecture

    DEFF Research Database (Denmark)

    E Andersson, Jonas; Grangaard, Sidse

    2015-01-01

    This study of two architectural competitions suggests that the fit between architectural design and older users, who depend on regular caregiving due to cognitive or functional disabilities, requires a particular consideration when designing new residential care homes....

  18. [Images of aging in the field of health care for the elderly. Findings and recommendations in the Sixth National Social Report on the Situation of the Elderly].

    Science.gov (United States)

    Berner, F

    2011-08-01

    This paper is based on the Sixth National Social Report on the Situation of the Elderly, published in November 2010, that deals with the images of aging that exist in society. The aim of this paper is to describe how the commission that wrote the Sixth National Social Report on the Situation of the Elderly evaluates the role of images of aging in the field of health care and to specify the need for change that the commission identifies with respect to images of aging. The paper consists of four parts. A general introduction is followed by a discussion of some important aspects of images of aging, including a description of central assumptions and concepts of the expert commission. The main part is then the analysis of images of aging in the field of health care for the elderly. Finally, the recommendations of the expert commission in order to promote an adjustment of health care to an aging society are presented.

  19. Consensus of primary care in acute pancreatitis in Japan

    Institute of Scientific and Technical Information of China (English)

    Makoto Otsuki; Tetsuhide Ito; Kazuo Inui; Tooru Shimosegawa; Shigeki Tanaka; Keisho Kataoka; Hiromitsu Saisho; Kazuichi Okazaki; Yosikazu Kuroda; Norio Sawabu; Yoshifumi Takeyama; Masahiko Hirota; Shinju Arata; Masaru Koizumi; Shigeyuki Kawa; Terumi Kamisawa; Kazunori Takeda; Toshihiko Mayumi; Motoji Kitagawa

    2006-01-01

    The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis.The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital.Monitoring of blood pressure, pulse and respiratory rate,body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as thediagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases.

  20. Terminally ill African American elders' access to and use of hospice care.

    Science.gov (United States)

    Noh, Hyunjin; Schroepfer, Tracy A

    2015-05-01

    The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care.

  1. Role of low dose cytarabine in elderly patients with acute myeloid leukemia: An experience

    Directory of Open Access Journals (Sweden)

    Yasir Bashir

    2015-01-01

    Full Text Available Purpose: To highlight the acceptable results seen after use of low dose cytarabine in elderly patients of acute myeloid leukemia (AML with comorbidities. Materials and Methods: This was a prospective study carried on 30 newly diagnosed patients of AML over 60 years of age who were unfit for standard treatment regimens. We did not use azacytidine and decitabine in our patients because these therapeutic modalities being extremely costly and our patient affordability being poor. After taking patient consent and institutional ethical clearance these patients were treated with 20 mg/m 2 cytarabine subcutaneously in two divided doses 12 h apart for 4 days every week for 4 weeks which constituted a cycle before disease, re-assessment was done. A repeat cycle was administered where ever needed and after attainment of remission, we continued low dose cytarabine for 2 days/week as maintenance after complete or partial response was documented. Results: In our study, we found that around 20% of patients achieved complete remission and 30% partial remission. The remission rates were definitely influenced by counts at presentation, performance at presentation, comorbidities, underlying myelodysplastic syndrome and baseline cytogenetics. Conclusion: Low dose cytarabine is effective treatment option for elderly patients with AML when standard treatment options are not warranted.

  2. Quality of life in elderly people at the start of using in-home care.

    Science.gov (United States)

    Imanishi, Miyuki; Tomohisa, Hisao; Higaki, Kazuo

    2015-01-01

    Quality of life (QOL) among 200 elderly people planning to use in-home care services available to those with severe illness was surveyed to identify the most effective method of improving QOL of the elderly through such care services. QOL was surveyed using a PGC Morale Scale, and factors related to QOL were verified by multivariate analysis. The most relevant factors for QOL among the 11 analyzed were the client's reason for choosing to use in-home care services and the client's family structure. The average PGC-MS score was 9.09 ± 2.6 (mean ± standard deviation). Analysis of factors significantly affecting PGC-MS score identified treatment history and job type (p MS score (p MS scores decreased in the order of three-generation families, those living alone, couples, and two-generation families. QOL of elderly people might be improved by the provision of in-home care services with consideration of consumers' intentions and factors known to influence QOL.

  3. [Securing the financing of care for the frail elderly: problems and solutions].

    Science.gov (United States)

    Theuws, A J; Paulus, A T G; van Steenkiste, B; Widdershoven, G A M; van der Weijden, T; Hobma, S O

    2014-04-01

    Projects within the Dutch National Program for Elderly Care (NPO) have been experimenting since 2008 to increase coherence in care for the frail elderly. Invest-NPO explored the problems and solutions to secure the financing of these innovative projects. Problems were expected with coordination because there was not yet a structural reimbursement for such an activity for the frail elderly. There where doubts about the adequacy of reimbursement for multidisciplinary consultation and certain structural conditions. The existing fragmentation across multiple domains and reimbursement rules made it difficult to achieve an integrated approach and creativeness in care. The principles of bundled payment can be helpful in problems concerning multidisciplinary consultation, structural conditions and coordination because joint agreements are needed. According to many, capitation is even a better solution if properly applied, because there are fewer boundaries in deciding how care is organized. Initiatives from entrepreneurs may represent first steps in the right direction. The findings of Invest-NPO may contribute to the development of further steps.

  4. [Home care needs for elderly people in the context of the Family Health Strategy].

    Science.gov (United States)

    Aires, Marinês; Paz, Adriana Aparecida

    2008-03-01

    This study had the objective of identifying the needs of care reported by a group of elderly people in a region covered by the Family Health Strategy (ESF). The methodology used was based on a descriptive cross-sectional study, with a sample of 176 persons over 60 years of age. Most of the individuals were females, between 60 and 69-years-old, with an average of 69.6 +/- 7.4 years. The elderly reported co-morbidities, most of which were related to diseases of the circulatory and endocrine systems, as well as nutritional and metabolic disturbances, musculoskeletal and conjunctive tissue diseases. Regarding the Basic Activities of Daily Life, 93.2% of the elderly reported to be independent, 81.3% were able to conduct instrumental daily life activities, and 24.4% reported needing a caregiver at home. The need for the family health team to adopt care technologies for the elderly in the scope of their homes is discussed.

  5. [Functional classification of the elderly in primary health care: proposed method].

    Science.gov (United States)

    Benítez del Rosario, M A; Hernández Estévez, P; de Armas, J; Barreto, J; Rodríguez Morales, H

    1995-05-31

    To develop a method of functional classification of the elderly (FCE) in Primary Health Care and to define the age limit for considering someone "a frail elderly person." A descriptive study in two phases: a) the method's design by means of "brainwriting" and b) the evaluation of the method in a descriptive crossover study. A rural medical consulting-room. The research team, in the design of the method; and the elderly population attending for health care (n = 131), in the method's evaluation. The FCE method was based on the Katz (IK) and Lawton-Brodie (IL-B) indices and classified the patients as independent and at different levels of disability. Urinary incontinence (UI) was excluded from the IK. 85.4% of the patients were independent, which bore relation to age (p < 0.001), but not to gender. When UI was included in the IK, the number of people classified as disabled increased by 32% (CI 95%, 23-41%) over when it was not included. Yet 80% of patients with UI were independent. No differences in the percentage of disabled patients were observed when the cut-off age for detecting disabled patients varied from 75 to 80. The inclusion of UI as a negative factor in the IK gives rise to overestimates of the number of disabled people. In our study the data suggested that the age for considering an elderly person as 'frail' should be 80.

  6. [Acute care of patients with bacterial meningitis].

    Science.gov (United States)

    Stetefeld, H R; Dohmen, C

    2016-04-01

    Bacterial meningitis is a life-threatening emergency that is still associated with high mortality and poor outcome. The purpose of this article is to provide a review of clinical presentation, diagnostic procedure, therapy, and prognosis in bacterial meningitis. Prognostic factors which could be influenced positively are identified and a focused procedure in the emergency setting and for the treatment of complications are provided. This work is based on a literature search (PubMed, guidelines) and personal experience (standard operating procedures, SOP). Despite improved health care, bacterial meningitis is still associated with high mortality and poor neurological outcome, which has remained largely unaltered during recent decades. Diagnosis and, more importantly, effective therapy of bacterial meningitis are often delayed, having an immediate negative influence on clinical outcome. Neurological and nonneurological complications often necessitate intensive care and may occur rapidly or in the further course of the disease. Immediate initiation of effective therapy is crucial to positively influence mortality and neurological outcome. Antibiotics should be administered within 30 min after admission. To achieve this, a focused and well-organized procedure in the emergency setting is necessary. Because of intra- and extracranial complications, patients need to be treated on intensive care units including neurological expertise and interdisciplinary support.

  7. Organizing principles and management climate in high-performing municipal elderly care.

    Science.gov (United States)

    Kajonius, Petri; Kazemi, Ali; Tengblad, Stefan

    2016-01-01

    Purpose - Previous research has shown that user-oriented care predicts older persons' satisfaction with care. What is yet to be researched is how senior management facilitates the implementation of user-oriented care. The purpose of this study is to investigate the organizing principles and management climate characterizing successful elderly care. Design/methodology/approach - The department in one highly ranked municipality was selected and compared with a more average municipality. On-site in-depth semi-structured interviews with department managers and participatory observations at managers' meetings were conducted in both municipalities. Findings - Results revealed three key principles for successful elderly care: organizing care from the viewpoint of the older person; recruiting and training competent and autonomous employees; instilling a vision for the mission that guides operations at all levels in the organization. Furthermore, using climate theory to interpret the empirical material, in the highly successful municipality the management climate was characterized by affective support and cognitive autonomy, in contrast to a more instrumental work climate primarily focusing on organizational structure and doing the right things characterizing the more average municipality. Originality/value - The authors suggest that guiding organizing principles are intertwined with management climate and that there are multiple perspectives that must be considered by the management, that is, the views of the older persons, the co-workers and the mission. These results can guide future care quality developments, and increase the understanding of the importance of organizational climate at the senior management level.

  8. Can FES-augmented active cycling training improve locomotion in post-acute elderly stroke patients?

    Directory of Open Access Journals (Sweden)

    Elisabetta Peri

    2016-06-01

    Full Text Available Recent studies advocated the use of active cycling coupled with functional electrical stimulation to induce neuroplasticity and enhance functional improvements in stroke adult patients. The aim of this work was to evaluate whether the benefits induced by such a treatment are superior to standard physiotherapy. A single-blinded randomized controlled trial has been performed on post-acute elderly stroke patients. Patients underwent FES-augmented cycling training combined with voluntary pedaling or standard physiotherapy. The intervention consisted of fifteen 30-minutes sessions carried out within 3 weeks. Patients were evaluated before and after training, through functional scales, gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy group. Sixteen patients completed the training. After treatment, a general improvement of all clinical scales was obtained for both groups. Only the mechanical efficiency highlighted a group effect in favor of the experimental group. Although a group effect was not found for any other cycling or gait parameters, the experimental group showed a higher percentage of change with respect to the control group (e.g. the gait velocity was improved of 35.4% and 25.4% respectively, and its variation over time was higher than minimal clinical difference for the experimental group only. This trend suggests that differences in terms of motor recovery between the two groups may be achieved increasing the training dose. In conclusion, this study, although preliminary, showed that FES-augmented active cycling training seems to be effective in improving cycling and walking ability in post-acute elderly stroke patients. A higher sample size is required to confirm results.

  9. Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

    Institute of Scientific and Technical Information of China (English)

    Ibrar Rafique; Umbreen Akhtar; Umar Farooq; Mussadiq Khan; Junaid Ahmad Bhatti

    2016-01-01

    Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR)=4.41], when the poisoning occurred at home (OR=21.84), and was related to self-harm (OR=18.73) or assault (OR=7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.

  10. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  11. [Acute care nursing pathology: case report of odynophagia].

    Science.gov (United States)

    Hernández-Fabà, Eva; Sanfeliu-Julià, Cristina

    2010-01-01

    Since 2008, the Institut Catala de la Salut (ICS) introduced the nurses management plan for acute pathology, in primary care centres. In the implementation of this system of organization, the ICS introduced various diseases protocols with performance algorithms. To raise awareness of the the practice of acute pathology, we present a clinical case. An urgent consultation of a 30 year-old male, with fever, sore throat and cough, which was managed and resolved by a nurse. The aim of this new management plan is that nursing is the first health professional to take care of patient coming to primary care centre without a scheduled visit, to avoid saturating the general clinic or hospital emergencies. This new organisational system involves an increase in the responsibilities of nursing in the diagnosis and treatment of patients.

  12. [Promote the autonomy and safety of the elderly: basic care].

    Science.gov (United States)

    Casado, Veredejo Inés; Iglesias, Guerra José Antonio; Postigo Mota, Salvador

    2013-06-01

    The aging process brings with it changes to biological, psychological and social level that hinder the maintenance of the autonomy of older people and, consequently, decrease their quality of life. The progressive aging population, due to the health, social and economic development of recent times, generates new challenges to the professionals involved in the maintenance of the autonomy of this increasingly long-lived population group. One of the fundamental strategies for the maintenance of the satisfaction of new needs that have arisen is the promotion of self-care. Nurses are the leading providers of care and up to us much of the responsibility to cope with the new demands of care demanded by the population aging.

  13. The costs and service implications of substituting intermediate care for acute hospital care.

    Science.gov (United States)

    Mayhew, Leslie; Lawrence, David

    2006-05-01

    Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.

  14. A transitional care service for elderly chronic disease patients at risk of readmission.

    Science.gov (United States)

    Brand, Caroline A; Jones, Catherine T; Lowe, Adrian J; Nielsen, David A; Roberts, Carol A; King, Bellinda L; Campbell, Donald A

    2004-12-13

    Multiple hospital admissions, especially those related to chronic disease, represent a particular challenge to the acute health care sector in Australia. To determine whether a nurse-led chronic disease management model of transitional care reduced readmissions to acute care. A quasi-experimental controlled trial. A large tertiary metropolitan teaching hospital. 166 general medical patients aged > or = 65 years with either a history of readmissions to acute care or multiple medical comorbidities. Implementation of a chronic disease management model of transitional care aimed at improving patient management and reducing readmissions to acute care. Readmission rates and emergency department presentation rates at 3-and 6-month follow up. Secondary outcome measures include quality of life, discharge destination, and primary health care service utilisation. There was no difference in readmission rates, emergency department presentation rates, quality of life, discharge destination or primary health care service utilisation. The difficulties inherent in evaluating this type of multifactorial intervention are discussed and consideration is given to patient factors, the difficulty of influencing readmission rates, and local system issues. The outcomes of this study reflect the tension that exists between implementing multifaceted integrated health service programs and attempting to evaluate them within complex and changing environments using robust research methodologies.

  15. Innovative use of tele-ICU in long-term acute care hospitals.

    Science.gov (United States)

    Mullen-Fortino, Margaret; Sites, Frank D; Soisson, Michael; Galen, Julie

    2012-01-01

    Tele-intensive care units (ICUs) typically provide remote monitoring for ICUs of acute care, short-stay hospitals. As part of a joint venture project to establish a long-term acute level of care, Good Shepherd Penn Partners became the first facility to use tele-ICU technology in a nontraditional setting. Long-term acute care hospitals care for patients with complex medical problems. We describe describes the benefits and challenges of integrating a tele-ICU program into a long-term acute care setting and the impact this model of care has on patient care outcomes.

  16. Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women.

    Science.gov (United States)

    Muniz de Souza, Helga; Rocha, Taciano; Campos, Shirley Lima; Brandão, Daniella Cunha; Fink, James B; Aliverti, Andrea; de Andrade, Armele Dornelas

    2016-06-15

    It is not completely described how aging affect ventilatory kinematics and what are the mechanisms adopted by the elderly population to overcome these structural modifications. Given this, the aim was to evaluate the acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Variables assessed included: tidal volume (Vt), total chest wall volume (Vcw), pulmonary rib cage (Vrcp%), abdominal rib cage (Vrca%) and abdominal compartment (Vab%) relative contributions to tidal volume. These variables were assessed during quiet breathing, maximal inspiratory pressure maneuver (MIP), and moderate inspiratory resistance (MIR; i.e., 40% of MIP). 22 young women (age: 23.9 ± 2.5 years) and 22 elderly women (age: 68.2 ± 5.0 years) participated to this study. It was possible to show that during quiet breathing, Vab% was predominant in elderly (pelderly (p=0.249). When MIP was imposed, both groups presented a predominance of Vrcp%. In conclusion, there are differences in abdominal kinematics between young and elderly women during different inspiratory efforts. In elderly, during moderate inspiratory resistance, the pattern is beneficial, deep, and slow. Although, during maximal inspiratory resistance, the ventilatory pattern seems to predict imminent muscle fatigue.

  17. A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

    OpenAIRE

    2016-01-01

    Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran.Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps...

  18. Surgical acute abdomen in the elderly. Hospital Nacional Daniel Alcides Carrión - Callao - 1992-1996

    OpenAIRE

    Arrus Soldi, José; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    The aim of this descriptive and retrospective study was to assess the main causes leading to Surgical Acute Abdomen (S.A.A.) in the elderly, as well as their clinical manifestations and morbi-mortality. All individuals older than 60 years which were admitted with the diagnosis of S.A.A. and underwent surgery at the emergency room of the Hospital Nacional Daniel A. Carión (HNDAC) between january 1th, 1992 and december 31th, 1996, were considered. There were 317 cases of S.A.A. in elderly patie...

  19. Social Occupational Therapy in the care of the elderly: life history and production of meanings

    OpenAIRE

    Amabile Teresa de Lima Neves; Maria Daniela Corrêa de Macedo

    2015-01-01

    This paper addresses the experience report of accompanying an elderly woman attended by the Specialized Home Care Service (SEAD) of the social assistance network of the municipality of Vitoria, Espirito Santo state, Brazil. Through the Social Assistance Specialized Reference Center (CREAS), SEAD is offered to people with disabilities and older people with some degree of dependency and under situation of violation of human rights, as well as to their caregivers and family. In order to contextu...

  20. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Vjollca Shpata,1 Ilir Ohri,2 Tatjana Nurka,1 Xhensila Prendushi1 1Faculty of Medical Technical Sciences, 2University Hospital Center of Tirana “Mother Theresa”, Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania Purpose: Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutritio...

  1. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Purpose Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18–64 years), and to examine the negative consequences associated with risk of malnutrition in older adults. Materials and methods A prospective cohort study in the ICU of the Universi...

  2. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Vjollca Shpata,1 Ilir Ohri,2 Tatjana Nurka,1 Xhensila Prendushi1 1Faculty of Medical Technical Sciences, 2University Hospital Center of Tirana “Mother Theresa”, Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania Purpose: Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of mal...

  3. Leadership in Care of the Elderly: Assessing Needs and Challenges.

    Science.gov (United States)

    Stryker-Gordon, Ruth

    1982-01-01

    This article discusses the following questions: What opportunities and challenges for nursing leadership present themselves in institutions that provide care for our expanding aged population? Should nursing administrators take up these challenges? If so, what skills, resources, and attitudes will they need? (Author/CT)

  4. EFFECTIVE COMMUNICATION AS AN IMPORTANT SKILL FOR QUALITY CARE IN ELDERLY PATIENTS.

    Science.gov (United States)

    Rubinstein, Dorit

    2014-10-01

    The increase in the number of older people in the world emphasizes the need to reevaluate and change health care policy and care services priorities. The provision of health care for this growing population has consequently become an important worldwide concern. The purpose of this article is to highlight the challenges stemming from the growing number of elderly people and their need for care. Collaborative and coordinated health care services for elderly people should be focused on the ethical issues deriving from the interpersonal relationships between the professional caregiver and the older person. Any discussion on ethics and aging should be focused on the roles of autonomy, informed consent, respect, advance directive, end of life decisions and privacy. In addition, such a discussion should stress the important role of effective communication and its effect on the older person's adherence with the recommended treatment. The desired consequence should be the empowerment of positive and successful experiences attained by the recipients of the health care services.

  5. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

    Directory of Open Access Journals (Sweden)

    Unni Alice Dahl

    2014-04-01

    Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews.Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients.Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

  6. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

    Directory of Open Access Journals (Sweden)

    Unni Alice Dahl

    2014-04-01

    Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital.  Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

  7. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  8. The Health Heterogeneity of and Health Care Utilization by the Elderly in Taiwan

    Directory of Open Access Journals (Sweden)

    Li-Fan Liu

    2014-01-01

    Full Text Available A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC, Functional Impairment (FI, Frail (FR, and Relatively Healthy (RH. Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one’s family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures.

  9. Elderly care by physiotherapists on Family Health Support Center in Arapiraca, Alagoas, Brazil

    Directory of Open Access Journals (Sweden)

    Almir Vieira Dibai Filho

    2012-03-01

    Full Text Available Objective: To analyze the actions of physiotherapists in Nuclei to Support Family Health (NSFH with senescent individuals residing in the city of Arapiraca-AL, Brazil. Methods: The study was characterized as descriptive and qualitative. The research subjects were eight physiotherapists performing interventions with the elderly in NSFH, from both genders, regularly registered in Regional Council of Physiotherapy and Occupational Therapy 1 (RCPOT 1. Data were obtained in October 2010 with a questionnaire to characterize the sample, having been collected personal data and issues related to academic and work in NSFH. In addition, there was an interview addressing opinions of physiotherapists relating to care of the elderly in the Family Health Strategy (FHS and the NSFH, the role of physiotherapists in NSFH with seniors, and the difficulties experienced in this work. Qualitative analysis was performed using the technique of collective subject discourse. Results: The professionals included in the study considered positive and regular the care to the elderly in the ESF and the NSFH, respectively. The interventions are based on NSFH actions based on primary health care and the difficulties relate to the multidisciplinary team and the lack of resources and infrastructure. Conclusion: The physiotherapists in NSFH of the municipality under study develop their actions in senescent population, with an emphasis on educational measures, preventive and health promoting.

  10. Team social cohesion, professionalism, and patient-centeredness: Gendered care work, with special reference to elderly care - a mixed methods study.

    Science.gov (United States)

    Öhman, Ann; Keisu, Britt-Inger; Enberg, Birgit

    2017-06-02

    Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly. A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi(2) and constructivist grounded theory were used to analyse the data. There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'. The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power

  11. Use of telemedicine-based care for the aging and elderly: promises and pitfalls

    Directory of Open Access Journals (Sweden)

    Bujnowska-Fedak MM

    2015-05-01

    Full Text Available Maria Magdalena Bujnowska-Fedak, Urszula Grata-Borkowska Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland Abstract: Telemedicine-based care provides remote health and social care to maintain people's autonomy and increase their quality of life. The rapidly aging population has come with a significant increase in the prevalence of chronic diseases and their effects, and thus the need for increased care and welfare. The elderly have become one of the main target groups for telecare technologies. Smart home systems allow older adults to live in the environment of their choice and protect them against institutionalization or placement in a nursing home. It gives the elderly person a feeling of reassurance and safety, and appears to be one of the most promising approaches to facilitate independent living in a community-dwelling situation. Telecare solutions give a new opportunity for diagnosis, treatment, education, and rehabilitation, and make it possible to monitor patients with a number of chronic diseases. It also reduces socioeconomic disparity with regard to access to care and gives equal chances to patients from urban and rural areas. However, although telecare has undisputed benefits, it also has some limitations. Older people are often resistant to use of new technology, in particular acquiring the knowledge and skills necessary for use of electronic devices and computer systems. Further, privacy and security are important elements when building confidence in telemedicine systems. Leaking of sensitive information, such as health or test results, may have a negative and far-reaching impact on the personal and professional life of the patient. Telemedicine-based care should now be personalized for the needs, capabilities, and preferences of the elderly, with adaptation over time as care needs evolve. If technologies are introduced that are familiar, usable, desirable, and cost-effective, and able to be adapted to

  12. Hospital medicine (Part 2): what would improve acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John

    2009-09-01

    There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

  13. Do nurses and other health professionals' in elderly care have education in family nursing?

    Science.gov (United States)

    Sunde, Olivia Sissil; Øyen, Karianne Røssummoen; Ytrehus, Siri

    2017-05-19

    Family caregivers are an important resource for providing care to elderly living at home. How nurses and other health professionals interact with family caregivers can have both a positive and a negative impact on the family caregivers' situation. We lack knowledge of Norwegian nurses' and other health professionals' participation in educational programmes about family caregivers' needs and situations. The purpose of this study was to investigate whether nurses and other health professionals working in home-care nursing had participated in educational programmes about family caregivers. Additionally, the study aimed to determine whether participation in educational programmes was associated with awareness of family caregivers' contributions to elder care. This is a quantitative study, and it was conducted as a cross-sectional study. The participants were required to be educated as nurses, nursing assistants or other health professionals with relevant health education and to be working with the elderly in home-care nursing settings. Descriptive statistics and trivariate table analysis using the Pearson Chi-square t-test were conducted using Statistical Package for the Social Sciences (SPSS). A total of 152 nurses and health professionals in home-care nursing in 23 municipalities have participated (in one county in Norway). The results showed that only half of the respondents had participated in educational programmes about family caregivers' needs and situations. The study did not provide a clear answer regarding the association between participation in educational programmes and awareness of family caregivers' contributions. The results indicate that nurses and other health professionals, to a small extent, have participated in educational programmes about family caregivers. Our findings indicate that participation in educational programmes may be particularly important for health professionals in leadership positions and for health professionals with vocational

  14. Strategic prevention of musculoskeletal disorders in elderly care

    DEFF Research Database (Denmark)

    Seim, Rikke; Edwards, Kasper; Poulsen, Signe

    2015-01-01

    exposed to heavy physical work. The known risk factors for developing MSD are: 1) Heavy manual work including person lifting and moving, 2), Monotonous, repetitive and monotonous, stressful work, 3) Straining, awkward postures and movements, 4) Whole-body vibration (NFA 2009, National Research Council...... and the Institute of Medicine 2001). The first three risk factors are prevalent in the health care sector and employees are prone to develop MSDs due to the high level of manual labor e.g. physical handling of patients. The sector work environment council for the social and health care sector (BAR SOSU) has joint...... is a serious and comprehensive work environment problem. It is also recognized as such in the Danish National Work Environment Strategy 2020, where MSD is ranked as one of three main focus areas with the aim of reducing the number of MSD incidents with 20% by the year 2020 (WEA 2020). It is estimated...

  15. Welfare Technology and Surveillance in Care Work for Elderly Citizens

    DEFF Research Database (Denmark)

    Hansen, Agnete Meldgaard; Kamp, Annette; Grosen, Sidsel Lond;

    ‘Welfare technologies’ are increasingly used in a variety of settings in the Danish welfare state (Mortensen 2015), where they are envisioned as leading to a new and smarter form of welfare state service delivery, promising increased efficiency, better quality, and citizen empowerment (Finansmini......‘Welfare technologies’ are increasingly used in a variety of settings in the Danish welfare state (Mortensen 2015), where they are envisioned as leading to a new and smarter form of welfare state service delivery, promising increased efficiency, better quality, and citizen empowerment...... (Finansministeriet 2014). Based on two ethnographic field studies we discuss how selected technologies facilitate care and surveillance of citizens in different manners and with different consequences for care relationships between citizens and eldercare professionals. We focus on ‘intelligent floors...

  16. [Empathy fatigue and psychiatric care of the elderly].

    Science.gov (United States)

    Hazif-Thomas, Cyril; Thomas, Philippe

    2015-01-01

    Empathy is one of the qualities which enable caregivers to develop high quality care. The circumstances of professional practice such as pressure and lack of time can see this quality pushed to one side. The risk of burnout is all the greater as empathy alone does not protect caregivers from submitting themselves to their hierarchy. Compassion, on the other hand, enables caregivers to actively take on their responsibilities. Copyright © 2015. Published by Elsevier Masson SAS.

  17. A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

    Directory of Open Access Journals (Sweden)

    Salime Goharinezhad

    2016-11-01

    Full Text Available Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design: This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results: The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion: According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

  18. Quality of private personal care for elderly people with a disability living at home: correlates and potential outcomes.

    Science.gov (United States)

    Bilotta, Claudio; Vergani, Carlo

    2008-07-01

    To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the 'poor or fair care' group (n = 16), the 'intermediate care' group (n = 39) and the 'optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean +/- standard deviation (SD) were, respectively, 45 +/- 23.2, 63.7 +/- 19.7 and 68.8 +/- 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean +/- SD were, respectively, 34.9 +/- 25.3, 26 +/- 17.7 and 17.6 +/- 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care.

  19. A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

    Science.gov (United States)

    Goharinezhad, Salime; Maleki, Mohammadreza; Baradaran, Hamid Reza; Ravaghi, Hamid

    2016-01-01

    Background With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue. PMID:27876456

  20. [Nurse-Led Care Models in the Context of Community Elders With Chronic Disease Management: A Systematic Review].

    Science.gov (United States)

    Hsieh, Pei-Lun; Chen, Ching-Min

    2016-08-01

    Longer average life expectancies have caused the rapid growth of the elderly as a percentage of Taiwan's population and, as a result of the number of elders with chronic diseases and disability. Providing continuing-care services in community settings for elderly with multiple chronic conditions has become an urgent need. To review the nurse-led care models that are currently practiced among elders with chronic disease in the community and to further examine the effectiveness and essential components of these models using a systematic review method. Twelve original articles on chronic disease-care planning for the elderly or on nurse-led care management interventions that were published between 2000 and 2015 in any of five electronic databases: MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text, Cochrane Library, and CEPS (Chinese Electronic Periodicals Service)were selected and analyzed systematically. Four types of nurse-led community care models, including primary healthcare, secondary prevention care, cross-boundary models, and case management, were identified. Chronic disease-care planning, case management, and disease self-management were found to be the essential components of the services that were provided. The care models used systematic processes to conduct assessment, planning, implementation, coordination, and follow-up activities as well as to deliver services and to evaluate disease status. The results revealed that providing continuing-care services through the nurse-led community chronic disease-care model and cross-boundary model enhanced the ability of the elderly to self-manage their chronic diseases, improved healthcare referrals, provided holistic care, and maximized resource utilization efficacy. The present study cross-referenced all reviewed articles in terms of target clients, content, intervention, measurements, and outcome indicators. Study results may be referenced in future

  1. Continuity of care for elderly patients with diabetes mellitus, hypertension, asthma, and chronic obstructive pulmonary disease in Korea.

    Science.gov (United States)

    Hong, Jae Seok; Kang, Hee Chung; Kim, Jaiyong

    2010-09-01

    We sought to assess continuity of care for elderly patients in Korea and to examine any association between continuity of care and health outcomes (hospitalization, emergency department visits, health care costs). This was a retrospective cohort study using the Korea National Health Insurance Claims Database. Elderly people, 65-84 yr of age, who were first diagnosed with diabetes mellitus (n=268,220), hypertension (n=858,927), asthma (n=129,550), or chronic obstructive pulmonary disease (COPD, n=131,512) in 2002 were followed up for four years, until 2006. The mean of the Continuity of Care Index was 0.735 for hypertension, 0.709 for diabetes mellitus, 0.700 for COPD, and 0.663 for asthma. As continuity of care increased, in all four diseases, the risks of hospitalization and emergency department visits decreased, as did health care costs. In the Korean health care system, elderly patients with greater continuity of care with health care providers had lower risks of hospital and emergency department use and lower health care costs. In conclusion, policy makers need to develop and try actively the program to improve the continuity of care in elderly patients with chronic diseases.

  2. Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients

    DEFF Research Database (Denmark)

    Ringoir, L.; Widdershoven, J. W.; Pedersen, S. S.

    2014-01-01

    Background The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. Aim To assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram. Design...... and setting Cross-sectional screening study in five general practices in the south-east of the Netherlands. Method Between June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist. All patients...

  3. Serum Fatty Acids, Traditional Risk Factors, and Comorbidity as Related to Myocardial Injury in an Elderly Population with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Laake, Kristian; Seljeflot, Ingebjørg; Schmidt, Erik B;

    2016-01-01

    ), and peak Troponin T (TnT) levels in elderly patients with an acute myocardial infarction (AMI). Materials and Methods. Patients (n = 299) consecutively included in the ongoing Omega-3 fatty acids in elderly patients with myocardial infarction (OMEMI) trial were investigated. Peak TnT was registered during...

  4. The influence of eastern philosophy on elder care by Chinese Americans: attitudes toward long-term care.

    Science.gov (United States)

    Smith, Cary Stacy; Hung, Li-Ching

    2012-01-01

    Chinese philosophy has been a major cornerstone of Chinese culture for millennia and has bestowed on the world traditions such as Taoism, Yin and Yang, and filial piety. Although these beliefs have remained steadfast over thousands of years, their ability to survive unchanged in the future is uncertain. As the world forges ahead into the 21st century, several pertinent questions arise: Will age-old axioms, primarily those concerning elderly Chinese and their relationship with their children, survive? When ancient, traditional beliefs conflict with newer, Western ideas, which system of thought is likely to be the victor? Moreover, will elderly Chinese Americans and their perceptions concerning long-term care facilities cause problems with the traditional familial unit? This article will discuss these issues in detail.

  5. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  6. Care of the elderly persons in the system of social protection in the Republic of Srpska

    Directory of Open Access Journals (Sweden)

    Lepir Ljubo

    2010-01-01

    Full Text Available The number of the elderly in the overall population is increasing, which poses a need to seek an adequate model of organizing social care of the elderly. Most of them get social safety through the social welfare system. A functional and sustainable social welfare system requires application of efficient management and technique models based on the theoretical premises of contemporary management. The role and the importance of old people's protection in a social welfare system is becoming a topic of great importance both for theoreticians and the practitioners in the social sector area. This research analyzes the management functions and the roles of managers in running social protection of the elderly in the example of the social welfare system in the Republic of Srpska. A decentralized system, such as the one existing in the Republic of Srpska, brings along a number of organizational problems which points out to a need to apply the theoretical bases of managerial processes. The results obtained via empirical analyses indicate a number of deficiencies and obstacles in the implementation of social protection of the elderly in the social welfare system of the Republic of Srpska which are result of the insufficient and inconsistent application of the basic managerial elements. The obstacles emerging from this analysis indicate that there are chances and opportunities to improve the system and enhance the development of new forms of protection by applying managerial theories. .

  7. Nursing care gestion of chronically ill elderly people. Policlinico 2, year 2007

    Directory of Open Access Journals (Sweden)

    Liudmila Carbonell Sanamé

    2009-01-01

    Full Text Available A descriptive prospective study was made to those patients aged more than 60 years who are attended in the Policlinico 2 “Leonilda Tamayo Matos” in Isla de la Juventud during the year 2007. The study population was 1254 and 700 chronically ill elderly people were taken as representative sample, using a simple random sampling. The Mini Mental State Examination and a satisfaction survey was made to old people, all these with their informed consent. The main variables to study were: sex, age, race, civil state, educational level, work, assistance to the Grandparent’s Circle and satisfaction level. There exists a feminine predominance (61% over male, as well as the age group from 60 to 64 years old. Mixed race is the most common one (43%, followed by black (35%. 43% of these elders have secondary studies, and 64% of them are retired. The assistance to the Grandparent’s Circle is good, 338 of all the elders studied (48.2% assist to it. The results were expressed with real numbers and percentages, and were represented in bar and pie charts. There exists a predominance of arterial hypertension and diabetes mellitus in the elders studied. The quality of the nursing cares to the chronically ill old people of the policlinic 2 in 2007 was good.

  8. Challenges to culturally sensitive care for elderly chinese patients: a first-generation Chinese-American perspective.

    Science.gov (United States)

    Chan, Karen C

    2013-01-01

    Physicians and medical institutions in the United States are placing increasing emphasis on providing culturally sensitive care for patients, such as implementing a Confucian family-based model of medical decision making when caring for elderly Chinese patients. In this article, I articulate various reasons why deferring to the family is not a guarantee of culturally sensitive care, particularly when family members are first-generation Chinese-Americans. Nonetheless, I offer several suggestions to help physicians, medical institutions, and family members to provide more culturally sensitive care for elderly Chinese patients.

  9. The important things in the life of older people: elderly women in social houses and home care.

    Science.gov (United States)

    Kasepalu, Ulle; Laidmäe, Virve-Ines; Tulva, Taimi

    2014-01-01

    The purpose of the article is to analyze the aging experiences of elderly women in Estonia and the factors influencing them. The assessments of two groups using social services are compared-the elderly living in Tallinn's social houses and the elderly receiving care at home. From February to August 2011, a total of 80 elderly women were interviewed. Inhabitants of social houses find that their old age is satisfying more often (65% of the inhabitants of social houses and 40% of the people in home care). Many home care clients were convinced that it is best to spend old age among loved ones and in a familiar environment. Those living at home have many difficulties, which is why 20% of them are on a waiting list to go to a social house. Home services should include services with which the inhabitants of social houses are very satisfied.

  10. Acute aerobic exercise increases brain-derived neurotrophic factor levels in elderly with Alzheimer's disease.

    Science.gov (United States)

    Coelho, Flávia Gomes de Melo; Vital, Thays Martins; Stein, Angelica Miki; Arantes, Franciel José; Rueda, André Veloso; Camarini, Rosana; Teodorov, Elizabeth; Santos-Galduróz, Ruth Ferreira

    2014-01-01

    Studies indicate the involvement of brain-derived neurotrophic factor (BDNF) in the pathogenesis of Alzheimer's disease (AD). Decreased BDNF levels may constitute a lack of trophic support and contribute to cognitive impairment in AD. The benefits of acute and chronic physical exercise on BDNF levels are well-documented in humans, however, exercise effects on BDNF levels have not been analyzed in older adults with AD. The aim of this study was to investigate the effects of acute aerobic exercise on BDNF levels in older adults with AD and to verify associations among BDNF levels, aerobic fitness, and level of physical activity. Using a controlled design, twenty-one patients with AD (76.3 ± 6.2 years) and eighteen healthy older adults (74.6 ± 4.7 years) completed an acute aerobic exercise. The outcomes included measures of BDNF plasma levels, aerobic fitness (treadmill grade, time to exhaustion, VO2, and maximal lactate) and level of physical activity (Baecke Questionnaire Modified for the Elderly). The independent t-test shows differences between groups with respect to the BDNF plasma levels at baseline (p = 0.04; t = 4.53; df = 37). In two-way ANOVA, a significant effect of time was found (p = 0.001; F = 13.63; df = 37), the aerobic exercise significantly increased BDNF plasma levels in AD patients and healthy controls. A significant correlation (p = 0.04; r = 0.33) was found between BDNF levels and the level of physical activity. The results of our study suggest that aerobic exercise increases BDNF plasma levels in patients with AD and healthy controls. In addition to that, BDNF levels had association with level of physical activity.

  11. Suffering caused by care—elderly patients’ experiences in community care

    Directory of Open Access Journals (Sweden)

    Rune Svanström

    2013-11-01

    Full Text Available Background: Growing old involves many changes in life and implies an increased risks of illness and different forms of disabilities. Life may change in a radical way when a person gets a disease like dementia or moves to a nursing home due to disabilities or needs. In both cases, it often leads to an increased dependency on care where the patient becomes exposed and vulnerable and thereby at a higher risk for experiencing different forms of suffering. Aim: The aim of this study was to elucidate and gain a deeper understanding of elderly patients’ experiences of suffering in relation to community care in nursing homes and home care services. Materials and methods: A lifeworld hermeneutical approach was used. Phenomenological interviews and conversations with an open approach were conducted and analysed with a focus on meanings. Findings: The findings were presented in four main themes; an absence of the other in care, an absence of dialogues, a sense of alienation and a sense of insecurity. The findings in this study revealed that persons who were cared for in nursing homes and home care services sometimes were exposed to an unnecessary suffering. The suffering sometimes was caused by various caring actions, that is, unnecessary suffering. The suffering caused by care that aroused was due to caregiver's inability to be present, to show their face, and truly meet the patient. Conclusion: Suffering from care increased the elderly patients’ feelings of insecurity, loneliness, and alienation; this seemed to be the foundation for patients’ experiences of being outside a human community. There was a lack of knowledge and understanding about the patient's lifeworld.

  12. Inpatient care of the elderly in Brazil and India: assessing social inequalities.

    Science.gov (United States)

    Channon, Andrew Amos; Andrade, Monica Viegas; Noronha, Kenya; Leone, Tiziana; Dilip, T R

    2012-12-01

    The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.

  13. Compassion fatigue within double duty caregiving: nurse-daughters caring for elderly parents.

    Science.gov (United States)

    Ward-Griffin, Catherine; St-Amantr, Oona; Brown, Judith Belle

    2011-01-31

    This article examines compassion fatigue within double duty caregiving, defined here as the provision of care to elderly relatives by practicing nurses. Using qualitative data from our two studies of Canadian double duty caregivers, we identified and interviewed 20 female registered nurses whom we described as "living on the edge." The themes of context, characteristics, and consequences emerged from the findings. In this article, we argue that being both a nurse and a daughter leads to the blurring of boundaries between professional and personal care work, which ultimately predisposed these caregivers to compassion fatigue. We found that the context of double duty caregiving, specifically the lack of personal and professional resources along with increasing familial care expectations, shaped the development of compassion fatigue. Nurse-daughters caring for elderly parents under intense and prolonged conditions exhibited certain characteristics, such as being preoccupied and absorbed with their parents' health needs. The continual negotiation between professional and personal care work, and subsequent erosion of those boundaries, led to adverse health consequences experienced by the nurse-daughters. The study findings point to the need to move beyond the individualistic conceptualization and medical treatment of compassion fatigue to one that recognizes the inherent socio-economic and political contextual factors associated with compassion fatigue. Advocating for practice and policy changes at the societal level is needed to decrease compassion fatigue amongst double duty caregivers. In this article we review the compassion fatigue literature, report our most recent study methods and findings, and discuss our conclusions.

  14. Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease.

    Science.gov (United States)

    Ngeh, Joseph; Gupta, Sandeep; Goodbourn, Colin; Panayiotou, Barnabas; McElligott, Geraldine

    2003-01-01

    Multiple studies have suggested an association between Chlamydia pneumoniae infection and atherosclerotic vascular disease. We investigated whether serological markers of C. pneumoniae infection were associated with acute stroke or transient ischaemic attack (TIA), exclusively in elderly patients. One-hundred white patients aged over 65 years admitted with acute stroke or TIA, and 87 control patients admitted with acute non-cardiopulmonary, non-infective disorders were recruited prospectively. Using an enzyme-linked immunosorbent assay kit, the presence of C. pneumoniae immunoglobulins IgA, IgG, IgM in patients' sera was determined. The seroprevalence of C. pneumoniae-specific IgA, IgG, IgM were 63, 71, and 14% in the stroke/TIA group (median age = 80), and 62, 65, and 17% in the control group (median age = 80), respectively. Using a logistic regression statistical model, adjusting for age and sex, history of hypertension, smoking, diabetes, ischaemic heart disease (IHD), ischaemic electrocardiogram (ECG), the odds ratios (ORs) of having a stroke/TIA in relation to C. pneumoniae-specific IgA, IgG, IgM were 1.04, 1.24, 0.79 (p = NS). Further analysis identified 43 acute stroke/TIA cases and 44 controls without history of IHD or ischaemic ECG or both. After adjusting for history of hypertension, smoking, diabetes, age and sex, the ORs in this subgroup were 1.40 for IgA [95% confidence interval (CI) 0.53-3.65; p = 0.49], 2.41 for IgG (95% CI 0.90-6.46; p = 0.08) and 1.55 for IgM (95% CI 0.45-5.40; p = 0.49). Although a high seroprevalence of C. pneumoniae in elderly patients was confirmed, no significant association between serological markers of C. pneumoniae infection and acute cerebrovascular events was found. There was, however, a weak trend towards increased ORs for acute cerebrovascular disease in a subgroup of C. pneumoniae seropositive elderly patients without any history of IHD or ischaemic ECG. Copyright 2003 S. Karger AG, Basel

  15. Planning for subacute care: predicting demand using acute activity data.

    Science.gov (United States)

    Green, Janette P; McNamee, Jennifer P; Kobel, Conrad; Seraji, Md Habibur R; Lawrence, Suanne J

    2016-04-07

    Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) care following acute in-patient episodes provided in Australian hospitals.Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre.Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs.Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning.What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of subacute care, it is timely to find improved methods of estimating demand for this type of care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions.What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the methodology

  16. [Multimodal neuromonitoring for the critical care management of acute coma].

    Science.gov (United States)

    Ltaief, Z; Ben-Hamouda, N; Suys, T; Daniel, R T; Rossetti, A O; Oddo, M

    2014-12-10

    Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase. The aim of this review is to describe the utility of multimodal neuromonitoring for the critical care management of acute coma.

  17. Pain management in the acute care setting: Update and debates.

    Science.gov (United States)

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  18. Prevalence, seriousness and reporting of work-related violence in the Danish elderly care.

    Science.gov (United States)

    Sharipova, Muborak; Borg, Vilhelm; Hogh, Annie

    2008-12-01

    A survey study (paper and pencil) among staff of elderly care institutions in 36 Danish municipalities (n = 9949) was conducted in 2005 with a response rate of 78%. The majority of the participants of the study were women (96%). The paper presents the prevalence, perpetrators, seriousness (self-rated seriousness, injuries, sick leave and type of violence) of work-related physical violence towards care workers in the Danish elderly care and the frequency of reporting the incidents to the safety organization. The findings show that every fourth caregiver was exposed to violence in 2005. Care personnel working in nursing homes and integrated institutions had the highest prevalence of violence (40%) and were also most often (10%) exposed to violence. Clients were most often (>90% of cases) the perpetrators. The most frequent types of violence were hitting (63%) and scratching/pinching (63%). Being held (32%) or kicked (27%) was also mentioned as frequent types of violence; use of weapon, throwing or hitting with a hard objects were more seldom. Nearly 1/3 of the exposed respondents rated at least one incident as very serious. There were significant associations between self-rated seriousness and type of violence, injuries and sick leave. The incidents were, in particular when perpetrators were clients, often rated as not serious. Only 22% of the victims of violence reported the violent incidents to the safety organizations. Reports of violent incidents were significantly associated with frequency of exposure, type of violence, physical injury, sick leave and perpetrators. The more frequent and most serious cases were reported most often and cases where the perpetrators were clients were reported less often than when perpetrators were others. It has been suggested that underreporting of violence occurs because it is time consuming, lacks supervisory support, because it won't make any difference, because it is part of the job, and also because there is a tendency to

  19. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  20. Frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan.

    Directory of Open Access Journals (Sweden)

    Waris Qidwai

    Full Text Available OBJECTIVE: To study frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan. METHODOLOGY: A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC, Aga Khan University Hospital (AKUH Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent. RESULTS: A total of 400 elderly completed the interview. Majority were females, 65-69 years age, More than half of the individuals ie: 227 (85% had received Care Giver experience for assistance and among these 195(72% had care provided by an immediate family member. A large proportion of them stated that their Care Givers managed to provide less than four hours in a day for care giving. Around 37% showed substantial improvement in their relationship with the care givers. About 70% of the respondents stated that the care provided by the Care Giver improved their quality of life. CONCLUSION: Elderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.