ECMO: back where we started, again.
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Decision Making↗
Biomedical subjects
L Clemson
Publications and source records attributed to L Clemson.
Families and nursing home placements: a cross-cultural study.
With the aging of many populations, health care workers and families increasingly find themselves jointly involved in situations involving decisions about nursing home placements. How each approaches such situations is affected by beliefs and assumptions about the role of family members in the care of family members and the decision making process. This paper explores the responses of people from four cultural groups living in Australia (Anglo-Celtic Australian, Chinese, Greek, Lebanese) to a critical incident scenario about a Russian family in Australia faced with such a decision. The responses to this scenario were remarkably similar across the four cultural groups. All saw making such a decision as difficult, but the reasons for the difficulty suggest some interesting cross-cultural distinctions. Some groups viewed care of a family member more in terms of a social and role obligation while others addressed it as a personal responsibility. To not care for elderly parents in the home was accompanied by a sense of guilt among some respondents and a sense of public social shame among others. Ambivalence about nursing homes and placing a family member in a nursing home, culture change and cross-generational differences, and roles and role support were other important themes. The results are consistent with other data analysed in conjunction with the Intercultural Interaction Project. The findings from this research suggests a need to examine more closely the beliefs and assumptions associated with nursing home placements and one way to help students and health professionals to do so.
Journal Article↗
Managing risk and exerting control: determining follow through with falls prevention.
PURPOSE/METHOD: This study used in-depth interviews to explore the perspectives of nine older women who had not followed through with environmental modification recommendations to reduce their risk of falls in the home. RESULTS: It was found that the core concept of 'exerting control' provided an understanding of their experience following an occupational therapy home visit. Exerting control was a behavioural, cognitive and affective process whereby the women made decisions about whether or not to follow through with environmental modification recommendations based on their knowledge of environmental risks, perceptions of degree of risk, perceived ability to mediate these risks through behaviour and the degree of freedom she had in decision making. Exerting control meant that the women made daily choices about their home environment which increased or decreased the risk of falls with identified home hazards. CONCLUSION: The findings suggest that, for some women, health professionals need to understand and work with the phenomenon of exerting control, in order to work with clients to reduce environmental hazards.
Accidental Falls↗
Case-control study of hazards in the home and risk of falls and hip fractures.
The importance of environmental hazards in the home as risk factors for falls and fractures is uncertain. A case-control study was conducted, involving people aged 65 years and over referred to an occupational therapy department for home assessment. There were 52 subjects with a recent hip fracture, 43 fallers (subjects with two or more falls in the past year but no hip fracture), and 157 non-fallers (subjects without hip fracture and with fewer than two falls in the past year). Subjects' homes were assessed for environmental hazards by occupational therapists using a structured home assessment form comprising 35 potential hazards. Overall, the homes of fallers were no more hazardous than the homes of non-fallers. However, fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment. A wide range of environmental hazards was associated with hip fractures. Many of the findings of this study could be due to bias inherent in the case-control design. To overcome the inadequacies of observational studies for the investigation of home hazards and falls, randomized trials are recommended to determine if removing hazards reduces the risk of falls and fractures.
Accidental Falls↗
Adherence to occupational therapist recommendations for home modifications for falls prevention.
OBJECTIVE: This study examined adherence to home modification recommendations made by an occupational therapist and attempted to identify predictors of adherence. METHOD: An experienced occupational therapist visited the homes of 178 people (mean age = 764 years) to evaluate for and recommend appropriate home modifications for falls prevention. One year later, a research assistant visited these persons' homes to assess adherence. RESULTS: At least one home modification was recommended in 150 of the 178 homes visited. The most common recommendations were to remove mats and throw rugs (48%), to change footwear (24%), and to use a nonslip bathmat (21%). In the 121 homes revisited after 12 months, 419 home modifications had been recommended, and 216 (52%) were met with partial or complete adherence. The only significant predictors of adherence were a belief that home modifications can prevent falls and having help at home from relatives. CONCLUSION: A major barrier to adherence to home modification recommendations is that many older people do not believe that home modifications can reduce their risk of falling.
Accidental Falls↗