Recent developments in vitamin D deficiency and muscle weakness among elderly people.
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Accidental Falls↗
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Mental health services for homebound elders from home health nursing agencies and home care agencies.
OBJECTIVE: This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. METHODS: A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. RESULTS: Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. CONCLUSIONS: Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies.
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Prevalence and recognition of depressive symptoms among homebound older adults with urinary incontinence.
Within a group of homebound elders with urinary incontinence, the objectives of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized by health care providers, (3) describe the type and intensity of antidepressant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A descriptive correlational design was used. The 15-item Geriatric Depression Scale (GDS-15) was administered to 345 homebound adults age 60 years and over referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large metropolitan county in Pennsylvania. Data were collected during in-home assessments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Service Center Physical and Instrumental Activities of Daily Living scales, Mini-Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toileting Assessment, and bladder diaries. One half of the participants (n = 173; 50.1%) had significant depressive symptomatology, with 35.7% having scores suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class of antidepressants was tricyclic antidepressants, being taken by 9.0% (n = 31) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antidepressants continued to exhibit significant depressive symptomatology. Greater dependence in physical activities of daily living, the need for assistance during ambulation, higher MMSE scores, and higher levels of comorbidity were associated (P < .05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older adults with urinary incontinence, but clinical recognition and treatment are limited.
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Prospective study of black-white differences in food insufficiency among homebound elders.
OBJECTIVE: This study examines race differences in the association of sociodemographic and health-related characteristics with change in food sufficiency status over 1 year in homebound older adults. METHOD: Using sociodemographic and health-related data collected during two in-home assessments as part of the North Carolina Nutrition and Function Study, logistic regression models (binary and nominal outcomes) adjusted for covariates and examined the characteristics associated with 1-year change in risk (RFI) and presence (FI) of food insufficiency among a random sample of 268 home-delivered meals participants. RESULTS: Not having enough money for food and having to prepare cheaper and smaller meals was associated with increased RFI and FI at 1 year; having to borrow money for food, loss of food stamps, and inadequate income increased the odds among Whites, and increased medication use among Blacks. DISCUSSION: The findings suggest that race, independent of other characteristics, is associated with diminished food sufficiency over 1 year.
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Older adults' and case managers' perceptions of smoking and smoking cessation.
OBJECTIVE: This study explores older smokers' and case managers' perceptions of smoking and smoking cessation. METHODS: Data were collected from 48 case managers via focus group sessions and questionnaires and from 20 smoking clients via structured interviews. RESULTS: Case managers identified barriers to addressing clients' smoking at the client, staff, and organizational levels. Clients and case managers lacked information on the benefits of smoking cessation in older adults. The majority of clients interviewed had no plans to quit smoking. DISCUSSION: Results suggest that smoking cessation programs for this population need to be geared to clients who are not ready to quit. Education about the benefits of quitting smoking in older adults is needed for both case managers and smokers.
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Homebound status in a community-dwelling elderly population in Japan.
The present study investigated the association between sociodemoraphic profiles, health condition and functional disabilities of subjects with a homebound status in a rural community setting. The subjects were residents aged 65 years or over in a mountain village of Japan. A comprehensive questionnaire was used to obtain their data. Among the 1,002 residents, the information of 866 residents (85%), who voluntarily completed the entire survey, was obtained for this study. All the subjects were native Japanese. Of the 866 subjects investigated, 301 (34.8%) were homebound as defined by the parameters of this study. Univariate analysis revealed age, female gender, functional impairment (vision, hearing and memory), all the ADL impairments, and the use of a portable toilet were associated with homebound status. Multivariate analysis revealed that older age, female gender, visual and two ADL impairments (moving inside the home and bathing) and use of a portable toilet remained significantly related to homebound status. Homebound elderly people have more functional limitation and disability related factor than their nonhomebound counterparts. Functional impairment, particularly in the mobility domain and sensory disturbances, was associated with homebound status. These data indicate the importance of assessment in the provision of home care for elderly people.
Activities of Daily Living↗
Modelling home televisiting services using systems dynamic theory.
A quantitative model was developed to study the provision of a home televisiting service. Systems dynamic theory was used to describe the relationships between quality of care, accessibility and cost-effectiveness. Input information was gathered from the telemedicine literature, as well as from over 75 sessions of a televisiting service provided by the Severo Ochoa Hospital to 18 housebound patients from three different medical specialties. The model allowed the Severo Ochoa Hospital to estimate the equipment needed to support increased medical contacts for intensive cardiac and other patients.
Adult↗
Falls prevention and the role of home exercise programmes.
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Accidental Falls↗
Strategies used by home health nurses to assess the mental status of homebound elders.
Home health nursing practice requires the ability to accurately assess elderly clients and, based on this assessment, arrange for needed home care services. Accurate evaluation of a homebound elder's mental status is particularly important, for it indicates whether the individual will be able to survive in his or her home and thereby avoid institutionalization. However, previous studies suggest that nurses in a variety of settings use assessment criteria that result in inaccurate judgements about their client's cognitive status. This study was undertaken to investigate specific strategies used by home health nurses to determine mental status. A convenience sample of 84 home health nurses was surveyed about the assessment criteria they used in their practice. Findings showed that these nurses, like others, rely primarily on orientation to evaluate cognition.
Adult↗
Home health visits using a cable television network: user satisfaction.
There are about 1.5 million home patients who receive home health care (nurses visiting patients in their homes) in the US each year. In a significant proportion of these visits, hands-on care is not needed. Rather, the nurse needs to verify compliance with medication regimes, assess mental or emotional status, or check blood sugar levels, blood pressure and the like. Many of these activities might be handled by a nursing visit using interactive video to the patient's home, saving the nurse's time wasted in driving, finding parking, etc. A system for delivering home health care using interactive video has been piloted in the state of Kansas. Using the local cable television infrastructure for audio and video transmission, this system permits a nurse to see patients in their homes for a fraction of the cost of an on-site visit. This new method of delivering home health care is being evaluated with an ongoing study of utilization and user satisfaction. We conducted a prospective survey administered to home health nurses (n = 2) and homebound patients (n = 3) using a cable TV-mediated interactive video system, to assess utilization and user satisfaction with televideo-mediated home health care visits. One hundred and eighty-one patient questionnaires and 193 nurses questionnaires were completed. The average length of a visit was 15 minutes (range 1-91). All mean scores tabulated for the questions indicated strong nurse and patient satisfaction with the system. Participating nurses and clients were satisfied with the televideo encounters. The mean score for all questions was better than neutral. Recognizing that this was a pilot study, hampered by small numbers and subject to the inherent biases of a single institution study, the results support further investigation and implementation of this modality for home health care.
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Using cable television networks for interactive home telemedicine services.
Most recent cable television network infrastructures can be used to deliver broadband interactive telemedicine services to the home. These facilities allow the provision of social and health services like medical televisiting for elderly, disabled and chronically ill patients; health tele-education; and teleconsultation on demand. Large numbers of patients could benefit from these services. There is also the increasing European tendency to offer customized home-care services. These applications are being developed and validated by a pilot project in Madrid as part of the ATTRACT project of the European Commission. The long-term aim is to develop broadband applications on a large scale to support low-cost interactive home telemedicine services for both patients and institutions.
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[Prevalence of the homebound in the elderly population within a community determined by using three measurement scales].
OBJECTIVES: In this cross-sectional study, we examined the prevalence of the homebound among community-dwelling elderly people who were independent in daily living and similarity in the criteria of three measurement scales of homebound. METHODS: Of all residents aged 65 and older residing in Kishimoto town, Tottori Prefecture (n = 1,383), 1,316 (95.2%) who were living at home participated in a baseline survey in October 2001. All the subjects were independent in daily living. They were asked to fill out a questionnaire, which was delivered to them by a member of a public committee. We examined the prevalence of the homebound using three measurement scales (capability of leaving the house independently, frequency of going outdoors, and place of daily activities) with the chi-square test. RESULTS: The prevalences of the homebound were 4.2% for the capability of leaving the house independently, 26.8% for the frequency of going outdoors, and 8.4% for the place of daily activities. The significant factors for the homebound were age and gender. Differences in prevalence were noted by judging the three measurement scales. In typical farming villages, the prevalence of the homebound going outdoors less than once a week was higher than that in other areas. The criteria of the three measurement scales for the homebound were not similar (Cohen's Kappa = 0.13, 0.12, 0.27). CONCLUSIONS: We considered that using three measurement scales together in the study of the prevalence of the homebound is practical. The monitoring of the rate of mortality and disabilities associated with being homebound should be continued.
Activities of Daily Living↗
Nursing management of constipation in housebound older people.
In this article two algorithms are suggested for use by district nurses in the management of constipation in dependent older people at home. Prescribing for this group of patients requires a complex assessment of medical and social factors as 24-hour supervision is not always available and local health and social service resources may impact on the level of care that is available in terms of the provision of food and drink and the taking of medicines.
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Falls prevention in practice: guidance and case study.
Falls are a major health issue for older people. Each year 1.57 million older people fall more than three times and 70,000 fracture their hips, and injury which frequently leads to disability and even death. The National Service framework for Older People identified falls prevention as a major health priority. This article explains how a community based falls service led by a nurse and physiotherapist identified falls risk factors affecting a housebound 97-year-old lady. Factors identified and treated were poor balance and strength, osteoarthritis of the knees and thumbs, inadequate pain control, uncorrected poor vision, oedema of the legs and feet, unsuitable footwear and an unsuitable walking aid. As a result of the interventions falls risk was reduced and quality of life improved.
Accident Prevention↗
Understanding and tackling fear of crime among older people.
In this article, brought to you in association with Help the Aged, Alan Burnett examines the causes of fear of crime among older people, and proposes ways to reduce it.
Aged↗
The conceptual and empirical link between health behaviors, self reported health, and the use of home health care in later life.
The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.
Age Factors↗
Needs for physician housecalls--views from health and social service providers.
This article examines how the role of a physician housecall program is perceived by health and social service providers that refer their clients to the program in a Midwest suburban community. Focus groups and semi-structured interviews with those providers revealed various housecall service needs of their homebound clients. In particular, the fact that home health agencies were the largest referral source suggests that the housecall program fills the needs that are not met by the current mainstream home health services. Our findings reinforce the argument for the increased physician involvement in home care and physician housecalls.
Attitude of Health Personnel↗
Reaching the homebound elderly: the Prescription Intervention and Lifelong Learning (PILL) program.
This article describes the Prescription Intervention and Lifelong Learning (PILL) program, a three-year pilot project to develop in-home pharmacy care services to clients of a community-based social service agency. Clients who were homebound, at least 62 years of age, and taking at least five medications were eligible for inclusion. Potential participants were referred by care managers to the pharmacist, who conducted an in-home evaluation of the medication regimen and assessed the risk for medication-related problems. The pharmacist provided instruction for hypertension and diabetes mellitus self-monitoring, extensive medication counseling for clients with complex medications regimens, and conducted other activities to promote positive medication- related outcomes. The clients served were primarily female, between 70 and 90 years of age, and almost one-half lived alone. They were taking an average of more than nine medications daily, and had at least one chronic disease. The clients of the social service agency were highly vulnerable to medication-related problems and were in need of in-home pharmacy care services.
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