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PubMed2003

Setting the standard for community-based care & creating a comprehensive continuum of care.

Home health and adult day services providers are natural collaborators, as both institutions seek to allow chronically ill patients to receive care at home. Well-formed partnerships between these two types of providers can result in better patient care that is more economical under the prospective payment system, and open up joint marketing opportunities. The authors review the benefits of home health-adult day services collaboration, as well as some considerations for home health agencies entering into an agreement with an adult day services provider.

Adult↗
PubMed2003

The David Jayne amendment: the story of one man's determination to improve the lives of thousands.

Stricken by ALS at the age of 27, David Jayne slowly lost the ability to walk, to eat, to speak, and to breathe. With the assistance of home health professionals, medical technologies, and volunteers, he has managed to maintain as full a life as possible, participating in some of his children's activities and even managing, with great effort, to attend a football game. However, when he was the subject of a newspaper article, his home health coverage was dropped because he didn't meet the federal definition of "homebound." This is the story of how he took on the political establishment single-handedly, and eventually realized a victory that has the potential of helping thousands of people in similar situations to no longer be imprisoned at home.

Adult↗
PubMed2004

Nutrient intake and BMI as predictors of severity of ADL disability over 1 year in homebound elders.

PURPOSE: Although it is well-recognized that good nutrition is essential to health, quality of life, and disease management, evidence of the role of nutrition, especially dietary intake, in the development of health-related disability among the more vulnerable older men and women in the community is largely unavailable. METHODS: We examined self-reported and performance-based measures at baseline (demographic, psychosocial and health-related factors, BMI, burden of disease, dietary intake from 3 24-hour dietary recalls, lower extremity physical performance, and activities of daily living [ADL]) and 1-year follow-up (ADL) from a randomly recruited sample of homebound elders. Structural equation modeling was used to simultaneously evaluate the direct and indirect relationships among baseline factors and severity of disability in activities of daily living (ADL) at 1-year in 253 homebound elders. results: Almost 32% of the homebound sample reported increased severity of disability over 1 year. The full structural model fit the data very well and revealed that better summary intake of calcium, vitamin D, magnesium, and phosphorus was directly linked to better lower extremity performance (LEP) and indirectly to less severity of disability at one year, after controlling for baseline disability and the interrelationships of other factors. Greater BMI was directly associated with worse LEP and indirectly with greater severity of disability. CONCLUSIONS: The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrient intake, BMI, and disability among homebound elders. These results suggest that nutrient intake and BMI may be reasonable targets for intervention with multiple functional outcomes.

Activities of Daily Living↗
PubMed2004

[Long-term care insurance system and osteoporosis].

The Long-term Care Insurance is the principal system that supports the Japanese elderly more than 24 million in number. The recipients of this system are increasing rapidly and get up to 3 million now. In Japan, hip fracture is one of the primary causes that make the elderly bedridden. In our study with the cases of hip fractures, 51.6% of the whole patients were self-reliant before fracture, but 25.6% one year after fracture. Keep it in mind that half of the self-reliant elderly will need support after fracture and encourage patients and their families to apply for certification of need for support.

Aged↗
PubMed2004

[Life with fear of falling after hip fracture].

Elderly people who experienced hip fracture often experience complicated psychological reaction as well as decline in physical functions. In order to avoid falls and re-fractures, they limit various activities resulting to worsening physical performance. This article reports perception among the community dwelling elders who experienced hip fracture, it includes quotation from the interviews conducted with focus clients. Elders were always worried about falling and some avoid the activities that were major cause of hip fracture. Also, they complained of feeling a foreign substance coming dull pain resulting from the bipolar hip prosthesis. They were also worried about being bed-ridden so that they tried to expand their level of mobility, which tend to increase their risk of falling.

Accidental Falls↗
PubMed2003

Increasing fruit and vegetable intake in homebound elders: the Seattle Senior Farmers' Market Nutrition Pilot Program.

INTRODUCTION: Diets that are high in fruits and vegetables lower an individual's risk of chronic disease and contribute to healthy aging. Homebound seniors often have low intake of fruits and vegetables and limited access to fruits and vegetables with the most protective nutrients and phytochemicals. From June through October 2001, the Seattle Senior Farmers' Market Nutrition Pilot Program delivered bi-weekly market baskets that included a variety of fresh, locally grown produce to 480 low-income Meals on Wheels participants. The purpose of this study was to determine if the program increased fruit and vegetable intake in individuals who received the baskets. METHODS: One hundred basket recipients were recruited to complete a telephone survey before and at the end of the farmers' market basket season. Fifty-two low-income homebound seniors who lived outside the project service area were recruited to serve as control respondents. Fruit and vegetable intake was determined with modified versions of the 6 fruits and vegetables questions in the Behavior Risk Factor Surveillance System. RESULTS: Seniors who received the baskets reported consuming an increase of 1.04 servings of fruits and vegetables. The difference between the mean servings in the seniors who received the baskets compared to the controls was 1.31 (95% CI, 0.68-1.95, P < .001). At baseline, 22% of the basket recipients were consuming 5 or more servings of fruits and vegetables per day, but by the end of the season, 39% reported consuming 5 or more per day. CONCLUSION: Home delivery of fruits and vegetables is an effective way to increase fruit and vegetable intake in homebound seniors.

Aged↗
PubMed2003

Qualitative assessment of participant utilization and satisfaction with the Seattle Senior Farmers' Market Nutrition Pilot Program.

INTRODUCTION: The Seattle Senior Farmers' Market Nutrition Pilot Program delivered fresh fruits and vegetables to homebound seniors in King County, Washington, from June through October 2001. A primary objective of the program was to increase participants' intake of fruits and vegetables. A qualitative study was conducted to examine the impact of the program on participating homebound seniors. METHODS: Semi-structured interviews were performed with 27 participants in their homes to identify benefits and barriers they encountered and to measure their use and sense of satisfaction with the program. RESULTS: Analysis of the transcribed interviews revealed several common themes: Participants appreciated the variety and quality of the fresh fruits and vegetables. Some participants would not have had access to fresh fruits and vegetables without the program. Home-delivered baskets of fresh fruits and vegetables brought participants joy, stimulated interest in healthy foods, and improved quality of life. The program newsletter supported consumption of fresh produce. CONCLUSION: Program success was rooted in the multiple ways the program addressed potential barriers and reinforced behavioral intent.

Aged↗
PubMed2005

Medical House Call Program: extending frail elderly medical care into the home.

The current US healthcare system, focused mostly on acute and episodic care, has difficulty meeting the needs of ill, frail elderly and their families or other caregivers. Because of their low mobility and complex medical conditions, these "oldest old" patients and their families or caregivers must make frequent, difficult, and expensive trips to multiple physicians to receive care. The result is that the frail elderly most often receive delayed or crisis care rather than timely primary care. To address these and other needs, a coordinated approach to the care of the oldest old requires a new model that includes primary medical care in the home. This article discusses how the Medical House Call Program (MHCP) model can provide high-quality primary healthcare to the frail elderly at home, improve the continuity of care between the home and the hospital, provide support and education to families or caregivers, and provide linkage to a broad range of social and supportive services in the community. The MHCP model is one of a number of evolving for-profit and nonprofit approaches that seek to provide medical care in the home. This article also discusses how the MHCP model, working with oncology physicians and programs, can have similar benefits and applications for the growing number of elderly cancer patients and their families or caregivers.

Aged↗
PubMed2005

Access to dental care among older adults in the United States.

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.

Aged↗
PubMed2005

A team approach to bladder retraining: a pilot study.

Research has shown that bladder retraining can reverse or reduce symptoms of urge or stress/urge incontinence. An analysis of the A+ Links bladder-retraining program showed improved urinary symptoms and improved quality of life. There were statistically significant reductions in nocturia and episodes of urinary incontinence. There was also a significant increase in the mean amount of urine voided in milliliters. This pilot study appeared to validate and provide evidence that a bladder retraining program is a valuable strategy to reduce the impact of this most debilitating problem.

Activities of Daily Living↗
PubMed2005

Designing and Evaluating Home-Based, Just-in-Time Supportive Technology.

At MIT, a multi-disciplinary team of researchers is studying how to create pervasive computing environments for the home. We are developing technologies and design strategies that use context-aware sensing to empower people with information by presenting it at precisely the right time and place. Contrary to many visions of future home environments in the literature, we advocate an approach that uses technology to teach as opposed to using technology primarily for automated control. We have constructed a "living laboratory" that will provide a unique, flexible infrastructure for scientifically studying the power of pervasive computing for motivating learning and behavior change in the home. This facility, called the PlaceLab, is being used to study technology for creating homes that are supportive.

Biomedical Technology↗
PubMed2005

Students' comfort level in treating vulnerable populations and future willingness to treat: results prior to extramural participation.

This study analyzed senior dental students' perceptions prior to extramural rotations for comfort and future willingness to treat patients with special needs and other vulnerable groups. The sample included 690 University of Iowa senior dental students who graduated from 1992 through 2004. These students completed a questionnaire concerning twelve vulnerable population groups. Logistic regression models were performed, using student comfort and future willingness to treat each group as the dependent variable. There was a wide percentage of range of comfort with these groups, yet there was no individual group that more than 60 percent of these students were willing to treat in their future practices. Generally, prior experience with the group had a positive impact on comfort level. When gender was included in the regression models, male students were more likely to express comfort. In all instances except one, experience had a positive influence on perceived future willingness to treat the associated group. However, younger graduates had a greater willingness to treat. When controlling for other variables within the future willingness to treat models, comfort was statistically significant only for HIV+/AIDS and non-English speaking groups. This study provides insight about comfort with and perceived future willingness to treat special needs and other vulnerable patient groups.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Health promotion in older adults. Prescribing exercise for the frail and home bound.

Some degree of physical activity is always preferable to a sedentary lifestyle. For home bound elderly, with limited mobility and strength, physical activity should be focused on "functional fitness," such as performing activities of daily living, transfers, and mobility. We examine the benefits of exercise for frail home bound elderly, potential barriers to exercise, and ways to initiate a physical activity program.

Activities of Daily Living↗