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PubMed1997

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol.

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.

Aged↗
PubMed1996

[A study on reduction in care burden of the family caregiver of the bedridden and senile elderly--examination of subjective factors about construction in care burden].

The purpose of this study was to develop a supporting system in the community which reduces care burden of the family caregiver members of bedridden elderly age 75 and over. Preliminary study was carried out in order to find out fundamental elements of care burden. Five families were picked up among the families living in Chuo ward in Tokyo who were provided professional nursing care services at home. A nursing intervention was done through home visits and interviews with caregivers and their subjects who need proper care services. 1. fundamental elements of a caregiver's care burden: a) main elements are health and mental condition of elders, b) influential elements are the function of caregivers, the function of assistant caregivers, the function of professionals and the function of care systems. 2. The line of stress defence: All the functions except that of caregivers were positioned at the line of stress defense, and in our view the caregiver's coping capability would be increased as the line of stress defense functions and, hence, the care burden might be reduced. 3. Assessment of fundamental elements shall be determined from 3 aspects a) health and mental condition of elders, b) accessibility to buffers and their quality and c) capacity and skill of a care giver. In order to reduce the care burden of the family caregiver, it is necessary to assess multilaterally the constituents and/or structures of care in the future, and at the same time the additional functions will be required to furnish information and educate the caregivers on how to utilize various social care services, there by enabling them to cope with psychological stress effectively. These findings suggest that it is also necessary to complete the training of professional concerning feasible means that could promote the caregivers' abilities to cope with the bedridden and senile elderly.

Aged↗
PubMed1998

Needs of the homebound morbidly obese patient: a descriptive survey of home health nurses.

The purpose of this descriptive survey was to identify challenges encountered by the home care provider when caring for a morbidly obese client in the home care setting and to provide recommendations to those involved in the transition of the patient from the acute care setting to the home. This descriptive study used a convenience sample of 25 RNs employed in one of the many referral home care agencies in the greater Los Angeles, California area. The referral home care agencies were selected randomly. Criterion for inclusion was that the nurse had cared for at least three patients in the past 12 months with a Body Mass Index (BMI) of > or = 40. A semi-structured interview was completed using a ten item survey tool which included open ended questions. One hundred percent of the subjects approached participated (N = 25). The home care setting was their primary place of employment for at least 2 years (mean 5 years), and each RN had cared for an average of 4 patients with a BMI of greater than 40 in the past years. Challenges expressed by the nurses in the home care setting include: equipment (n = 25), reimbursement (n = 25), access to resources (n = 18), client motivation (n = 8), and family/significant other support (n = 10).

Attitude of Health Personnel↗
PubMedDate not supplied

A role change for auxiliaries.

Development of a practice-based, self-contained community nursing team prompted consideration of how best to make use of available skill mix. This article describes an initiative involving training of the nursing auxiliary in the team to offer venepuncture to housebound patients.

Community Health Workers↗
PubMed1995

Home care challenges for those affected by AIDS.

AIDS is affecting more and more people, yet our health care system has been slow to respond to this growing population. Public interest has focused on AIDS as an acute illness while ignoring the chronically ill, homebound majority of persons with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Characterizing the use of health care services delivered via computer networks.

OBJECTIVE: Evaluators must develop methods to characterize the use of the rapidly proliferating electronic networks that link patients with health services. In this article the 4-S framework is proposed for characterizing the use of health services delivered via computer networks. The utility of the 4-S framework is illustrated using data derived from a completed, randomized field experiment in which 47 caregivers of persons who had Alzheimer's disease accessed ComputerLink, a special computer network providing information, communication, and decision support to homebound caregivers of persons who have Alzheimer's disease. DESIGN: Human-computer interaction theories characterize the use of health services delivered via computer networks in behavioral terms. The 4-S framework incorporates perspectives based on user (subject) behavior: access to and use of the total system, use of specific services, behavior within single sessions, and enduring behavioral characteristics. The 4-S framework was tested in a secondary analysis of data from over 3,800 uses of ComputerLink. MEASUREMENT: The 4-S framework was instantiated using data obtained from the ComputerLink evaluation. Three types of secondary data were obtained. A passive monitor of access to the computer network provided quantitative information, such as time of day when access occurred, duration of access, and sequence of services used. Full-text messages were available from the public message postings. Subjective appraisal of use was obtained from self-reporting by users at the end of the experiment. RESULTS: The components of the 4-S framework were suitable to characterize operational aspects of ComputerLink use by Alzheimer's disease caregivers. Through application of the 4-S framework, an understanding of both quantitative use and qualitative use emerged (e.g., insight was gained into the differential use of specific services). CONCLUSIONS: The 4-S framework provided a mechanism for combining various measures of use into a coherent whole. The framework promotes a precise characterization of use and thereby facilitates evaluation of health services delivered via computer networks. It is suitable for evaluation of user satisfaction, measurement of needs resolution, and ascertainment of selected clinical outcomes.

Alzheimer Disease↗
PubMed2004

[Effect of a life review process to improve quality of life for the homebound elderly in Japan].

OBJECTIVE: This study examined the therapeutic effects of Life Review processes on physical and psychological functions of homebound elderly in Japan. METHODS: From 1998, a cohort of people aged 65 and over living in two cities in Yamagata Prefecture has been followed. Sixty-three subjects (24 men, 39 women) were classified as rank A (homebound). Fifty-two persons completed the baseline survey in 1999 and 46 eligible persons (18 men and 28 women) were allocated to intervention and control groups whose age and sex distribution were matched. Intervention entailed giving some health information and Life Review processing for four months, twice a month on average. Each session started with provision of health information followed by the Life Review process which took an hour to finish. All subjects of both groups were assessed for dependent variables at the beginning and the end of the intervention period (pretest and post-test). Dependent variables were physical (Activities of Daily Living, Visual deficit, and others), psychological (subjective health, life satisfaction, self-efficacy scale, and others), and social (functional ability and frequency of getting out of the house). The control group received only the pretest and the post-test. RESULTS: Pretest scores for all physical, psychological, and social variables did not significantly differ between the two groups. The rate for improvement/no change were higher with regard to hearing deficit, ADL (eating, dressing), cognition, subjective health, ikigai and frequency of getting out of house in the intervention group than in the control group, but there were no significant differences. CONCLUSION: The developed intervention program featuring delivery of health information and structured Life Review Process had no negative influence on physical and psycho-social functions. Practicability of the intervention was suggested. But the study highlights problems such as selection of subjects, duration and method of intervention.

Aged↗
PubMed2001

Nutritional risk in an urban homebound older population. The nutrition and healthy aging project.

PURPOSE: To establish the prevalence of nutritional problems and their related socio-demographic and health-related risk factors in the homebound elderly population. METHODS: Subjects included 239 men and women, ages 65 to 105 years. Trained, two-person field teams conducted comprehensive in-home assessments. Medical record reviews assessed co-morbidity and medication use. RESULTS: The majority of these urban study subjects are of very advanced age (mean age 81 years), female (72%), non-white (73%), living alone (51%), of low income (76%), and somewhat socially isolated (26% had no weekly social contact). More older women than men were widowed (60 vs. 33%, respectively) and poor (80 vs. 67%). The disease burden and functional dependency were both high in men and women; 77% had three or more chronic medical conditions; 76% were functionally dependent in one or more ADL's and 95% in one or more IADL's. Poor dietary quality was universal in these older men and women; half or more consumed diets that deviated from recommended standards for at least 13 of the 24 nutritional guidelines studied. Five percent of subjects were underweight (Body Mass Index (BMI) <18.5); 22% were overweight (BMI 25.0-29.9); and 33% were obese (BMI >30.0). Fasting albumin, hemoglobin, and absolute lymphocyte concentrations were borderline to very low in 18-32%. Dyslipidemia was more common in women; however, men and women had similar Total:HDL cholesterol ratios. CONCLUSIONS: Nutritional status is poor in homebound persons of very advanced age with substantial co-morbidity and functional dependency. The complexities of nutritional risk necessitate multi-disciplinary and individualized nutritional intervention strategies.

Activities of Daily Living↗