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PubMed1988

Team approach enables frail elderly to stay home.

St. Vincent's Hospital and Medical Center of New York has been caring for homebound frail elderly persons since 1973 through a comprehensive network of professional, paraprofessional, and community services that allows many older persons to remain in their homes and communities and avoid institutionalization. The staff consists of physician-nurse-social worker teams that bring to each patient their individual skills as professional practitioners. In addition, working together, they create and attempt to carry out a complete, flexible plan of care. The Chelsea-Village Program (CVP) is open to all persons who the team believes are capable of being maintained independently or who can obtain the necessary additional support of family, friends, or neighbors. The patients, whose average age is 83, are homebound due to orthopedic disorders, arthritis, stroke, chronic cardiac and pulmonary disease, or generalized debility and weakness. St. Vincent's and donations from foundations and individuals fund the program, which is free of charge to its patients. In 1988 about 10 physicians, some in private practice, participated during a typical month; subspecialists have made themselves available; and resident physicians share in the work. The staff has come to understand that human beings are most fulfilled when they are able to use their personal resources in independence and that they must ask the patients for their own definitions of life's goals and serve them as they seek those goals.

Aged↗
PubMed1995

ComputerLink: the impact of a computer network on Alzheimer's caregivers' decision-making confidence and skill.

1. INTRODUCTION. Decision-making demands faced by homebound caregivers of persons with Alzheimer's Disease (AD) are numerous and complex. Although caregivers frequently know what to do in caring for the person with AD, they lack confidence in their decisions [1]. The challenge of caregiving decisions may be compounded by the lack of resources to aid in decision-making or affirm decisions made. Because many caregivers are homebound, they are unable to avail themselves of traditional health and social services. ComputerLink, computer network, was designed to address the needs of these homebound caregivers. 2. DESCRIPTION. The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network. The three main features of the ComputerLink, which may provide aid to caregivers in decision making, include: the electronic encyclopedia (EE); a communications utility composed of a question and answer bulletin board (Q&A) and public (Forum) and private mail services; and a decision support module (DSM). The EE contained illness-specific information to support decision-making. The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions. Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers. The DSM could be accessed to gain information about decision-making or to actually work through a decision problem. The DSM was built on a multi-attribute utility model which employed English-language questions to guide users through a decision analysis. The analysis strategy was designed to help the user focus on the values and trade-offs that occur during difficult choices. The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger randomized experiment. 102 AD caregivers were recruited: 51 caregivers in the control group and 47 in the experimental group completed the 12-month study. The mean age of the caregivers was 60 years. Thirty-three percent were male and 28 percent were Black. The groups did not differ in demographic characteristics. The ComputerLink interface was menu-driven and the system was available 24 hours. ComputerLink use was captured through a passive monitoring system. AD caregivers accessed ComputerLink a total of 3,875 times, with a mean access per individual of 83 (range: 3 - 590). The mean length of an encounter was 13 minutes; subjects typically accessed two or more functions during this time. The decision support model was accessed 91 times. The communication functions were most frequently used (3,724 Forum accesses and 1,888 private mail); the information utility was accessed 518 times. 3. RESULTS. Decision confidence was objectively measured using a modification of the Saunders and Courtney confidence-in-decision making instrument. Caregivers who had access to ComputerLink experienced greater confidence in decision-making than caregivers in the control group (t = 2.73, p < .01). Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems (t = .18, p < .05). Decision-making confidence correlated positively with ComputerLink accesses (r = .32, p = < .02) and with length of time spent on ComputerLink (r = .30, p = < .02). 56% of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making, though only 38 percent reported using the DSM to make a decision. 4. DISCUSSION. Access to ComputerLink increased decision-making confidence, but not decision-making skill in AD caregivers. The impact of ComputerLink on decision confidence, and not skill, may be related to the differential use of the utilities. (abstract truncated)

Alzheimer Disease↗
PubMedDate not supplied

Nursing protocol for telephonic supervision of clients.

Access to care, client vulnerabilities, technology, and health costs affect not only the delivery of health care but also the roles, responsibilities, and opportunities for nurses. Patients are often managed in the home or discharged from hospitals before they or their families are ready. To address some of these needs, nurses are utilizing telehealth opportunities. For many nurses, telehealth translates to telephonic nursing. This article provides an algorithm that nurses can utilize in order to safely monitor patients in their homes. This can be a cost-effective program, particularly for those who are homebound or for persons, such as the elderly or those with chronic illness, who have long-term needs that vary between relative health and acute illness. This algorithm serves as a guide in our nursing practice for the telephonic supervision of patients in the home environment.

Algorithms↗
PubMed1990

Nutritional assessment of homebound rural elderly.

Approximately one quarter of Americans aged 65 and older live in rural areas. Homebound rural elderly are a hard to reach, often poor and frail population. Failure to include homebound rural elderly in nutritional studies may bias representativeness of samples of elderly persons. This paper discusses some challenges in recruiting homebound older persons to participate in nutritional studies and in establishing quality control procedures in a field setting.

Aged↗
PubMed1997

Predictors of decline in manual performance in older adults.

OBJECTIVE: To determine factors that predict decline in manual performance using a multivariate model of determinants of functional limitation. DESIGN: Longitudinal observational study. SETTINGS: Ambulatory general medicine clinics, residences of homebound individuals, and a continuing care retirement community. PARTICIPANTS: Subjects were 485 persons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older persons (n = 65), and ambulatory older adults (n = 205). Mean age at baseline was 78 years. MEASUREMENT: Independent variables included demographics, physician measures of upper-extremity joint impairment, comorbidities derived from physical examination and chart abstract, self-assessed arthritis pain, depression, and anxiety. The major dependent variable was 2-year decline in timed manual performance below a threshold associated with need for long-term care services. RESULTS: The proportion of subjects who exceed a Timed Manual Performance Test threshold of 350 seconds increased slowly from baseline through Year 4 for all age groups but rose rapidly from Year 4 to Year 6 for the oldest group (> 85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted crossing the manual performance threshold within a 2-year period. CONCLUSIONS: The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for future functional limitation. Since diminished hand function has been shown to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain would appear to be a high research priority.

Age Factors↗
PubMed2000

Computers and caregiving: reaching out and redesigning interventions for homebound older adults and caregivers.

This article discusses computer resources for homebound older adults and informal caregivers as an intervention to promote social support and mental health. Published information related to a computer network designed as an intervention for informal caregivers of persons with Alzheimer's disease is included. This information suggests that homebound older adults and informal caregivers can gain valuable information, confidence, and support by using computer resources. A review of the literature supported those findings and suggested that computer technology can facilitate continuing education and the refinement of skills for nurses. Implications for the use of computer resources in nursing education, practice, and research are presented.

Aged↗
PubMedDate not supplied

Obesity among older persons: Screening for risk of adverse outcomes.

A research overview is presented that highlights the growing prevalence of obesity among older persons and the associated risks for medical co-morbidity, healthcare resource use, functional decline and homebound status. Findings reveal that even for obese individuals poor diet quality and micronutrient deficiencies are relatively common concerns. Currently available nutrition risk screening instruments lack validity for overweight / obese older persons. Development and preliminary testing of a new Nutrition Health Outcomes Questionnaire (NHOQ) for this application are presented.

Activities of Daily Living↗
PubMed2007

Telephone follow-up for patients with amyotrophic lateral sclerosis.

The relentless evolution of amyotrophic lateral sclerosis (ALS), a severe neurodegenerative disorder of the upper and lower motoneurons, leads to an increasing level of disability. Most patients, during the course of the disease, become unable to attend the tertiary clinical care center and are thus prevented from enrolling in clinical trials or benefiting from specialized care and management. The main objective of this study was to verify whether the ALS functional rating scale (ALSFRS) could be reliably administered by telephone to patients, when unable to attend the ALS clinic, or to their caregivers. ALSFRS is a validated instrument that assesses the functional status and the disease progression in ALS. We first administered the functional rating scale directly in the clinic to 30 patients, with definite or probable ALS, and to their respective caregivers, and found a very high agreement between the two groups for the total score and the majority of the rating items. Next, we showed, in both patients and caregivers, a high degree of correlation between the total score of the ALSFRS measured by telephone and that reported in the clinic. This indicates that ALSFRS is a reliable instrument for monitoring the disease progression in homebound patients, even when the person contacted by telephone is the caregiver. We also performed a telephone clinic, based on an unstructured interview, with 16 ALS patients at an advanced stage of the disease and unable to attend the ALS clinic. On some occasions, the person interviewed was the caregiver. The symptoms most frequently reported were a worsening of muscle strength, swallowing and breathing problems, constipation, and inability to clear lung secretions. Several patients asked for assistive and adaptive equipment. All patients and caregivers found the telephone clinic very useful and considered it a good complement to the management and care programme.

Activities of Daily Living↗
PubMed2006

Contribution of falling and being homebound status to subsequent functional changes among the Japanese elderly living in a community.

Using the data from the community-based longitudinal study of the elderly persons aged 65 or older, this study examined relationships between the occurrence of falls varied by their activity level and subsequent functional decline over time. Of the 705 respondents at baseline, 662 and 632 subjects were assessed at first and second follow-ups. Falling and homebound status at baseline and health function (self-rated general health, activities of daily living (ADLs), instrumental activities of daily living (IADLs), intellectual activity, and social role) at baseline and follow-ups were assessed, and changes in each health function were compared among four groups defined by baseline falling/homebound status. Baseline falling/homebound status was significantly associated with subsequent decline in ADLs over 1 year, and in ADLs, IADLs, intellectual activity, and social role over 2 years. Being homebound might act as a stronger risk factor for ADLs disabilities rather than the occurrence of falls. Moreover, the homebound elderly with no experience of falls was at the greatest risk of the decline of social role. We consider that prevention program and home-based care for homebound elderly should be provided in the community.

Accidental Falls↗
PubMed2001

[Statistical analysis of a dental care program for homebound elderly patients in Shinjuku-ku].

A dental care service program for homebound elderly patients has been operating since 1988 in Shinjuku-ku, Tokyo. The purpose of this study was to clarify the characteristics of patients who received this dental care service. Based on a survey questionnaire and treatment card from April 1995 to March 1999, we analyzed the characteristics of patients. The following conclusions were obtained. 1. We studied 301 patients (males, 124; females, 177). The average age of the patients was 81.2 +/- 9.0 years. Eighty-four percent of the patients had a medical history. 2. Oral hygiene was practiced by 68% of the subjects: 78% by themselves, and 22% by caregivers. Half of the patients (53%) brushed their teeth every day, and one-third (32%) did not. 3. The mean number of DMF teeth was 25.4 (DT, 1.6; MT, 20.5; FT, 3.3). 4. About eighty percent (79%) of the patients had removable dentures, and one-third of them were upper and lower complete dentures. 5. The chief complaint of homebound elderly was the denture problem (73%). Therefore, the care provided at the bedside was mainly denture-related treatments. 6. Average times for visiting were 5.1. 7. Sixty-eight percent of the patients requested home dentist's visitation for dental care service, and 80% of the requested dentists performed such treatment. 8. Seventy-eight percent of the elderly patients were satisfied with the service program. This dental care program for homebound elderly patients seemed to work well. However, to meet needs for the expanding number of aged persons and to make it coincide with the new health and welfare scheme, reform of the program might be necessary.

Aged↗
PubMed1998

Medicare's Catch 22.

People with disabilities need home care to help them leave their homes; if they actually leave, however, HCFA now says they are no longer homebound and don't qualify for home care under Medicare. Many policymakers and legislators believe that the Medicare home health benefit was intended originally to be a post-acute benefit; however, current law does not support that attitude.

Activities of Daily Living↗
PubMed2001

[Incidence and prognosis of, and risk factors for the home-bound in a community elderly population].

This longitudinal study examined numbers of homebound and bed bound individuals over time, and risk factors in a rural community elderly populations. A total of 731 older persons who needed no assistance of another person in traveling from their homes participated in the baseline survey in 1992 and were assessed annually for their ability to travel for subsequent six-years. We defined operationally a homebound status as the necessity for assistance of another person to be able to leave home, but without being bedbound. During the follow-up period, 86 homebound (23.7 per 1,000 person-years) and 32 bedbound cases (8.4 per 1,000 person-years) were noted, the former being 2.8 times more likely to occur. Of the newly bound cases 26% returned to a state capable of leaving home by themselves one year later, and maintained this independent living level even two years later. Of the other cases who remained as homebound or bedbound one year later, only one (1/31) had returned to independent living after two years; most of them became bedbound at home, hospital admitted or deceased. Stepwise multiple logistic regression analysis showed that independent risk factors for the homebound include older age, male gender, slower walking speed, history of hospital admission in the previous year, lower masticatory ability, and higher level of serum beta 2-microglobin. These results indicate that health promotion programs for prevention of becoming homebound among community elderly people should target more intensively assistance to maintaining walking and masticatory ability. In addition, public health professionals should pay more attention to elderly people shortly after hospital discharge.

Activities of Daily Living↗