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PubMed2006

Obesity: changing the face of geriatric care.

Statistics suggest that more and more older Americans are carrying extra weight-an estimated 40% of individuals between the ages of 60 and 69 have a body mass index >30 and 30% of persons between ages of 70 and 79 years are obese. Obesity, coupled with the challenges of aging, leads to an unfortunate burden of chronic disease, functional decline, poor quality of life, and an increased risk of being homebound. Physical assessment of the elderly obese patient should include measurement of height, weight (to determine body mass index) and waist circumference (to address central obesity) and consideration of vascular, skin, and mobility issues. Weight management strategies such as diet and hydration should balance nutritional requirements with weight loss; particular attention to protein needs in chair- and bedbound patients is necessary. Additional approaches such as exercise, bariatric weight loss surgery, and weight loss medication should be considered on an individual basis related to their inherent risks in this population. Weight loss/management options framed from an interdisciplinary perspective can improve quality of life for these patients and their caregivers. Research specific to obesity in this age group is warranted.

Aged↗
PubMed1999

The community social alarm service as a primary health care service.

The history of calls to the community social alarm centre in Ljubljana and the service subscribers' records were analysed with the aim of finding out how the service helps in emergencies when calls related to health problems are received. The network, being a pilot project in Slovenia, was established in 1992 primarily to offer social services to elderly and disabled people living in their own home environments. The article highlights the role of the network in solving the medical problems of the users of the system. Among the 18,500 calls received in four years at the centre, 395 (2.1%) of them were health-related. An additional 24 emergency calls (0.2%) were received from non-subscribers to the centre using an "ordinary" telephone. Although the absolute number of health-related calls is low, the network plays an important role in preventive primary health care aimed at the observed population groups. The network meets most of the specific technical and organisational requirements for a community health care emergency call system. From a telematic point of view it is important that a telematic device--an emergency call unit--has entered an elderly or disabled person's home and been well accepted.

Aged↗
PubMed1998

Fall injuries among elderly persons living at home.

Falls and their consequences are a major health problem for elderly people. The aim of this study is to describe and analyse registered fall injuries in people 65 years and older, living in their own homes, during one year. In a local health care district, injuries of such severity as to require the attention of a doctor were registered. A form designed according to the National Swedish Board of Health and Welfare classification for registration of accident injuries was used. The computer program Epiinfo was used for processing and analysis. One thousand six hundred and thirty-nine fall injuries among elderly people living at home were registered. The women accounted for 70%. The injuries occurred mostly at home or in the home area during daytime and in connection with daily routines. Fractures accounted for 46.4% of the injuries. Of the victims, 44.4% needed to make only one visit to a doctor. Additional visits and admission to hospital were more common among the women. The study reveals that most of those injured were women, and that the falls occurred during their daily routines. Registration of this kind tells nothing about the persons and the circumstances behind the accidents. In order to gain deeper knowledge, complementary investigations are necessary.

Accidental Falls↗
PubMed1999

Model for the self-care of home-dwelling elderly.

The aim of this study was to develop a model to clarify the existing knowledge concerning the self-care of home-dwelling elderly people. The data were collected in Oulu, a medium-sized city in northern Finland, by interviewing 40 home-dwelling elderly persons aged 75 or more. Data were analysed using the constant comparative method of the grounded theory approach. The model consists of four modes of self-care with different conditions for action and different meanings: responsible self-care consists of responsible activity by the elderly person based on a positive orientation towards the future and a positive experience of ageing. The meaning of responsible self-care is a desire to continue living as an active agent. Formally guided self-care consists of uncritical observance of instructions and routine performance of daily tasks. This approach is based on life experiences of taking care of others and realistic awareness of the effects of old age. The meaning of formally guided self-care is a tendency to accept life as it comes. Independent self-care is based on the person's desire to listen to his/her own internal voice. These persons aim to manage in life independently and deny the prospect of growing old. The meaning of independent self-care is an attempt to maintain the constancy of life. Abandoned self-care is characterized by helplessness and lack of responsibility. It involves bitterness and a negative attitude towards ageing. The meaning of abandonment is a desire to 'give up'. According to this study, self-care is not a separate part of old men's or women's lives, it is associated closely with their past life and with the future. As an activity, self-care is not just a rational way to maintain health. It also reflects the person's overall attitude towards health care, illnesses and manner of living.

Activities of Daily Living↗
PubMed2004

External hip protectors in home-dwelling older persons.

BACKGROUND AND AIMS: External hip protectors have been shown to have a good preventive effect against hip fractures in many studies. However, these studies were carried out either entirely or mostly among older persons living in institutions. The aim of this study was to investigate whether health nurses can, after brief training, choose the right persons to use external hip protectors, so that, with a fairly small number of protectors, the number of hip fractures in home-dwelling older persons in a given area could be significantly reduced. METHODS: One hundred and fifty pairs of external hip protectors were given to the health nurses of the Central district of Tampere Health Center, to give to those older persons aged more than 75 years who, in their opinion, most needed preventive measures against hip fractures. Older persons living in other districts served as controls. The number of hip fractures in each district for each 6-month period was obtained from the Data Center of Pirkanmaa Health District. RESULTS: Whereas in control districts the number of hip fractures increased by 14 from 1.1.-30.6.1998 to 1.1.-30.6.2000 (49-63), their number diminished by 4 (43-39) in the Central district, where the protectors were used. The total cost of the external hip protectors was less than that required to treat one hip fracture in the first year. CONCLUSIONS: External hip protectors are most probably effective and economical in preventing hip fractures also among home-dwelling older persons, as has previously been shown among nursing home patients.

Accidents, Home↗
PubMed2004

[Individual background factors for "cannot go out alone to distant places" among medium elderly persons living alone in a metropolitan suburb].

OBJECTIVE: To verify whether the statement "cannot go out alone to distant places" should be considered a risk factor for disability among medium elderly persons living alone autonomously in a metropolitan suburban environment, the present cross-sectional study was performed. METHODS: Self-rated mobility levels in elderly persons living alone were surveyed by questionnaire in 1,216 elderly people (209 male, 1007 female) aged 65 to 74 years, living in a metropolitan suburb, who had autonomy and ambulation competence. Two categories were used for evaluation of the self-rated mobility level: the A group were those who were able to go out alone to distant places and the B group were those who were able to do so in the locality, but not to distant places without help (cannot go out alone to distant places). Factors such as everyday lifestyle, self-rated health, and psychological, functional, physical and social items were investigated. RESULTS: Although the frequency of going out was nearly the same between the A and B groups, the B group showed the lower hobby and association activity in social communities. Individual factors such as self-rated health, instrumental activities of daily living (Tokyo Metropolitan Institute of Gerontology), eyesight, masticatory ability, 1 km continuous walking, pedestrian crossing walking on a green light, and fracture history, medicine intake, cerebrovascular disorder related subjective symptoms, intermittent claudication related subjective symptoms, physical pain, symptoms of depression, daytime sleep, number of meals, and no regular walking and light gymnastic exercises demonstrated significant differences in levels between the A and B groups. The B group had characteristics of lower social activities in social communities, deterioration of physical functions, subjective symptoms of sickness and depression, and a worse self-rated level of health. On stepwise multiple logistic regression analysis, individual frailty-risk factors related to "cannot go out alone to distant places", were "inability to continuously walk a distance of 1 km", "lower masticatory ability", "having depressive symptoms", and "having symptoms of intermittent claudication". CONCLUSIONS: The findings from this study show that with autonomous medium elderly persons, those who "cannot go out alone to distant places" have risk factors for a trend toward disability.

Activities of Daily Living↗
PubMed2002

Diabetes in the elderly: problems of care and service provision.

Diabetes is common in the elderly and old UK citizens, affecting between 10% and 25%. There is considerable associated morbidity and mortality, with dementia being a common problem. The diabetic elder is also at risk of drug side-effects. Most of the evidence base for treatment is based on trials performed in younger diabetic subjects or older nondiabetic subjects; however, we can practice evidence-biased medicine whilst awaiting the results of ongoing trials. The older persons national service framework (NSF) may share some similarities with the diabetes NSF; it was 1 year late, and had no clear funding, amongst several other worries. Residential care, which is more likely to be required by diabetic elders, is also under-funded with major concerns about the quality of care for the diabetic resident. The little evidence that we have regarding care of the older diabetic person also suggests inadequacies. Given the likelihood that we will have to manage with present resources, managed clinical networks may be one way to cope.

Aged↗
PubMed1997

Psychiatric home care for the elderly.

This study summarizes descriptive information concerning an existing psychiatric home care service and lays the foundation for more sophisticated studies of elderly depressed persons who receive this type of long term care. Using existing medical record data, the demographic and clinical characteristics of the elderly patients using a multi-site home health care service are summarized, including: (1) their functional/psychiatric status, (2) their length of stay, (3) caregiver availability, (4) scope of multidisciplinary interventions provided, and (5) reasons for discharge. Prospective research of elderly persons receiving psychiatric home care is needed in the future.

Activities of Daily Living↗
PubMed2003

Telephone use among noninstitutionalized persons with dementia living alone: mapping out difficulties and response strategies.

The aim of this study was to map out and describe difficulties and response strategies in telephone use among elderly, noninstitutionalized persons with dementia living alone. To obtain explorative data, interviews and observations in the homes were undertaken with 10 participants diagnosed with dementia. The participants were observed when showing their telephones, calling a well-known number, responding to a request previously sent by letter to make a telephone call, and finding a number in the telephone directories. The data were analysed using a comparative approach, and resulted in descriptive categories. The participants' difficulties were categorized as difficulty in 'knowing what', 'knowing where', 'knowing how' and overcoming motor, perceptual, verbal and environmental obstacles. In responding to these, they used a variety of environmentally related strategies such as using perception or habits and habitual places, verbalizing aloud, seeking help from others, and adjusting the physical environment. They also used a few cognitively related strategies such as repeating and stopping and reflecting. Overall, difficulties were frequent and common, and the effectiveness of the strategies was questionable. The results indicate that it might be unrealistic to assume that elderly persons with symptoms of dementia who live alone are able to satisfactorily use the telephone for safety, communication and participation in society.

Activities of Daily Living↗
PubMed1999

Saliva, salivary micro-organisms, and oral health in the home-dwelling old elderly--a five-year longitudinal study.

High scores of chair-side salivary microbial tests have been found to be related to an increased prevalence and incidence of coronal and root caries. Many elderly face an increased risk of the growth of oral microbes, and previous studies have reported high salivary microbial counts in elderly populations. The aim of this follow-up study was to compare, at five-year intervals, stimulated salivary flow rates with the numbers of selected salivary micro-organisms (mutans streptococci, lactobacilli, and yeasts) in a group of home-dwelling elderly in Helsinki. A further aim was to study the influence of baseline microbial counts on five-year root caries increments and rates of tooth loss. The baseline study population was comprised of 270 subjects who were all participants in the population-based Helsinki Aging Study. Salivary flow rates and microbial conditions were determined as part of their dental examination at the Institute of Dentistry, University of Helsinki, in 1990-1991. Of these subjects, 110 underwent a follow-up examination in 1995-1996. Commercially available kits (Dentocult SM strip mutans for mutans streptococci, Dentocult LB for lactobacilli, and Oricult N for yeasts) were used for the enumeration of micro-organisms, after the collection of paraffin-wax-stimulated whole saliva. The stimulated whole saliva flow rates of the subjects were significantly lower at the follow-up than at baseline (paired t test, difference -0.16 mL/min; p < 0.05), whereas buffer capacity was higher (paired t test, difference 0.19 on a three-unit scale; p < 0.05). Apart from lower salivary lactobacilli counts at follow-up (paired t test, difference -0.44 CFUs/mL of saliva; p < 0.001), no changes were found in salivary microbial levels. Salivary microbial counts were clearly associated with the subjects' dentition types: More denture-wearers had high microbial counts than persons with natural dentitions. None of the salivary factors correlated with the root caries incidence or the number of teeth lost during the five-year follow-up.

Aged↗
PubMed2003

Use of psychotropics among home-dwelling nondemented and demented elderly.

OBJECTIVE: To describe the use of psychotropics in the nondemented and demented elderly. PARTICIPANTS: The home-dwelling elderly (n=523) among the random sample of 700 subjects from the total population of individuals aged 75 years or more in 1998 and living in the city of Kuopio, Finland. METHODS: A trained nurse interviewed the participants about their health and current use of medicines. A geriatrician performed clinical examinations and diagnosed diseases. Dementia and depression were diagnosed according to the DSM-IV criteria. RESULTS: The demented subjects used more medicines of all kinds (p<0.01), and especially more psychotropics than the nondemented (p<0.001). One in four demented subjects, compared to one in ten nondemented ones used at least two psychotropics (p<0.01). The demented subjects used antipsychotics six times more often than the nondemented ones (p<0.001). Among the nondemented subjects, one out of two antipsychotics users was suffering from depression according to DSM-IV criteria. Three out of four persons who had dementia with Lewy bodies were using psychotropics. Persons with moderate dementia were more commonly using all kinds of psychotropic preparations especially, antipsychotics three times more commonly than persons with mild or severe dementia. CONCLUSION: Psychotropics, especially antipsychotics, are commonly used in the treatment of both nondemented and demented elderly, even without proper indication. Physicians need more training about the appropriate use of psychotropics to minimize their adverse effects.

Aged↗
PubMed1998

Prevalence and conditions of urinary incontinence among the elderly.

In Japan, elderly disorders and diseases have markedly increased in recent years, because of rapid aging and an increasing number of older persons. The situation is creating serious social and community problems. These disorders, particularly dysuria and urinary incontinence (UI), disturb the quality of life (QOL) in latelife. Few reports on UI have been published, but precise investigation into the community level remains to be made. Our presentation is the development, implementation and evaluation of elderly UI in Kumamoto Prefecture. This study includes 2,304 people (male: 856, female: 1,448), over 65 years of age, living in two different communities; one is an urban (K) and the other is a typical rural area (S). The rate of UI was in homebound elderly persons, male: 4.7%, female: 11.3%, and in nursing home residents, male: 16.2%, female: 23.2%. The condition of UI was: almost Urinary Urgency in male (61.5%), and Stress Incontinence (such as, caused by coughing, sneezing, and exercise) in female (46.3%). The influence of UI on the activity of daily life was investigated. Most of the male cases were giving concerns for family and community. In contrast, females hesitated to participate in group excursions and outdoor exercise, and had a tendency to live alone or indoors. However, most persons (81.5%) with UI did not visit a physician. From this investigation, we conclude that a community health care program and public support system are essential for proper understanding and solution of the elderly UI problem.

Activities of Daily Living↗
PubMed1997

Prevalence of cancer in older persons living at home and in institutions.

Even though the elderly have the greatest risk of developing and dying of cancer, screening for cancer occurs less often in older persons. Cancer screening is appropriate for nursing home residents with the cognitive ability to understand the screening method and its implications, who do not have comorbid illnesses that would preclude treatment, and who have at least a five-year life expectancy. Screening recommendations are provided for cancers of the breast, cervix, prostate, colon, skin, and mouth.

Age Distribution↗
PubMed1996

Medical care in old age: what do nurses in long-term care consider appropriate?

OBJECTIVES: To determine whether nurses working in a long-term care institution, who are knowledgeable about the full range of conditions common among older people, favor limitations of treatment in old age; and to study whether the level of intensity of care they regard as appropriate varies with the overall health status of the older individual. DESIGN: Participants were asked to complete an intervention-specific advance directive for themselves, with scenarios representing terminal illness, dementia plus chronic illness, chronic illness in a nursing home resident, chronic illness in a community-dwelling older person, and a robust, community-dwelling older person. SETTING: A 725-bed long-term care institution, with residents having a mean age of 88 years and a wide range of physical and cognitive deficits. PARTICIPANTS: Full-time nurses at the long-term care facility were eligible and were given survey instruments; 102 of the 145 eligible nurses completed the questionnaire. MEASUREMENTS: The unit of analysis is the refusal rate, defined as the mean number of refusals of interventions for each respondent. MAIN RESULTS: The overall refusal rate for all five scenarios taken together was 72.1%. The refusal rate in the case of terminal illness was 90.9%, in the case of dementia plus chronic illness 81.8%, in the case of dementia in a nursing home 69.1%, for a homebound older person with chronic illness 70.9%, and for a previously healthy 85-year-old person living in the community, 50.0% (P < .001). CONCLUSIONS: Nurses working in a long-term care institution have strong preferences about limiting a variety of interventions in old age. The greater the degree of physical and cognitive impairment, the more limitations they favor. This suggests the necessity of expanding advance planning to include a discussion of what constitutes appropriate treatment in a broad range of circumstances.

Adult↗
PubMed2003

[Prevalence of dementia and Alzheimer's disease among subjects aged 75 years or over: updated results of the PAQUID cohort].

The progression of the prevalence of dementia in developed countries will increase the difficulties of medical and psycho-social management of demented patients and their family. The aim of this study was to estimate the prevalence of dementia among subjects aged 75 years and over. These subjects have been followed-up ten years after the baseline examination of the PAQUID study, a prospective population-based cohort study on normal and pathological aging after 65 years. A total of 1,461 subjects, aged 75 years and over, have been visited. The prevalence of dementia was estimated to be at 17.8 p.cent. About 38.5 p.cent of these demented subjects ware living in an institution, which leads to the fact that more than the two thirds of the subjects living in an institution were demented persons. Alzheimer's disease was the main etiology of dementia (79.6 p.cent). Based on the French population census, currently there would be about 769,000 demented people aged 75 years or over in France. Dementia accounts for 72 p.cent of the potential need for the French subvention for dependent persons, called Allocation Personnalisee d'Autonomie P. These results point out the importance of regarding dementia as a Public Health priority and of developing necessary measures for caring for these subjects, whether residing in their home or an institution.

Activities of Daily Living↗
PubMed1998

Using oral quality of life measures in geriatric dentistry.

OBJECTIVE: The purpose of this paper is to present potential uses of existing oral-specific quality of life (OQOL) instruments in geriatric dentistry. METHOD: Selected existing OQOL instruments were reviewed. Three examples of how such instruments have or could be used in geriatric dentistry are presented. CONTENT OF REVIEW: Nine OQOL instruments are briefly reviewed. The potential uses in geriatric dentistry include population applications and uses with individuals for political, theoretical and practical reasons. Practical uses include identification of persons needing treatment, assessing oral health needs in populations and estimating resources required to meet those needs, as endpoints in clinical trials and as measures of the impact of care provided. CONCLUSIONS: The ultimate value of OQOL measures will be measured by their usefulness in improving care of patients. The development of streamlined instruments and a core instrument which can be used in multiple populations and serve as a baseline to which other measures are added is recommended.

Activities of Daily Living↗
PubMedDate not supplied

Oral and nutritional status in frail elderly.

This article describes associations between oral health and nutritional status among chronically ill older adults who were living at home and receiving regular professional home care services. A structured questionnaire, oral examination, and Mini-Nutritional Assessment were completed for 51 subjects (mean age 83.7 years). Two-thirds of the sample were edentulous, and one-third had between 2 and 23 teeth (mean 10.59, SD +/- 6.92). Sixty percent of subjects complained of xerostomia, while dentists found only 48% to have clinical signs of dry mouth. More than half of the subjects had stimulated saliva rates of < 0.8 ml/min. Stimulated saliva secretion rates were lower for persons with no functional natural dentition or prostheses (p = 0.012). Subjects assessed their dentures to be more functional than did the dentist (Kappa 0.338). No one was considered malnourished. 47% were at risk of malnutrition, and 52% were well nourished. The dentist's estimation of dry mouth and eating problems were significantly associated to lower MNA scores (p = 0.049 and p = 0.015, respectively). Subjects with a natural functioning dentition had higher BMI scores (p = 0.0485).

Aged↗
PubMed1997

[A study on supporting methods for house-bound home care elderly to get independent life (1st report)--relation between ADL and daily hours out of bed].

It is important to prevent the House-Bound home care elderly from getting worse to the Bed-bound. We studied the relation between "daily hours out of bed" and the activity of daily living (ADL) estimated by FIM (Functional Independence Measure) in 50 house-bound home care elderly persons. Result are as follows; (1) The level of independence of "Toileting", one of the FIM self-care items, was most highly correlated with the "daily hours out of bed" in the house-bound home care elderly. (2) The level of independence of "Mobility to the Toilet" and "Bowel Control" were also highly correlated with the "daily hours out of bed" in the house-bound home care elderly. (3) The level of independence of "Toileting" had high correlation with a total score of FIM moter items in the house-bound home care elderly (r = 0.83, p < 0.001).

Activities of Daily Living↗