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PubMedDate not supplied

Mobile and portable dentistry: alternative treatment services for the elderly.

With the rapidly expanding geriatric population in the United States, the demand for geriatric dentistry is rising. With the financial, transportation, and motivational barriers the geriatric population faces, it can be difficult for them to seek dental treatment in a traditional setting. Mobile and portable dental units can be used as alternative methods to provide dental care to the geriatric population. Mobile and portable dental units offer advantages such as providing community outreach, increasing personal satisfaction for geriatric clients and dental professionals, and providing dental care to those who would otherwise not receive treatment due to some of the barriers. Although mobile and portable dental units are ideal for long-term facilities, disadvantages do exist in implementing the use of these systems. These include the initial cost of implementing such a unit, limitation of treatment options, the number of clients seen in a day, and maintenance for the unit. Until more research can be done to find ways to improve the quality of dental care for the geriatric population, these units seem to be a reasonable alternative to the traditional approach to providing the elderly with the dental care they require.

Aged↗
PubMed2005

Improving attitude towards elderly people: Evaluation of an intervention programme for caregivers.

There is yet no specific Government policy on care of the elderly in Nigeria despite increase in its awareness as well as the number of people reaching old age. This study was carried out to assess the attitude of caregivers in seven out of the eleven wards in Ilorin metropolis. The caregivers consisted of daughters (44.4%), sons (18.3%), family-relation (24.6%), employees (1.4%), neighbors (4.5%) and community members (6.8%). The data collection toll was a structured questionnaire consisting of three parts designed to determine the socio-demographic characteristics, general and specific attitude to the care of the elderly. Effect of Health Education on attitude of caregivers concerning the care of the elderly was also evaluated. Based on the scoring system, the attitude of the caregivers was found to be fairly positive and after the Health Education intervention, a significant improvement in the attitude of caregivers was recorded. The Mean (SD) score increased significantly from 78.4 +/- (14.6) pre-intervention to 96.8 +/-(15.2), post-intervention, p-value < 0.05. Religious teaching (35.9%), traditional/customary obligation (28.7%) and personal feeling (21.1%) were the most influencing factors of attitude of caregivers towards the care of the elderly. The influence of educational status of caregivers on where the elderly should be taken care of was found to be non statistically significant (p > 0.05). Gender had overall positive effect on attitudinal measurement. The deduction from this study is that care of the elderly is still being valued despite lack of specific government policy and support. The negative attitude of caregivers to institutional care may be difficult to change through health education intervention because care of the elderly at home is still being greatly valued in this country as it is seen as a responsibility of children and other family members. Institutional care is also considered as an abomination and irresponsibility by some caregivers Keywords: attitude, caregivers, elderly, intervention and health education.

Adult↗
PubMed2005

Concomitant use of analgesics and psychotropics in home-dwelling elderly people-Kuopio 75 + study.

AIMS: To investigate the extent of concomitant use of analgesic and psychotropic medicines among home-dwelling elderly people aged at least 75 years in Finland. METHODS: This was a population-based study in Finland, performed as part of Kuopio 75 + study focusing on the clinical epidemiology of diseases, medication and functional capacity. A random sample of 700 persons was drawn from the total population of the city of Kuopio, eastern Finland, aged 75 years on January 1, 1998 (n = 4518). Ninety-nine persons could not be examined and 78 were living in long-term institutions, so that the number of home-dwelling elderly persons amounted to 523. A trained nurse interviewed the participants about their use of medicines, and a geriatrician examined their overall physical and mental status. Dementia and depression were diagnosed according to the DSM IV criteria. Both regular and irregular prescribed and nonprescribed drug use was recorded. RESULTS: Every fourth elderly person (27.2%) used analgesics and psychotropics concomitantly, this use becoming twice as common with advancing age (19.6% in the age group 75-79 years, 38.2% among the oldest, aged 85 + years). Concomitant use of psychotropics and opioids also became more common with increasing age (2.8% in age group 75-79 years and 9.6% in the oldest group, aged 85 + years). The use of opioids was nearly twice as common among concomitant users (19.7%) than among those using only analgesics (11.3%). Concomitant users suffered from interfering daily pain and daily pain at rest more commonly than nonusers of analgesics. Depression, sleeping problems and polypharmacy were more common among the concomitant users, who had also had more hip fractures than the rest. CONCLUSIONS: Concomitant use of analgesics and psychotropics becomes more common with advancing age and is a potential risk factor for adverse drug effects.

Age Factors↗
PubMed2002

Psychotropics among the home-dwelling elderly--increasing trends.

OBJECTIVE: To assess the level of and changes in the use of psychotropics among the home-dwelling elderly in the 1990s. METHODS: A descriptive analysis based on data from two cross-sectional interview and health examination surveys of elderly persons aged 64 years or over conducted in Lieto, a typical semi-rural Finnish municipality, in 1990-91 and 1998-99. National prescription data were utilized to compare the use of psychotropics in the late 1990s by all Finnish home-dwelling elderly and the elderly in Lieto. In Lieto drug information was obtained from 1131 persons in 1990-91 and from 1197 in 1998-99, and the mean age of the informants was 73 years in both surveys. The brand names of the prescription drugs (both irregular and regular medication) taken by each interviewee during seven days prior to the interview were recorded and categorized by the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS: Every fourth person was taking at least one psychotropic drug in both surveys. Most users were on regular psychotropic medication. The use of hypnotics and antidepressants increased most during the study period. Polypharmacy and the use of psychotropics were most prevalent among those aged 85 years or over, with women predominating. Concomitant use of two or more psychotropics increased statistically significantly from 7% to 10% between the surveys. The young elderly, aged 64-71 years, used cyclic antidepressants equally commonly in both surveys. None of the young elderly used new atypical antipsychotics in 1998-99. CONCLUSIONS: Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly.

Aged↗
PubMed2000

Undue concern for others' opinions deters caregivers of impaired elderly from using public services in rural Japan.

OBJECTIVE: To determine whether opinions of others may discourage the use of public services for the elderly. DESIGN: Users and non-users were compared regarding several variables including caregivers' concerns about opinions of others. SETTING: Matsuyama Town, located in a rural area of northern Japan. SUBJECTS: Seventy pairs of (1) elderly persons in need of care assessed by the procedure employed by the Ministry of Health and Welfare, and (2) their respective family caregivers. MEASURES: Cognitive function (Hasegawa Dementia Rating Scale), diagnosis of dementia, activities of daily living (ADL: Barthel Index), caregivers' burden (Zarit Caregiver Burden Interview), behavioral disturbances (Dementia Behavioural Disturbance Scale), caregiver interviews. RESULTS: A logistic regression analysis revealed that those who looked after the elderly with severe dependency in ADL were three times more likely to use public services (OR = 3.33, 95% CI = 1.02 - 10.88, p = 0.04). Those concerned about what others think or say were less likely to use public services (OR = 0.22, 95% CI = 0.06 - 0.78, p = 0.01) than those who did not. CONCLUSIONS: Caregivers' undue concern for the opinions of others apparently deterred them from using public services. The overriding notion of care for the elderly as a family duty is still prevalent in rural Japan. It would be useful for the government to launch a public awareness programme to help caregivers understand the benefits of services available for the elderly.

Aged↗
PubMed1998

Reported dental attendance and perceived barriers to care in frail and functionally dependent older adults.

OBJECTIVES: This study was designed to investigate the reported dental attendance and the perceived barriers to dental care for frail and functionally dependent older adults. DESIGN: A single centre study of a housebound group of more than 60 years of age and their personal carers. SETTING: The study was carried out from a general dental practice in Ware, Hertfordshire, a market town 20 miles north of London. SUBJECTS AND METHODS: A group of 263 housebound adults more than 60 years old were identified. The subjects were living in 5 residential homes, 3 sheltered housing complexes and in private accommodation. The subjects and 115 of their personal carers were interviewed. RESULTS: 93% only attended a dentist when they had problems. The presence of natural teeth, residential status and age were all statistically significant independent explanatory variables for the time since the previous reported dental visit. Lack of perceived need was found to be a barrier to care for 86% of subjects. Cost and lack of suitable transport were also commonly identified. However, the true cost implication to a patient was poorly appreciated especially by those 34% of subjects who cited cost as a barrier. 52% of the whole group, rising with age to 75% of those more than 90 years old, expressed a preference for treatment to be carried out in their own homes. 93% of carers had found difficulty in arranging dental care for their clients but the difficulties were not always the same as the subjects' perceived barriers. Among the carers, younger, regular dental attendees who were paid to care were more likely to see benefit in obtaining dental care for their clients. CONCLUSION: The mechanisms by which these barriers to care may be lowered should be investigated in order to meet the unmet need identified by this study.

Adult↗
PubMed1995

[A study on health and caregiving status of the elderly over age 75 living in urban Tokyo--comparing 1987 with 1993].

The purpose of this study is to propose the improvement of the community care service and caregivers' support system. A questionnaire was sent to the elderly over age 75 living in Chuo Ward of Tokyo, on their living place, previous illness, health status, degree of assistance needed, and their caregivers. The same kind of surveys were made in 1987 and 1993, and the health status and home care were compared and changes in caregiver services were examined. Valid responses of 3,294 (response rate of 81.3%) in 1987 and 3,409 (response rate of 76.3%) in 1993 were analyzed and compared with each other. The results are following; (1) The total number of bedridden elderly persons decreased from 214 (6.5% of the total) in 1986 to 61 (1.8% of the total) in 1993. The number of elderly over age 75 with high health status increased. (2) The rate of the elderly who stay only indoors, although physically non-handicapped and in good health, was 20%. (3) The statistic of caregivers' concern about care services in the answer to open ended questions showed the increase of the desire for the supply of information, and the fact of more suitable pieces of advice having been given about the resources for care, care-give service, and family adjustment. It is necessary to establish the system to support and develop home care in the community in the future. Social support will also be necessary not only for infirm or handicapped elderly people, but also for demented, living in solitude, or non-social withdrawn healthy aged people to make use of community care service, counseling of care service and short stay at nursing homes. Especially the importance of community care service to prevent the elderly from being bedridden was suggested. Moreover, general broad support is necessary, such as social education, income guarantee and housing measure as well as that from the point of view of health and welfare.

Activities of Daily Living↗
PubMedDate not supplied

Meals-on-wheels improves energy and nutrient intake in a frail free-living elderly population.

BACKGROUND: With the increasing life expectancy and associated health care cost in the elderly population, it is fundamental to study and improve interventions that help older persons to have a better and healthier life in their home for a longer period. OBJECTIVES: Evaluate the effect of Meals-on-Wheels (MOW) on dietary intakes of frail elderly. DESIGN: An untreated control group quasi-experimental design with pretest and post-test was used to compare users (n = 20) and non-users (n = 31) of MOW. Descriptive and dietary data were compared at pretest and 8 weeks later. Analysis of Covariance (ANCOVA) was used to control for initial differences between groups. RESULTS: Both groups were similar at pretest except for weight (p = 0.028) and weekly number of meals eaten outside the home (p = 0.008). In both groups, dietary intakes at pretest were below Estimated Average Requirements (EAR) for the same nutrients. At post-test, intake of most nutrients increased in the Experimental group in comparison with the Control group. After controlling with the ANCOVA model, increases were significant for energy (p = 0.050), protein (p = 0.030), lipid (p = 0.034) and thiamin (p = 0.035). Provision of MOW did not permit to achieve a low risk of nutrient inadequacy in the Experimental group. CONCLUSIONS: MOW programs improve dietary intakes of recipients. However, a more intensive intervention is needed to prevent nutrient deficiencies in this group.

Aged↗
PubMed1995

[A study on health and caregiving status of the elderly over age 75 living in urban Tokyo--social services and caregiving for the bedridden and senile elderly].

Interviews during home visits were used to assess social services and caregiving status for the bedridden and senile elderly living at home in urban Tokyo. In Chuo ward 197 bedridden and senile elderly were identified from 3,409 mailed surveys (response rate 5.8%). This study analyses data from 110 subjects who were followed up with interviews during home visits. As indicated by the Karasawa senile scale, 70% of the respondents have communication problems with the elderly person in their care. Incontinence problems are reported in 56.7% of the frail elderly. There is no significant association between incontinence problems and decisions by caregivers to institutionalize the elderly. The mean age of the main caregiver is 61.9 +/- 12.7 years. There are 55.5% of the families with secondary caregivers. The mean period of care is 6.3 +/- 8.2 years. Even the families who take care of their elderly relative for longer periods of time have no one to consult about caregiving. Caregiver strain was measured by the Family Maslach Burnout Inventory. The subscale, emotional exhaustion, occurs most frequently. Only 25.0% of caregivers indicate willingness to accept social services, on the other hand 63.5% of the caregivers desire family care. The questionnaire listed twenty five resources currently available for families in this ward for social services. Only 52.2% know about resources for social services. Only 8.5% of the respondents use social services. Respondents know about and use social services for direct care of their elderly relative more than they use support for adapting the home environment for the care of the elderly. These findings suggest the following: (1) In order to promote effective use of social services a systematic case finding and assessment plan is needed. (2) Development of services from the viewpoint of prevention and emotional support are needed. (3) Case management is needed to achieve a mix of both the family care and social services.

Aged↗
PubMed2006

The Nutrition, Aging, and Memory in Elders (NAME) study: design and methods for a study of micronutrients and cognitive function in a homebound elderly population.

BACKGROUND: Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home. OBJECTIVES: The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly. NAME targets homebound elders because they are understudied and particularly at risk for poor nutritional status. METHODS: Subjects are community-based elders aged 60 and older, recruited through area Aging Services Access Points. The NAME core data include demographics; neuropsychological testing and activities of daily living measures; food frequency, health and behavioral questionnaires; anthropometrics; gene status; plasma micronutrients, homocysteine, and other blood determinants. A neurological examination, psychiatric examination, and brain MRI and volumetric measurements are obtained from a sub-sample. RESULTS: Preliminary data from first 300 subjects are reported. These data show that the NAME protocol is feasible and that the enrolled subjects are racially diverse, at-risk, and had similar basic demographics to the population from which they were drawn. CONCLUSION: The goal of the NAME study is to evaluate novel relationships between nutritional factors and cognitive impairment. These data may provide important information on potential new therapeutic strategies and supplementation standards for the elderly to maintain cognitive function and potentially reduce the public health costs of dementia.

Activities of Daily Living↗
PubMed2007

Depression is associated with low plasma Abeta42 independently of cardiovascular disease in the homebound elderly.

BACKGROUND: Depression often precedes the onset of Alzheimer's disease (AD) before the appearance of cognitive symptoms. Plasma Amyloid-beta peptide 42 (Abeta42) declines before and soon after the onset of AD, yet the relationship between plasma Abeta42 and depression is unclear. METHODS: We used 515 homebound elders aged 60 and older in a population-based, cross-sectional study to investigate associations between plasma Abeta levels and depression with and without cardiovascular co-morbidities. Depression was evaluated by using the Center for Epidemiological Studies Depression (CES-D) scale. Plasma Abeta40 and Abeta42 were measured. RESULTS: The elderly with depression had lower plasma Abeta42 (median: 15.3 vs. 18.9, p = 0.008) than those without depression. The CES-D score was inversely associated with plasma Abeta42 (p = 0.001) in subjects with no cardiovascular disease (CVD); however, in the presence of CVD, this association did not exist. Low plasma Abeta42 (OR = 0.41, p = 0.007) and the presence of CVD (OR = 1.84, p = 0.005) were independently associated with depression after adjusting for the confounders of age, stroke and apolipoprotein E4. CONCLUSIONS: Depressive symptoms are associated with low plasma Abeta42 independently of CVD. Prospective studies are needed to determine whether depression associated with low plasma Abeta42 is a separate depression subtype that could predict the onset of AD.

Age Factors↗
PubMed2003

Homebound schooling is the least favorable option for continued education of adolescent cancer patients: a preliminary report.

BACKGROUND: With an overall objective to improve the educational programs of pediatric cancer patients, the purpose of this study was to compare the quality of educational experiences of adolescent cancer patients undergoing treatment while enrolled in hospital, homebound, or community schools. PROCEDURE: Ten students, 12-17 years of age at diagnosis, their parent and their teachers were interviewed with a structured list of open-ended questions designed to assess their perceptions of their homebound, hospital, and community school experiences. The interviews were taped, transcribed, and analyzed using qualitative methods for recurring themes. RESULTS: High achieving students engaged in extracurricular activities prior to diagnosis performed well academically in all three schooling situations. Those less engaged in school prior to diagnosis did poorly in homebound schools, better in their community schools, and best in the hospital school. CONCLUSIONS: Homebound learning during cancer therapy does not appear to be as meaningful as either hospital or community learning environments. Prior academic performance, as well as social, emotional, and health factors should be considered in selecting the most appropriate formal school environment for adolescent cancer patients.

Activities of Daily Living↗
PubMed2004

Effect of preventive home visits for ambulatory housebound elders in Japan: a pilot study.

BACKGROUND AND AIMS: Programs of preventive home visits for ambulatory housebound elders have not yet become established in Japan. The aim of this randomized pilot study was to investigate effects of such visits by public health nurses in Japan. METHODS: A randomized controlled study with 18-month follow-up was conducted in a small Japanese agricultural town. Participants (n=119) were ambulatory housebound elders aged 65 and over, who were able to walk but who went outdoors less than three times a week at baseline survey. They were randomly assigned to intervention (n=59) or control group (n=60). Intervention group subjects received preventive home visits by public health nurses over 18 months (mean home visits=4.3). Control group subjects received usual primary and community care. Activities of daily living (ADLs), functional capacity, self-efficacy for daily activities, self-efficacy for health promotion, depression, and social support were collected via questionnaire at baseline and at the 18-month follow-up point. RESULTS: At follow-up, 81.4% of intervention group subjects were still living at home vs 73.3% of control group subjects (NS). Simple group comparisons following repeated measures (ANCOVA) showed that the intervention group had higher ADL scores than the control group at follow-up (p=0.044). CONCLUSIONS: These pilot results suggest that home visits by public health nurses may be effective in helping to reduce ADL decline among ambulatory housebound elders.

Activities of Daily Living↗
PubMed2000

Factors relating to place of death of Japanese people from a small town in a rural area.

The objective of our retrospective study was to clarify factors relating to place of death of Japanese people from a small town in a rural area who had been bedridden for at least one week before dying. The caregivers of subjects aged 40 and above who died during a three-year period were surveyed by trained interviewers. Of 352 subjects who died, 312 caregivers responded and agreed to a face-to-face interview. A total of 213 subjects were considered as an eligible sample. The main outcome measures were odds ratios for death at home in relation to age, pain, cause of death, and home visit service. One hundred and two people died at home, while 112 people died in a hospital. Multivariate logistic regression analysis showed that the probability of home death increased with age of the bedridden, lack of pain during the bedridden period, not having cancer as a cause of death, having senility as a cause of death, and receiving regular home visits by a Public Health Nurse. In conclusion, expansion of the home visit programs by Public Health Nurses may enable people to die at home as they so desire. Further prospective research is needed to explore the association between the attitude toward terminal care and the place of death.

Adult↗
PubMed1999

[Drug prescriptions and multiple falls in community-dwelling frail elderly subjects].

The purpose of the study was to identify associations between drug prescriptions and the risk of falls in community-dwelling frail elderly people. 360 frail elderly patients underwent a comprehensive geriatric assessment during hospital stay. After discharge, the home falls were recorded by a questionnaire during the follow-up year and a home visit was carried out at the end of the year. Of 279 final patients with complete data, 141 subjects (50.5%) fell once; 62 subjects (22.2%) had a history of two or more falls during the follow-up period. Compared with subjects who did not fall or fell at the most once, those subjects with two or more falls showed a significantly higher prescription of tranquillizers/hypnotics, neuroleptics, diuretics, nitrates, and five or more different drugs. In multivariate analysis the prescription of tranquillizers/hypnotics with an adjusted odds ratio of 2.02 (95 percent confidence interval, 1.14 to 3.68) and the prescription of five or more different drugs with an adjusted odds ratio of 2.25 (95 percent confidence interval, 1.03 to 4.49) were found to be independent risk factors for multiple falls. In this prospective study in community-dwelling frail, elderly people the prescription of tranquillizers/hypnotics and five or more different medications could be identified as independent risk factors for multiple falls.

Accidental Falls↗
PubMed2004

Patterns of complementary therapy use by homebound cancer patients in Taiwan.

This study explores the use of complementary therapy and factors associated with the use of such therapies by cancer patients in Taiwan who were receiving surgery, chemotherapy, or radiotherapy and lived at home. Data were collected by purposive sampling and analyzed by chi-square testing. Subjects (N = 137) from two Taipei area hospital-based oncology centers were interviewed by using a structured questionnaire. Sixty percent of the total sample used complementary therapies. Variables, such as gender, duration of illness, diagnostic stages, chemotherapy, and symptoms distress, were significantly (p <.05) related to the use of complementary therapies. Western health professionals need to know what complementary therapies their clients are using so that they can respond appropriately to questions raised by their clients, as well as help them to acknowledge diverse kinds of treatment in their therapeutic plans.

Adult↗