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Home care of the frail elderly.

Statistics indicate that as the population ages, there will be an increased need for home care. Despite this increased need and the legal, clinical, and ethical obligations for physicians to participate, little training is available to physicians in the area of home care. This article provides physicians with an understanding of home care and how to incorporate it into clinical practice. The goals of this article are to (1) explain what home care is and what services are available, (2) teach physicians how to access these services and oversee their implementation, and (3) show how physicians can be reimbursed for this increasingly important part of their practice.

Advance Directives↗

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch.

OBJECTIVE: This study evaluated the influence that expanding a home-delivered meals service to include breakfast and lunch would have on the nutritional status and quality of life of at-risk older adults. DESIGN: This cross-sectional field study compared two groups. The breakfast group (n=167) received a home-delivered breakfast and lunch, 5 days per week. The comparison group (n=214) received a home-delivered lunch 5 days per week. Participants' 24-hour food recall, demographics, malnutrition risk, functional status, and surveys of quality of life as health, loneliness, food enjoyment, food security, and depression were obtained. PARTICIPANTS: Study participants were recruited from five Elderly Nutrition Programs involved in the Morning Meals on Wheels breakfast service demonstration project. They formed a geographically and racially/ethnically diverse sample. Participants ranged in age from 60 to 100 years, were functionally limited, and at high nutritional risk. Most were low income, lived alone, and had difficulty shopping or preparing food. STATISTICAL ANALYSIS: Descriptive statistics were used to assess group comparability. Independent sample t tests were used to examine group differences, with Bonferroni's method used to control for familywise Type I error. RESULTS: Breakfast group participants had greater energy/nutrient intakes (P<.05), greater levels of food security (P<.05), and fewer depressive symptoms (P<.05) than comparison group participants. CONCLUSIONS: The addition of a breakfast service to traditional home-delivered meals services can improve the lives of frail, homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service to a targeted population.

Aged↗

Psychological responses of pregnant women to an infectious outbreak: a case-control study of the 2003 SARS outbreak in Hong Kong.

OBJECTIVE: The aim of the present study was to examine the behavioral and psychological responses of pregnant women during the 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong. METHODS: Ethnographic interviews were first conducted to identify the common psychological and behavioral responses to the outbreak. This was followed by a case-control study of 235 consecutive pregnant women recruited during the SARS epidemic, and a historical cohort of 939 pregnant women recruited a year before the outbreak. Both cohorts completed standardized rating scales on depression, anxiety, and social support. RESULTS: Women in the SARS cohort adopted behavioral strategies to mitigate their risk of contracting infection. However, pregnant women tended to overestimate the risk of contracting SARS and nearly a third of the women were homebound. The anxiety level of the SARS cohort was slightly higher than that of the pre-SARS control. No statistical difference was found between the depression levels of the two cohorts. CONCLUSION: The improved social support experienced by pregnant women during SARS might have buffered the stress associated with an outbreak. However, clinicians should monitor for overestimation of infectious risk among pregnant women.

Adult↗

Home-delivered meal programs for homebound people with HIV/AIDS.

In major cities within the past decade, 17 community-based, home-delivered meal programs have emerged to meet the specialized nutrition needs of homebound people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (HIV/AIDS). This review includes specifics about these meal programs: funding, eligibility criteria, establishing and following nutrition and food safety standards, creating a network of volunteers for delivery of meals, providing nutrition counseling, and conducting periodic program evaluation. People living with HIV/AIDS may need the services of home-delivered meal programs throughout the course of HIV disease. Clinical dietitians and public health nutritionists should become familiar with existing programs and refer clients to services as needed.

Acquired Immunodeficiency Syndrome↗

Evaluation of the use of a pain diary in chronic cancer pain patients at home.

Systematic assessment of pain is the basis for adequate pain treatment. In the home situation, however, it is difficult to assess patients' pain intensity. A group of 159 cancer patients who had been admitted to a cancer hospital with pain caused by cancer, cancer therapy, or illness that persisted for at least 1 month received a pain diary. These patients were asked to register their pain intensity at home. Patients were instructed by a nurse to record their Present Pain Intensity on a scale from 0-10 once every morning and every evening for a period of 2 months. In this study, the use of a pain diary in cancer pain patients at home was evaluated. To determine the effects of the pain diary, patients were interviewed at baseline, at 2, 4, and 8 weeks postdischarge. Pain intensity scores were obtained both by patient interviews and from the pain diary. Results show that the use of a pain diary is an appropriate way to assess patients' pain intensity at home. Patients' compliance was high (86%), even in seriously ill patients. When comparing pain scores obtained by patient interview with scores obtained by pain diary, results showed that Present Pain Intensity scores, rather than Average Pain Intensity scores, should be used in both the clinical and the home setting because patients' recall accuracy depends, in part, on the stability of the pain. Because the pain intensity scores fluctuate greatly during the day and over a period of time, the use of a pain diary is useful in the home setting. In 60% of the patients, completing the pain scores helped them to cope with the pain.

Evaluation Studies as Topic↗

A pilot study on home visiting in Aspen Community Care Services.

The aim of this study was to test a questionnaire for more detailed management information of a community care program in rural Alberta. A total of 24 community care clients and 486 home visits to these clients were assessed. The Client Homebound Score (CHS) and the Case Management Intensity Score (CMIS) were positively associated with time spent on home visits. These scores would be useful indicators for improved resource-based planning of home visiting.

Activities of Daily Living↗

Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients.

This retrospective study investigated the validity of hand-grip dynamometry with respect to its use in predicting generalized upper extremity strength. The records of 37 patients (mean average age, 77.7 years) receiving home care were used. Discriminant construct validity was examined by comparing their dynamometry measurements with measurements of age- and gender-matched healthy individuals reported in the literature. Convergent construct validity was described by the correlations of their dynamometry measurements and manual muscle test scores of the upper extremities. The patients' dynamometer-measured grip forces were significantly less than reported normative values. The patients' dynamometer measured grip forces were correlated significantly with their manual muscle test scores. These findings support the construct validity of hand-grip dynamometry for characterizing upper extremity strength impairment among adults treated in a home care setting.

Aged↗

The effect of bladder training on urinary incontinence in community-dwelling older women.

OBJECTIVE: The effect of bladder training on urinary incontinence among a group of community-based older women was investigated. DESIGN: Quasi-experimental. SETTING AND SUBJECTS: Nineteen functionally independent, community-dwelling women, aged 64 to 88 years, with a history of urinary incontinence occurring at least once a week, participated in the study. METHODS: Bladder training methods consisted of mandatory voiding schedules, self-monitored voiding records, and weekly telephone communication between subject and researcher. MAIN OUTCOME MEASURES: The number of incontinent episodes over a 1-week period was used to determine the effectiveness of bladder training. RESULTS: The mean frequency of incontinent episodes at baseline was compared to the frequency of incontinent episodes at both end of treatment and at 6-month follow-up. CONCLUSIONS: Bladder training is effective in reducing episodes of urinary incontinence in community-dwelling older women.

Activities of Daily Living↗

A nurse owned and managed home health agency.

The downsizing epidemic that has swept across the country's acute care facilities has forced many nurses to reassess their goals and explore different career options. Home care has become an important alternative to hospital nursing for many nurses. During a management reorganization of a major medical center in Oakland, California, in early 1993, several middle managers in the nursing department were laid off. What started as informal, support group meetings to help one another face the transition and explore new career alternatives led to the formation of Professional Health Care at Home (PHCH). PHCH is a nurse owned and operated home care agency serving homebound patients in the San Francisco Bay Area. In these initial meetings, many nurses expressed an interest in home care and discovered the talent in their group that enabled them to start their own company.

Community Health Nursing↗

Exercise, immunity, acute respiratory infections, and homebound older adults.

Appropriate exercise may enhance immune function and lessen acute upper and lower respiratory tract infection (ULRI) symptoms in older adults. Home health care professionals need to know about this potential exercise effect because increased disease resistance and well-being can have a direct impact on activities of daily living (ADL) and independence. This article discusses recent exercise immunology research results, briefly explains the pathways by which exercise might affect immunity and ULRI, and provides guidance for home health care personnel regarding the delivery of an exercise program for their clients.

Acute Disease↗

Assessing laboratory values: serum Na+, K+, and Ca+.

Three common electrolytes--sodium, potassium, and calcium--often are measured in home health patients. The nurse must monitor these laboratory values so that any abnormalities are detected early. Early detection and early treatment can prevent further complications for the homebound patient.

Calcium↗

A place to care: the homebound elderly.

As America's elderly population continues to age, accessing adequate primary health care becomes more difficult. A survey of 22 homebound elderly people examined their acceptance of the expanded role functions of nurse practitioners to meet primary care needs in their homes. Chi-square analyses correlated participants' answers to demographic information. Only the variables of income and religion indicated statistical significance (P < .05) when correlated with expanded functions. Protestants, elders with no religious affiliation, and those with incomes below $20,000 indicated they would allow nurse practitioners to perform more expanded role functions than Catholics and those with higher incomes would. Generalizability is limited because of the small sample size, indicating a need for additional research with larger samples and more diverse populations.

Aged↗

A physician house call program for the homebound.

BACKGROUND: A growing number of homebound frail older adults have multiple chronic diseases with frequent flare ups of acute episodes. A physician house call program affiliated with a nonprofit community health system was deployed as a strategy to improve quality of care for homebound patients. PROGRAM DESCRIPTION: A medical team (either a physician and a medical assistant or a nurse practitioner), with a vehicle filled with portable medical equipment and supplies, fulfills the house call and primary care physician functions, establishes diagnoses, designs a treatment plan, arranges for any other needed services, and fosters continuity of medical care. EVALUATION: Interviews and focus groups with selected patients, family caregivers, program staff, and other service providers indicated that the program operated consistently with its intent. For example, the patient and caregiver interviews converged on four major themes: (1) the program improves patients' medication and health management and optimizes health, (2) caregivers felt more informed about the patients' medical conditions and medications and relieved of the burden of transporting patients to physicians, (3) the program reduces use of hospital and emergency services, and (4) the programs enables patients to die at home. DISCUSSION: The success of any future programs and further replications will depend on creating trusting relationships with local service providers and getting decision makers of affiliated community health systems or hospitals to embrace the necessary vision.

Aged↗

Dental demands of older people living at home in Hertfordshire: changes over a 10-year period.

A random sample of 300 subjects aged 65 and over, living at home in Hertfordshire, was interviewed to establish whether any changes in their oral status had arisen since a previous survey 10 years earlier. Results show that considerable improvements have taken place. The level of perceived need has fallen by about one-third, there has been a large fall in the proportion who are edentulous and a marked increase in the percentage of those with 10 or more natural teeth. Those with dentures are replacing them more frequently.

Aged↗