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At least 19 recordsLinked to original sources
PubMed1996

Social support and knowledge level of the older adult homebound person with diabetes.

The purpose of this study was to continue research related to the identification of social support systems for an older adult homebound population of people who have diabetes compared to a control group of elder home care clients without diabetes, their knowledge level, and the significance of home health care intervention in these support networks. A sample of 11 older adult homebound people with diabetes and 11 older adult home care controls without diabetes from two home care agencies in Connecticut were used for this pilot study. A large sample was projected, but home-visiting scheduling difficulties arose. Eighty-two percent of both groups had adequate support systems. There was some difficulty with interpretation of the Homebound Diabetes Knowledge Level Questionnaire and further refinement is needed, especially in relationship to non-insulin-dependent diabetes mellitus client responses. Results from chart review, utilizing the Diabetes Clinical Indicator Tool, yielded a 59%-66% rate of the criteria met in the four categories outlined. It is evident that social support makes a significant contribution to the physical and psychological well-being of the home care elder, but further study is needed to examine the relationship between an individual's personal and professional network of support in this setting.

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PubMedDate not supplied

Nutritional parameters in homebound persons of greatly advanced age.

There exists a deficiency of accurate information regarding standard nutritional parameters in people of greatly advanced age. In order to begin obtaining appropriate data, we assessed nutritional status in 45 elderly homebound individuals with a mean age of 84 yr, using anthropometric methods, skin testing, and blood analysis. We compared our data with those from the HANES survey, a reasonable approach to the testing of new possible standards for nutritional assessment. Our results suggest that standard measures in common use are inappropriate for people of greatly advanced age.

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PubMed1995

Vitamin D deficiency in homebound elderly persons.

OBJECTIVE: To assess the vitamin D status in homebound, community-dwelling elderly persons; sunlight-deprived elderly nursing home residents; and healthy, ambulatory elderly persons. DESIGN: A cohort analytic study. PARTICIPANTS: Of 244 subjects at least 65 years old, 116 subjects (85 women and 31 men) had been confined indoors for at least 6 months, either in private dwellings in the community (the Hopkins Elder Housecall Program) or in a teaching nursing home (The Johns Hopkins Geriatrics Center). The 128 control subjects, a healthy ambulatory group, came from the Baltimore Longitudinal Study on Aging. All subjects were free of diseases or medications that might interfere with their vitamin D status. MAIN OUTCOME MEASURES: Serum levels of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-[OH]2D) were measured in all subjects. In a subgroup of 80 subjects, serum levels of intact parathyroid hormone (PTH), ionized calcium, and osteocalcin and intake of vitamin D (through 3-day food records) were assessed. A randomly selected cohort of sunlight-deprived subjects also had serum levels of vitamin D binding protein measured. RESULTS: In sunlight-deprived subjects overall, the mean 25-OHD level was 30 nmol/L (12 ng/mL) (range, < 10 to 77 nmol/L [< 4 to 31 ng/mL]) and the mean 1,25-(OH)2D level was 52 pmol/L (20 pg/mL) (range, 18 to 122 pmol/L [7 to 47 pg/mL]). In the sunlight-deprived subjects, 54% of community dwellers and 38% of nursing home residents had serum levels of 25-OHD below 25 nmol/L (10 ng/mL) (normal range, 25 to 137 nmol/L [10 to 55 ng/mL]). A significant inverse relationship existed between 25-OHD (ie, Log [25-OHD]) and PTH when they were analyzed together (r = -0.42; R2 = 0.18; P < .001) and for each cohort separately. All other parameters measured, except ionized calcium, differed significantly from the Baltimore Longitudinal Study Group means. The mean (SD) daily intakes of vitamin D (121 [132] IU) and calcium (583 [322] mg) were below the recommended dietary allowance only in the community-dwelling homebound population. The mean vitamin D binding protein level in the sunlight-deprived subgroup was in the normal range. CONCLUSIONS: Despite a relatively high degree of vitamin supplementation in the United States, homebound elderly persons are likely to suffer from vitamin D deficiency.

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PubMed1990

The impact of community care on provision of informal care to homebound elderly persons.

This study examined the impact of community care on informal care provided by family and friends to homebound elderly persons. Secondary analyses were conducted on data collected from clients at baseline, 9 months (N = 225), and 48 months (N = 76) after acceptance to community care and home-delivered meals programs. Analyses revealed a significant increase in the amount of formal services provided to both groups of clients at 9 months and to community care clients at 48 months. The increase was attributed to the large proportion of "new" or "supplementary" services provided by agencies. No significant decrease in the amount of service provided by informal caregivers was found. In addition, regression analyses demonstrated only a weak impact of formal service on informal care. Analysis of patterns of service provision for each client demonstrated that formal care supplemented rather than substituted for informal care significantly more often in both the 9- and 48-month samples. We conclude that formal care in general supplemented the efforts of informal caregivers, and that informal caregiving remained stable over time.

Activities of Daily Living↗
PubMed1993

The real world experience: death of homebound elderly persons. Staff views from the front lines.

If advance directives are implemented properly, this could, in the long term, be a vehicle for more appropriate utilization of health care services and health care technology. Yet in our own large agency we find few patients and families making the choice to have advance directives. This confirms that real change in this area is not being achieved through legislative or regulatory mandate but rather through an interactive process. Home care agencies are in a strong position to effect this change. Next we need to move beyond compliance and into an understanding of how advance directive requirements must be integrated with a patient, the family, and their culture, along with the ongoing relationships that evolve between the nurse and the patient over time.

Advance Directives↗
PubMed1996

The future of clinical communication in an electronic environment.

Computer technologies, particularly electronic computer networks, can enhance nurses' abilities to initiate, facilitate, and sustain interpersonal contact with patients. Computer networks are electronic links between remote sites and as such provide a pathway for communication between nurses and patients. In an innovative project known as the ComputerLink, a team of nurses used an electronic network to provide information, communication, and decision support to homebound persons and their caregivers. This experiment allowed exploration of the unspoken language of nursing and provides direction for considering how nursing therapeutics can capitalize on the benefits of the electronic network.

Communication↗
PubMedDate not supplied

Cognitive-behavioral intervention for homebound caregivers of persons with dementia.

BACKGROUND: Family caregivers experience considerable stress in their management of specific behaviors of persons with dementia. OBJECTIVE: To examine the effects of an 8-week cognitive-behavioral (C-B) intervention tailored to the specific deficits of persons with dementia (PWDs) on selected outcomes for homebound caregivers and the functional status of the PWD. METHOD: The design was a two-group randomized trial with measures taken at baseline, 4 weeks, 8 weeks, and 12 weeks. Subjects were 65 caregiver-care recipient dyads. A majority of the 65 female caregivers were spouses with a mean age of 66.5 years. Thirty-one women who received the C-B intervention were compared to 34 who received the attention-only (A-O) placebo telephone calls. Coping strategies, perceptions of caregiver burden and satisfaction, and emotional and physical health were assessed at the four points in time. RESULTS: Results indicated a time by group interaction in depression, with less depression in the C-B than the A-O group. Both groups experienced a significant reduction in anxiety, and a significant consistent decrease in satisfaction over time. Both groups also demonstrated decreased use of emotion-focused coping strategies. CONCLUSION: The results suggest a plausible effectiveness of the C-B intervention in preventing the progression of depression. Suggestions for future research are provided.

Adaptation, Psychological↗
PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

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PubMedDate not supplied

A comparison of two mobile treatment programs for the homebound and nursing home patient.

Two mobile treatment programs using portable equipment transported in vans to serve homebound persons in Denver and Chicago are compared for types of patients treated, use by local dentists, types of services provided, fees generated, and costs involved in operation during the 2-year period (1985-86). Both programs treated a similar, largely nursing home-based white female population that was predominantly older. Volunteer dentist participation varied greatly, with more than twice the number of dentists using the service in Chicago. Both programs accomplished essentially the same number of visits for the biennium studied, with 1,324 for Chicago and 1,320 for Denver. The Denver program was more efficient, generating more visits each time a dentist used the program. The services provided in total were about the same for both programs, with Denver generating 4,887 procedures and Chicago 4,602 for the biennium, but Denver had a more favorable ratio of diagnostic to treatment services. The costs of both programs were close, averaging about $60,000 per year. Denver was able to generate far more in equivalent fees than Chicago for the biennium, but Chicago dentists donated a greater percentage of services (67) than did Denver dentists (62).

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