Home visits to the housebound patient in family practice: a multicenter study. Israeli General Practice Research Network.
(1/56)
BACKGROUND: Most countries today are experiencing an accelerated pace of population aging. The management of the elderly housebound patient presents a special challenge to the family physician. OBJECTIVES: To investigate a series of home visits to housebound patients, the therapeutic procedures used, the equipment needed, and the diagnostic conclusions reached. METHODS: The details of 379 consecutive home visits to housebound patients were recorded by 91 family doctors serving 125,000 patients in Israel. RESULTS: The average age of the patients was 76.1 years. The vast majority of the visits were during office hours (94%). In 24.1% it was the doctor who decided to make the home visit on his/her own initiative. The most common initial reason for a home visit was undefined general symptoms, but the doctor was usually able to arrive at a more specific diagnosis after the visit. Medications were prescribed in 59.1% of the visits, and in 23.5% the medication was administered directly by the physician. The commonest drugs used were analgesics and antibiotics. In 19.3% of visits no action at all, other than examination and counseling, was undertaken. The equipment needed included prescription pads (73%), a stethoscope (81%), sphygmomanometer (74.9%), and otoscope/torch (30.6%). Only 15% of visits resulted in referral to hospital. CONCLUSIONS: Home visits to housebound patients serve as a support to caregivers, provide diagnostic information, and help the family with the decision as to when hospitalization is appropriate. The specific medical cause for the patient being housebound had little effect on the process of home visiting. (+info)
The prevalence of faecal incontinence in older people living at home.
(2/56)
BACKGROUND: faecal incontinence affects quality of life and causes caregiver strain. Patients are often reluctant to seek help because of embarrassment and perceived lack of effective treatment. Persisting faecal soiling may lead to unwanted and premature institutionalization. OBJECTIVE: to ascertain the prevalence of faecal incontinence and to identify health and socio-demographic characteristics of patients with this problem. DESIGN: a sample of 3000 older people, living at home in the UK, randomly selected from three Family Health Service Authorities. PARTICIPANTS: we interviewed 2818 men and women aged > or =65 years in their own homes: a response rate of 94%. RESULTS: 78 respondents (3%) reported faecal incontinence. There was a small but non-significant association with increasing age: 38 (2%) of those reporting incontinence were aged 65-74 years; 40 (3%) were aged > or =75 years. Faecal incontinence was significantly associated with sex, with reports from 15 men (1%) versus 63 women (4%; P<0.0005). It was also significantly associated with anxiety and with depression (P<0.00001) and very significantly associated with increasing disability (P<0.00001). Forty-six (59%) of those who had faecal incontinence had severe disability, compared with 426 (16%) of those who did not (P<0.00001). The association with urinary incontinence was also strong: 54 (69%) of those with faecal incontinence (2% of the total sample) had coexistent urinary incontinence. Over 50% had not discussed their problems with a healthcare professional. CONCLUSIONS: a reluctance to report symptoms and a significant association between faecal incontinence and symptoms of anxiety, depression and disability suggest that older people should be asked about faecal incontinence. Increasing the awareness of the scale of the problem among health- and social-care professionals, older people and their carers may lead to more appropriate management and effective provision of care. (+info)
Planning for death but not serious future illness: qualitative study of housebound elderly patients.
(3/56)
OBJECTIVE: To understand how elderly patients think about and approach future illness and the end of life. DESIGN: Qualitative study conducted 1997-9. SETTING: Physician housecall programme affiliated to US university. PARTICIPANTS: 20 chronically ill housebound patients aged over 75 years who could participate in an interview. Participants identified through purposive and random sampling. MAIN OUTCOME MEASURES: In-depth semistructured interviews lasting one to two hours. RESULTS: Sixteen people said that they did not think about the future or did not in general plan for the future. Nineteen were particularly reluctant to think about, discuss, or plan for serious future illness. Instead they described a "one day at a time," "what is to be will be" approach to life, preferring to "cross that bridge" when they got to it. Participants considered end of life matters to be in the hands of God, though 13 participants had made wills and 19 had funeral plans. Although some had completed advance directives, these were not well understood and were intended for use only when death was near and certain. CONCLUSIONS: The elderly people interviewed for this study were resistant to planning in advance for the hypothetical future, particularly for serious illness when death is possible but not certain. (+info)
Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors.
(4/56)
BACKGROUND: The prevalence of inadequate nutrient intakes among the homebound elderly and their correlation with individual characteristics and health-related factors remain poorly understood. OBJECTIVE: We assessed the extent of inadequate dietary intakes of key nutrients among the homebound elderly by using the newly released dietary reference intakes and examined the associations of individual characteristics and health-related factors with low nutrient intakes. DESIGN: This was a cross-sectional examination of data collected during the baseline assessment of a prospective study of nutrition and function among a randomly recruited sample of cognitively eligible recipients of home-delivered meals who completed a home visit and three 24-h dietary recalls (n = 345). Nutrient analysis was performed with the NUTRITION DATA SYSTEM software, and associations were identified through multiple regression models. RESULTS: In multiple regression models, lower intakes of specific nutrients were associated with subjects who were women, who were black, who reported a low income and limited education, and who did not usually eat breakfast. On the basis of the estimated average requirement standard for nutrient inadequacy, the intake of >/= 6 nutrients was inadequate in 27% of subjects, of 3-5 nutrients in 40% of subjects, and of 1-2 nutrients in 29% of subjects. On the basis of the adequate intake standard, a less than adequate intake of calcium was reported by 96% of subjects and of vitamin D by 99% of subjects. CONCLUSIONS: The findings suggest that home-delivered meals programs should target specific subgroups of participants with interventions, such as a breakfast meal or more-nutrient-dense meals, tailored to increase nutrient intakes and reduce the prevalence of nutrient inadequacy. (+info)
Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women.
(5/56)
BACKGROUND: Nutritional intake has been overlooked as a possible contributing factor to lower-extremity physical performance, especially in homebound elderly persons. OBJECTIVES: Our objectives were to examine the association of a summary measure of calcium, vitamin D, magnesium, and phosphorus intakes with 1) the inability to perform lower-extremity physical performance tests and 2) declining levels of summary lower-extremity physical performance. DESIGN: Baseline data from the Nutrition and Function Study were used to calculate a summary musculoskeletal nutrient (SMN) score as a measure of nutrient intake (factor analysis) and to examine the association of SMN intake with physical performance (multivariable regression models) among recipients of home-delivered meals who completed an in-home assessment (anthropometric measures and performance-based physical tests) and three 24-h dietary recalls. RESULTS: Among the 321 participants, elderly age, black race, body mass index (in kg/m2) > or = 35, arthritis, frequent fear of falling, and lowest SMN intake were independently associated with being unable to perform functional tests. The lowest SMN intake and the highest BMI were both significantly associated with increasingly worse levels of lower-extremity physical performance, after adjustment for health and demographic characteristics. CONCLUSIONS: Considering the importance of identifying short- and long-term outcomes that help elderly persons maintain adequate nutritional status and remain functionally independent at home, the results of this study suggest the need to identify intervention strategies that target the improvement of dietary intake and physical performance. Further investigation is indicated to identify the manner in which nutritional status contributes to the preservation or deterioration of physical performance in homebound elderly persons. (+info)
Risk and presence of food insufficiency are associated with low nutrient intakes and multimorbidity among homebound older women who receive home-delivered meals.
(6/56)
This study examined the independent association of food sufficiency status with lowest nutrient intakes and multimorbidity among homebound older women who received home-delivered meals. Baseline data from the Nutrition and Function Study were used to identify three categories of food sufficiency status [food sufficient (FS), risk of food insufficiency (RFI) and food insufficient (FI)], calculate summary measures of musculoskeletal (calcium, vitamin D, magnesium and phosphorus) and overall nutrient intakes, and examine, using multivariable logistic regression models, the association of food sufficiency status with nutrition and health outcomes among 279 women who received regular home-delivered meals service (5 weekday meals/wk) and completed an in-home assessment and three 24-h dietary recalls. Independent of income and other variables, the adjusted odds for reporting lowest intakes in individual and multiple nutrients (> or = 2 musculoskeletal and > or = 5 overall) were significantly greater among women who reported RFI [odds ratio (OR) = 1.96 to 2.91] and FI (OR = 2.85 to 5.21). In addition, FI women were more likely to report a burden of multimorbidity (OR = 3.69). Considering the importance of home-delivered meals as a primary source of food assistance to homebound older women, the results of this study suggest the need to reevaluate the traditional model of home-delivered meals and to include measures of food sufficiency status as an integral component of program assessment and evaluation for the targeting and monitoring of new, innovative and cost-effective strategies to alleviate risk and the presence of food insufficiency. (+info)
Increasing fruit and vegetable intake in homebound elders: the Seattle Senior Farmers' Market Nutrition Pilot Program.
(7/56)
INTRODUCTION: Diets that are high in fruits and vegetables lower an individual's risk of chronic disease and contribute to healthy aging. Homebound seniors often have low intake of fruits and vegetables and limited access to fruits and vegetables with the most protective nutrients and phytochemicals. From June through October 2001, the Seattle Senior Farmers' Market Nutrition Pilot Program delivered bi-weekly market baskets that included a variety of fresh, locally grown produce to 480 low-income Meals on Wheels participants. The purpose of this study was to determine if the program increased fruit and vegetable intake in individuals who received the baskets. METHODS: One hundred basket recipients were recruited to complete a telephone survey before and at the end of the farmers' market basket season. Fifty-two low-income homebound seniors who lived outside the project service area were recruited to serve as control respondents. Fruit and vegetable intake was determined with modified versions of the 6 fruits and vegetables questions in the Behavior Risk Factor Surveillance System. RESULTS: Seniors who received the baskets reported consuming an increase of 1.04 servings of fruits and vegetables. The difference between the mean servings in the seniors who received the baskets compared to the controls was 1.31 (95% CI, 0.68-1.95, P < .001). At baseline, 22% of the basket recipients were consuming 5 or more servings of fruits and vegetables per day, but by the end of the season, 39% reported consuming 5 or more per day. CONCLUSION: Home delivery of fruits and vegetables is an effective way to increase fruit and vegetable intake in homebound seniors. (+info)
Qualitative assessment of participant utilization and satisfaction with the Seattle Senior Farmers' Market Nutrition Pilot Program.
(8/56)
INTRODUCTION: The Seattle Senior Farmers' Market Nutrition Pilot Program delivered fresh fruits and vegetables to homebound seniors in King County, Washington, from June through October 2001. A primary objective of the program was to increase participants' intake of fruits and vegetables. A qualitative study was conducted to examine the impact of the program on participating homebound seniors. METHODS: Semi-structured interviews were performed with 27 participants in their homes to identify benefits and barriers they encountered and to measure their use and sense of satisfaction with the program. RESULTS: Analysis of the transcribed interviews revealed several common themes: Participants appreciated the variety and quality of the fresh fruits and vegetables. Some participants would not have had access to fresh fruits and vegetables without the program. Home-delivered baskets of fresh fruits and vegetables brought participants joy, stimulated interest in healthy foods, and improved quality of life. The program newsletter supported consumption of fresh produce. CONCLUSION: Program success was rooted in the multiple ways the program addressed potential barriers and reinforced behavioral intent. (+info)