Placement of dementia sufferers in residential and nursing home care.
(17/80)
BACKGROUND: Few UK studies have examined the associations of residential or nursing home placement in dementia sufferers. METHOD: 124 patients with mild to moderate dementia (according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised) and in contact with clinical services were evaluated with a detailed standardized assessment and followed-up at monthly intervals for 1 year. RESULTS: 25 (21.6%) of the 116 patients living at home were admitted to residential or nursing home care during the follow-up year. Institutional placement was associated with greater severity of cognitive impairment, severity of parkinsonism and the failure of carers to adopt active coping strategies. CONCLUSION: An intervention to improve coping skills in carers may decrease the rates of residential and nursing home placement. (+info)
Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey.
(18/80)
BACKGROUND: Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. METHODS: We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus. RESULTS: This article reports the life-expectancy results portion of the larger study. The study group (n = 116) was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73) felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75) wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions. CONCLUSION: The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate. Since about a third of participants perceived these discussions as not useful or even harmful, physicians should first ascertain patients' preferences before discussing their life expectancies. (+info)
Demand of elderly people for residential care: an exploratory study.
(19/80)
BACKGROUND: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that are associated with this demand. Furthermore, the accuracy of the waiting list as a reflection of this demand has been examined. METHODS: 67 elderly people waiting for admission into a home for the elderly, are subjected to semi-structured interviews. The data are analyzed by using multivariate statistics. RESULTS: Elderly people who indicate that they would refuse an offer of admission into a home for the elderly feel healthier (p = 0.02), have greater self-care agency (p = 0.02) and perceive less necessity of admission (p < 0.01), compared to those who would accept such an offer. Especially the inability to manage everyday activities and the lack of a social network are highly associated with the elderly people's demand for residential care. Furthermore, it is evident that waiting lists for homes for the elderly do not accurately reflect the demand for residential care, since 35% of the elderly people on a waiting list did not actually experience an immediate demand for residential care and stated that they would not accept an offer of admission. Quite a lot of respondents just registered out of a sense of precaution; a strategic decision dictated by current shortages in care provision and a vulnerable health status. CONCLUSION: The results contribute to the understanding of waiting lists and the demand for residential care. It became apparent that not everybody who asks for admission into a home for the elderly, really needed it. The importance of elderly people's resources like social networks and the ability to manage everyday activities in relation to the demand for care became clear. These findings are important because they indicate that resources also play a role in predicting elderly people's demand and as a result can guide the development and the (re)design of adequate health care services. (+info)
Home-based assistive technologies for elderly: attitudes and perceptions.
(20/80)
This study aim is to explore the perceptions of seniors in regard to "smart home" technology aiming to improve their quality of life and/or monitor their health status. A total of 15 older adults participated in three focus groups. Participants had a positive attitude towards these technologies and identified application areas such as emergency help, detection of falls, monitoring of physiological parameters. Concerns were expressed about privacy and the need for tailored training. (+info)
When do older adults become "disabled"? Social and health antecedents of perceived disability in a panel study of the oldest old.
(21/80)
Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults 'perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health. (+info)
Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities.
(22/80)
BACKGROUND: Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life. METHODS: Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life. RESULTS: Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations. CONCLUSION: This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults' attitudes about screening, or change their screening behavior. (+info)
Risk factors for medication misadventure among residents in sheltered housing complexes.
(23/80)
AIM: To identify risk factors for unplanned hospitalizations among residents of sheltered housing complexes (SHCs). METHODS: Medication-related risk factors for health outcomes among residents of SHCs in Aberdeen (n = 1137) were assessed using a postal questionnaire. Predictors of unplanned hospitalization/emergency department (ED) visit were identified using logistic regression. RESULTS: Of the 695 (61.1%) responses received, 645 were from residents (mean age 78.2 years) using prescribed medications. One or more risk factors for medication-related problems was seen in 467 (72.4%) respondents; 488 (75.7%) were using medications with high potential for adverse drug reactions (ADRs) in the elderly. Unplanned hospitalizations/ED visits (n = 230) were found to be associated with use of drugs of narrow therapeutic index [P < 0.001; odds ratio (OR) 2.98, 95% confidence interval (CI) 1.69, 5.28]; use of five or more different medications (P = 0.001; OR 2.10, 95% CI 1.34, 3.31); and greater disability (Townsend score) (P = 0.005; OR 1.06, 95% CI 1.02, 1.11). CONCLUSION: Residents of SHCs using drugs of narrow therapeutic index, using five or more different medications, and with greater disability warrant periodic monitoring. (+info)
Non-alcoholic beverage and caffeine consumption and mortality: the Leisure World Cohort Study.
(24/80)
OBJECTIVE: To examine the effects of non-alcoholic beverage and caffeine consumption on all-cause mortality in older adults. METHODS: The Leisure World Cohort Study is a prospective study of residents of a California retirement community. A baseline postal health survey included details on coffee, tea, milk, soft drink, and chocolate consumption. Participants were followed for 23 years (1981-2004). Risk ratios (RRs) of death were calculated using Cox regression for 8644 women and 4980 men (median age at entry, 74 years) and adjusted for age, gender, and multiple potential confounders. RESULTS: Caffeine consumption exhibited a U-shaped mortality curve. Moderate caffeine consumers had a significantly reduced risk of death (multivariable-adjusted RR=0.94, 95% CI: 0.89, 0.99 for 100-199 mg/day and RR=0.90, 95% CI: 0.85, 0.94 for 200-399 mg/day compared with those consuming <50 mg/day). Individuals who drank more than 1 can/week of artificially sweetened (but not sugar-sweetened) soft drink (cola and other) had an 8% increased risk (95% CI: 1.01-1.16). Neither milk nor tea had a significant effect on mortality after multivariable adjustment. CONCLUSIONS: Moderate caffeine consumption appeared beneficial in reducing risk of death. Attenuation in the observed associations between mortality and intake of tea and milk with adjustment for potential confounders suggests that such consumption identifies those with other mortality-associated lifestyle and health risks. The increased death risk with consumption of artificially sweetened, but not sugar-sweetened, soft drinks suggests an effect of the sweetener rather than other components of the soft drinks, although residual confounding remains a possibility. (+info)