Efficacy of influenza vaccine in the elderly in welfare nursing homes: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic.
(41/1708)
The effect of influenza vaccination on the occurrence and severity of influenza virus infection in a population residing in nursing homes for the elderly was studied during an influenza A (H3N2) epidemic in Japan. Of 22,462 individuals living in 301 welfare nursing homes, 10,739 received either one dose (2027 subjects) or two doses (8712 subjects) of inactivated, subunit trivalent influenza vaccine. During the period Nov. 1998 to March 1999, there were 950 cases of influenza infection diagnosed clinically, with virus isolation or serology. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection and deaths due to influenza in the vaccinated cohort (256 cases, 32 hospital admissions, 1 death) than in the unvaccinated controls (694 cases, 150 hospital admissions, 5 deaths; reduction rates 59.8%, 76.9% and 79.1% respectively). Vaccination was almost equally effective in those who received one dose of vaccine and those who received two doses. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is safe and effective in this population, and should be an integral part of the routine care of persons aged > or =65 years residing in nursing homes. (+info)
Dependency in older people recently admitted to care homes.
(42/1708)
OBJECTIVE: to investigate dependency and general health status of a cohort of older people admitted to residential or nursing homes for long-term care. METHOD: we assessed 308 people aged over 65 years within 2 weeks of admission for long-term care to one of 30 nursing or residential homes in north-west England. Dependency was assessed using the Barthel activities of daily living index and the Crichton Royal Behaviour Rating Scale. We collected information from the homes' records on diagnosed conditions and current medication. RESULTS: 50% of the cohort were in a 'low dependency' band (Barthel score 13 - 20): 31% of those in nursing homes and 71% of those in residential homes. In nursing homes, low-dependency residents were more likely to be self-funding than those with higher dependency. Of a number of broad diagnostic groupings, only a diagnosis of dementia was associated with nursing- rather than residential-home admission. Of 47 residents who scored 9 or less on the Mini-Mental State Examination (indicating severe cognitive impairment), 85% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. DISCUSSION: the high proportion of new admissions of subjects with low dependency needs raises questions about the effective targeting of resources and about management of the boundary between home-based and institutional care. The existence of an important group of self-funded, low-dependency new admissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local authorities. Many new admissions had conditions which might benefit from rehabilitation but there were almost no therapy staff in the studied homes. In some cases where severe cognitive impairment was evident, there was no evidence that the result of any formal pre-admission psychiatric evaluation had been communicated to nursing or care staff. (+info)
Changes in social support in relation to seniors' use of home care.
(43/1708)
OBJECTIVES: This article examines seniors' entry into government-supported home care in relation to changes in levels of social support and in living arrangements. DATA SOURCE: The analysis is based on longitudinal data from the household component of the first two cycles of the National Population Health Survey, conducted by Statistics Canada in 1994/95 and 1996/97. Data from a sample of 2,044 people aged 65 or older who were followed prospectively were weighted to represent 2.7 million household-dwelling seniors. ANALYTICAL TECHNIQUES: Descriptive data were produced using bivariate frequencies. A multiple logistic regression model was used to examine associations between home care entry and changes in levels of social support and in living arrangements, while controlling for demographic and health-related factors. MAIN RESULTS: Among people aged 65 or older who did not receive government-supported home care in 1994/95, an estimated 7% (192,000) were receiving these services in 1996/97. Changes in social support and in living arrangements between 1994/95 and 1996/97 were significantly associated with home care entry. (+info)
Living at home or in an institution: what makes the difference for seniors?
(44/1708)
OBJECTIVES: This article examines some of the health and socio-demographic factors associated with living in long-term health care facilities rather than in private households, for elderly people with various levels of disability. DATA SOURCE: The data are from the 1996/97 National Population Health Survey conducted by Statistics Canada. Data from a sample of 1,711 people aged 65 or older living in long-term health care facilities and 13,363 in private households were weighted to represent about 185,100 and 3.4 million seniors, respectively. ANALYTICAL TECHNIQUES: Descriptive data were produced using bivariate frequencies. Multiple logistic regression models were used to examine associations between living in long-term health care facilities and selected health and socio-demographic characteristics for seniors with self-reported severe, moderate or no disability. MAIN RESULTS: While health status was strongly associated with residence in a long-term health care facility, the absence of a spouse, low income, low education, and advanced age were also significant. (+info)
Study on work load of matrons under shift work in a special nursing home for the elderly.
(45/1708)
In order to find out the work load of matrons under shift work in a special nursing home for the elderly (SNH), six healthy female matrons volunteered to participate in the present study. For each subject, care working time, heart rate, walking steps, estimated energy expenditure and working time in different postures were determined during day shift work (540 min) and night shift work (960 min). Although the time on duty, working and recess were significantly longer in night shift work than day shift work, the percentages of working and recess time to duty time were nearly the same regardless of shift work. The longest care work in each shift work was individual care of residents in the SNH. The maximum, minimum and mean heart rate and percentages to estimated maximal heart rate were similar in each shift work. Although total walking steps in night shift work were significantly larger than those in day shift work, steps per hour did not differ between them. The estimated total energy expenditure (kcal) was significantly higher in night shift work than in day shift work; however, the work intensity (kcal/kg/min) was significantly higher in day shift work. The longest length and larger percentage of working time were observed in standing posture in each shift work. These findings suggest that physical activity and energy expenditure of matrons under either shift work in the SNH seem to be high. Further studies are needed to clarify the work load of matrons engaged in SNH to formulate countermeasures. (+info)
The National Nursing Home Survey: 1997 summary.
(46/1708)
OBJECTIVES: This report presents estimates of nursing home facilities, their current residents and discharges in the United States. Data are presented on facility characteristics, demographic characteristics, utilization measures, health and functional status of current residents, and discharges. METHODS: Data used in this report are based on data collected from the 1997 National Nursing Home Survey. The survey collects information about providers and recipients of care from nursing home facilities. (+info)
The impact of nursing home patients on general practitioners' workload.
(47/1708)
BACKGROUND: Although the number of people in nursing homes has risen substantially in recent years, the shift of responsibility into general practice has rarely been accompanied by extra resources. These patients may be associated with a higher general practitioner (GP) workload than others of similar age and sex. AIM: To assess the GP workload associated with nursing home residents and its associated costs. METHOD: All nursing home residents aged over 65 years and registered with nine Nottinghamshire practices during one year were matched with patients living in the community for general practice, age, and sex. Data were collected retrospectively for both groups on key workload measures. Costs for the workload measures were calculated using published estimates. RESULTS: Data were collected for 270 pairs of patients. Nursing home patients had more face-to-face contacts in normal surgery hours, telephone calls, and out-of-hours visits. The mean workload cost per month of a nursing home patient (assuming that one patient was seen per visit) was estimated to be 18.21 Pounds (10.49 Pounds higher than the cost of controls). A sensitivity analysis demonstrated that potential savings in visiting costs associated with increasing the numbers of patients seen per visit were 27% for one extra patient seen per visit and 44% for four extra patients. CONCLUSION: Nursing home residents were associated with higher workload for GPs than other patients of the same age and sex living in the community. Our costings provide a basis for negotiating suitable reimbursement of GPs for their additional work. (+info)
The optimal outcomes of post-hospital care under medicare.
(48/1708)
OBJECTIVE: To estimate the differences in functional outcomes attributable to discharge to one of four different venues for post-hospital care for each of five different types of illness associated with post-hospital care: stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fracture, and to estimate the costs and benefits associated with discharge to the type of care that was estimated to produce the greatest improvement. STUDY SETTING/DATA SOURCES: Consecutive patients with any of the target diagnoses were enrolled from 52 hospitals in three cities. Data sources included interviews with patients or their proxies, medical record reviews, and the Medicare Automated Data Retrieval System. ANALYSIS: A two-stage regression model looked first at the factors associated with discharge to each type of post-hospital care and then at the outcomes associated with each location. An instrumental variables technique was used to adjust for selection bias. A predictive model was created for each patient to estimate how that person would have fared had she or he been discharged to each type of care. The optimal discharge location was determined as that which produced the greatest improvement in function after adjusting for patients' baseline characteristics. The costs of discharge to the optimal type of care was based on the differences in mean costs for each location. DATA COLLECTION/EXTRACTION METHODS: Data were collected from patients or their proxies at discharge from hospital and at three post-discharge follow-up times: six weeks, six months, and one year. In addition, the medical records for each participant were abstracted by trained abstractors, using a modification of the Medisgroups method, and Medicare data were summarized for the years before and after the hospitalization. PRINCIPAL FINDINGS: In general, patients discharged to nursing homes fared worst and those sent home with home health care or to rehabilitation did best. Because the cost of rehabilitation is high, greater use of home care could result in improved outcomes at modest or no additional cost. CONCLUSIONS: Better decisions about where to discharge patients could improve the course of many patients. It is possible to save money by making wiser discharge planning decisions. Nursing homes are generally associated with poorer outcomes and higher costs than the other post-hospital care modalities. (+info)