Homebound Persons
Nontherapeutic Human Experimentation
Geriatric Nursing
Frail Elderly
Brief Psychiatric Rating Scale
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)A "homebound person" is a term used in the medical field to describe an individual who has a condition that restricts their ability to leave their home without considerable effort or assistance. According to the Centers for Medicare & Medicaid Services (CMS), a homebound patient is generally defined as someone whose illness or injury makes it so they have difficulty leaving their place of residence, and their condition must be such that it is contraindicated for them to leave their home, or they need the help of another person or medical equipment to do so. This designation is often used in the context of healthcare services, as patients who are considered homebound may be eligible for certain benefits, such as home health care.
"Researcher-Subject Relations" generally refers to the interactions and relationship between researchers (including scientists, clinicians, and social scientists) and the individuals who participate in research studies as subjects or participants. This relationship is governed by ethical principles that aim to protect the rights and welfare of research subjects, while also allowing for the production of valid and reliable research findings.
The Belmont Report, a foundational document in the ethics of human subjects research in the United States, outlines three key ethical principles that should guide researcher-subject relations: respect for persons, beneficence, and justice. These principles require researchers to obtain informed consent from potential research subjects, to minimize risks and maximize benefits, and to ensure fairness in the selection and treatment of research subjects.
Researcher-subject relations can take many forms, depending on the nature of the research and the characteristics of the research subjects. In some cases, research subjects may be patients who are receiving medical care, while in other cases they may be healthy volunteers who are participating in a study for compensation or other incentives. Researchers must be transparent about the purposes of the research, the potential risks and benefits, and the rights and responsibilities of research subjects, and must ensure that these issues are communicated in a clear and understandable manner.
Effective researcher-subject relations require trust, respect, and communication, as well as an understanding of the ethical principles and regulations that govern human subjects research. By building strong relationships with research subjects, researchers can help to ensure that their studies are conducted ethically and responsibly, while also producing valuable insights and knowledge that can benefit society as a whole.
Nontherapeutic human experimentation refers to medical research studies in which the primary goal is not to directly benefit the participants, but rather to advance scientific knowledge or develop new medical technologies. These studies often involve some level of risk or discomfort for the participants, and may include the administration of experimental treatments, procedures, or interventions.
Nontherapeutic human experimentation can take many forms, including clinical trials, observational studies, and other types of research involving human subjects. In these studies, researchers must carefully weigh the potential benefits of the research against the risks to the participants, and ensure that all participants are fully informed of the nature of the study, its purposes, and any potential risks or benefits before providing their consent to participate.
It's important to note that nontherapeutic human experimentation is subject to strict ethical guidelines and regulations, designed to protect the rights and welfare of research participants. These guidelines and regulations are intended to ensure that all research involving human subjects is conducted in a responsible and ethical manner, with the goal of advancing scientific knowledge while minimizing harm to participants.
Geriatric nursing is a specialized area of nursing practice that focuses on the care of older adults, typically those aged 65 and over. It involves providing comprehensive nursing care to this population group, addressing their unique healthcare needs and promoting their overall well-being. Geriatric nurses work in various settings, including hospitals, long-term care facilities, community health centers, and home health agencies.
The primary goals of geriatric nursing are to:
1. Promote functional independence and quality of life for older adults.
2. Prevent or manage chronic conditions and disabilities that commonly occur in later life.
3. Provide patient-centered care that respects the autonomy, dignity, and cultural diversity of older adults.
4. Collaborate with interdisciplinary teams to develop individualized care plans that address physical, mental, emotional, and social needs.
5. Educate older adults, their families, and caregivers about health promotion strategies, disease prevention, and self-care management.
6. Advocate for the rights and access to healthcare services for older adults.
Geriatric nurses must have a deep understanding of the aging process, common age-related diseases and conditions, and evidence-based practices for managing them. They also need excellent communication skills, empathy, patience, and a strong commitment to providing compassionate care to this vulnerable population.
The term "frail elderly" is not a formal medical diagnosis, but rather a general description used to identify older adults who are vulnerable and at increased risk for negative health outcomes. Frailty is a complex syndrome characterized by decreased physiological reserve and resistance to stressors, which results in increased vulnerability to adverse outcomes.
The frail elderly often have multiple chronic conditions, cognitive impairment, functional limitations, social isolation, poor nutritional status, and sensory deficits. These factors contribute to a decline in their physical function, mobility, and overall health, making them more susceptible to falls, disability, hospitalization, institutionalization, and mortality.
There are several tools and criteria used to define frailty, including the Frailty Phenotype model proposed by Fried et al., which identifies frailty based on the presence of three or more of the following five criteria: unintentional weight loss, weakness (measured by grip strength), self-reported exhaustion, slow walking speed, and low physical activity. Another commonly used tool is the Clinical Frailty Scale, which assesses frailty based on a person's level of dependence and coexisting medical conditions.
It is important to note that frailty is not an inevitable part of aging, and interventions aimed at addressing its underlying causes can help improve outcomes for the frail elderly. These interventions may include exercise programs, nutritional support, medication management, and social engagement.
The Brief Psychiatric Rating Scale (BPRS) is a widely used clinician-rated scale for assessing the severity of psychopathology in individuals with mental illness. It consists of 18 items, each rated on a 7-point scale (1=not present to 7=extremely severe), that measure various symptoms such as depression, anxiety, hostility, hallucinations, and unusual thoughts. The BPRS is often used in research and clinical settings to monitor treatment response and symptom changes over time.