Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28.971
Filtrar
2.
Soins Psychiatr ; 45(354): 26-29, 2024.
Artigo em Francês | MEDLINE | ID: mdl-39237216

RESUMO

In psychiatry, psychomotricians can play an essential role in multidisciplinary teams. The specificity of their clinical vision and analysis, as well as their care tools, make them specialists in understanding the symptoms expressed by the body, and in body-mediated therapy. Able to propose interventions for patients in crisis, and to plan long-term care for stabilized chronic patients, they adapt to the temporality of the pathology. Committed to teamwork, they play their part in the multi-disciplinary weave of containing and structuring that the psychiatric institution confers on the most fragile patients.


Assuntos
Hospitais Psiquiátricos , Comunicação Interdisciplinar , Transtornos Mentais , Equipe de Assistência ao Paciente , Enfermagem Psiquiátrica , Humanos , Transtornos Mentais/enfermagem , Transtornos Mentais/psicologia , França , Colaboração Intersetorial , Comportamento Cooperativo , Intervenção em Crise , Assistência de Longa Duração/psicologia
3.
Health Aff (Millwood) ; 43(9): 1296-1305, 2024 09.
Artigo em Inglês | MEDLINE | ID: mdl-39226503

RESUMO

Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5 percent of residents per month in 2013 to 16.9 percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid. As policy makers pursue strategies to coordinate medical and long-term care for dual-eligible beneficiaries, it remains critical to evaluate how these plans influence the care of dual-eligible nursing home residents.


Assuntos
Definição da Elegibilidade , Programas de Assistência Gerenciada , Medicaid , Medicare , Casas de Saúde , Estados Unidos , Humanos , Medicare/economia , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais , Assistência de Longa Duração/economia , Gastos em Saúde/estatística & dados numéricos
4.
Inquiry ; 61: 469580241273177, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39229704

RESUMO

In response to the aging population, an integrated care policy has been put forward and implemented in China. The key aspect of this policy is the reform of services within long-term care facilities, representing a significant shift and innovation. This study aims to explore the perceptions and experiences of integrated care among older residents living in long-term care facilities. A descriptive qualitative design was applied in our study. Utilizing a purposive sampling method, 18 older adults from 5 long-term care institutions in Shanghai, China were selected. Data were collected through semi-structured in-depth interviews from October 2022 to April 2023, continuing until data saturation was reached. Directed content analysis was applied to analyze the interview data, guided by the Fundamentals of Care (FoC) Framework. Five themes and 11 subthemes were identified, including (1) Policy level: positive attitude and negative feelings. (2) Physiological level: satisfied basic daily life, primary medical services accessibility and chronic care management enhancement needed. (3) Psychological level: need for psychological support and need for self-perception recognition. (4) Relationship level: enhancement of humanistic care and need for a family atmosphere. (5) Social level: interpersonal communication constrained by the times and inadequate social engagement. Strengthening the awareness and participation of older people in the integrated care policy, and fully meeting the diverse needs including advanced medical care, chronic disease management, personalized life care, psychological support, humanistic care and social engagement will contribute to the improvement of the policy, so as to better adapt the demographic shift.


Assuntos
Prestação Integrada de Cuidados de Saúde , Entrevistas como Assunto , Assistência de Longa Duração , Pesquisa Qualitativa , Humanos , Feminino , Masculino , Idoso , China , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Casas de Saúde , Percepção
5.
BMC Health Serv Res ; 24(1): 1064, 2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39272121

RESUMO

BACKGROUND: Quebec's healthcare system faces significant challenges due to labour shortage, particularly in long-term care facilities (CHSLDs). The aging population and increasing demand for services compound this issue. Teleconsultation presents a promising solution to mitigate labour shortage, especially in small CHSLDs outside urban centers. This study aims to evaluate the cost and cost savings associated with teleconsultation in CHSLDs, utilizing the Time-Driven Activity-Based Costing (TDABC) model within the framework of Value-Based Healthcare (VBHC). METHODS: This study focuses on CHSLDs with fewer than 50 beds in remote regions of Quebec, where teleconsultation for nighttime nursing care was implemented. Time and cost data were collected from three CHSLDs over varying periods. The TDABC model, aligned with VBHC principles, was applied through five steps, including process mapping, estimating activity times, calculating resource costs, and determining total costs. RESULTS: Teleconsultation increased the cost per minute for nursing care compared to traditional care, attributed to additional tasks during remote consultations and potential technical challenges. However, cost savings were realized due to reduced need for onsite nursing staff during non-eventful nights. Overall, substantial savings were observed over the project duration, aligning with VBHC's focus on delivering high-value healthcare. CONCLUSIONS: This study contributes both theoretically and practically by demonstrating the application of TDABC within the VBHC framework in CHSLDs. The findings support the cost savings from the use of teleconsultation in small CHSLDs. Further research should explore the long-term sustainability and scalability of teleconsultation across different CHSLD sizes and settings within the VBHC context to ensure high-value healthcare delivery.


Assuntos
Redução de Custos , Assistência de Longa Duração , Consulta Remota , Humanos , Consulta Remota/economia , Redução de Custos/métodos , Assistência de Longa Duração/economia , Quebeque , Custos e Análise de Custo/métodos , Casas de Saúde/economia , Cuidados de Saúde Baseados em Valores
6.
PLoS One ; 19(9): e0310139, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39250475

RESUMO

INTRODUCTION: Falls are a serious health problem in long-term care facilities (LTCFs), affecting more than 50% of residents. A key role of LTCF staff is to assess fall risks and implement fall prevention activities. Understanding the barriers and facilitators is key to successful implementation. METHODS: This descriptive qualitative study involving four LTCF facilities (varied provider types and sizes) in southwest Ireland. We recruited a convenience sample of 17 LTCF staff, who participated in semi-structured online 1:1 interviews (n = 7) or small group interviews (n = 10). The data were analysed using Braun and Clarke's reflective thematic analysis. RESULTS: The participants included two directors of nursing, three therapists, one ward manager, one general practitioner, five nurses and five healthcare assistants. Six main themes were identified, reflecting factors that influenced fall prevention: a need for sufficient staff and appropriate skill mix; fall policy, documentation and leadership; equipment and safe environments; person-centred care; staff knowledge, skills and awareness in falls prevention; and staff communication and collaborative working. A wide range of approaches that supported LTCF staff to overcome barriers were identified, including audits and feedback, falls champions, fall prevention leaders, daily communication (e.g., safety pauses) and staff collaboration. Formal multidisciplinary meetings and identification systems to highlight residents at high risk of falling were not considered helpful. Staff suggested that education should be briefer, ongoing and practice-based ("brief but often") to promote ownership and responsibility. CONCLUSION: LTCF staff identified several approaches to prevent falls in LTCFs as part of usual care, rather than lengthy, formal meetings and training. The potential role of families in fall prevention was under-appreciated and should be investigated further.


Assuntos
Acidentes por Quedas , Assistência de Longa Duração , Humanos , Acidentes por Quedas/prevenção & controle , Feminino , Pessoal de Saúde/psicologia , Irlanda , Masculino , Idoso , Pesquisa Qualitativa , Casas de Saúde , Adulto , Pessoa de Meia-Idade
7.
Trials ; 25(1): 597, 2024 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-39245714

RESUMO

BACKGROUND: In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Currently, the German healthcare system lacks such comprehensive structures. Our study aims to evaluate the effectiveness of a structured, multidisciplinary long-term approach compared to conventional "treatment as usual" (TAU). METHODS: A prospective, multicenter study with ten pediatric university clinics in Germany will be conducted. The cluster-randomization takes place at the clinic level. Children and adolescents who completed their cancer treatment at least five years ago and their parents will be eligible to participate. While the control group (CG) receives TAU, the intervention group (IG) participates in a structured program. This program includes risk-based medical treatment and psychosocial interventions tailored to each patient's individual needs within a two-month timeframe. The primary outcome is the improvement of self-efficacy. Secondary outcomes are satisfaction with health care, improvement of health-related quality of life (HRQoL), reduction of mental health problems, and improvement of transition readiness. DISCUSSION: This approach has the potential to optimize the health care for individuals who survived cancer during childhood or adolescence. It addresses the challenges of overuse, underuse, and misuse of health care resources. By considering both medical and psychosocial factors and promoting increased self-efficacy, independent from parental involvement, it may facilitate a smoother transition to adult medicine and enhance adherence to lifelong aftercare. If proven successful, this approach will contribute to the integration of multidisciplinary strategies into standard healthcare practice. TRIAL REGISTRATION: German Clinical Trials Register DRKS00029269. Registered on December 23, 2022.


Assuntos
Sobreviventes de Câncer , Estudos Multicêntricos como Assunto , Neoplasias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Criança , Adolescente , Sobreviventes de Câncer/psicologia , Estudos Prospectivos , Alemanha , Neoplasias/terapia , Neoplasias/psicologia , Assistência de Longa Duração , Autoeficácia , Fatores de Tempo , Equipe de Assistência ao Paciente , Resultado do Tratamento , Satisfação do Paciente , Saúde Mental , Adaptação Psicológica , Feminino , Masculino , Intervenção Psicossocial/métodos
8.
Nutrients ; 16(17)2024 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-39275133

RESUMO

Global warming poses a significant threat to our planet, with the food sector contributing up to 37% of total greenhouse gas emissions. This study aimed to assess the climate change impact and healthiness of menus in a long-term care facility in Italy. We analyzed two 28-day cyclical menus using the carbon footprint (CF) and the Modified EAT-Lancet Diet Score (MELDS) to evaluate adherence to the Planetary Health Diet (PHD). Monte Carlo simulations were employed to explore 20,000 daily menu permutations. Results showed that the mean GHGEs of spring/summer and autumn/winter daily menus were 2.64 and 2.82 kg of CO2eq, respectively, with 99% of menus exceeding the 2.03 kg of CO2eq benchmark. Only 22% of menus were adherent to the PHD, with MELDSs ranging from 12 to 29. A strong inverse association between the CF and adherence to the PHD was observed. These findings suggest significant potential for reducing the CFs of meals served in nursing homes while promoting adherence to a planetary diet, presenting an opportunity to set new standards in caregiving and environmental sustainability.


Assuntos
Pegada de Carbono , Assistência de Longa Duração , Casas de Saúde , Valor Nutritivo , Itália , Humanos , Pegada de Carbono/estatística & dados numéricos , Mudança Climática , Dieta Saudável/estatística & dados numéricos , Estações do Ano , Método de Monte Carlo , Serviços de Alimentação/normas
9.
Healthc Policy ; 19(4): 32-41, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39229661

RESUMO

This study assesses the quality of work life for Nova Scotian continuing care assistants (CCAs) (n = 266), nurses (n = 144) and managers (n = 45) from 10 long-term care (LTC) homes in late 2021. CCAs scored significantly worse than nurses and managers on measures of mental health and anxiety. All groups reported high levels of cynicism and emotional exhaustion; CCAs' scores were higher than nurses or managers. CCAs scored significantly higher on professional efficacy than other groups. CCAs can derive a strong sense of accomplishment from their work, but results raise concerns of a potential breaking point. This suggests the need for continued action to support LTC staff.


Assuntos
Assistência de Longa Duração , Humanos , Nova Escócia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Saúde Mental , Qualidade de Vida , Inquéritos e Questionários , Pessoal de Saúde/psicologia , Satisfação no Emprego , Assistentes de Enfermagem/psicologia
10.
BMC Geriatr ; 24(1): 726, 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39223462

RESUMO

BACKGROUND: Falls are the leading cause of injuries in older adults. Environmental objects (such as furniture, walls, and handrails) may act as hazards or facilitators to balance maintenance and safe landing. There is lack of objective evidence on how older adults interact with objects during falls. We addressed this gap by characterizing body part contacts with objects other than the floor during real-life falls in long-term care. METHODS: We analyzed videos of 1759 falls experienced by 584 residents to characterize the prevalence of contacts with objects before, during, and after fall initiation. Using generalized estimating equations, we compared the prevalence of falls with versus without contact to objects after fall initiation. Using linear mixed models, we tested for differences across body parts in the probability of contacting objects after fall initiation. RESULTS: In nearly one-third of falls, interactions with objects (e.g., trips over objects, loss of support with objects) or with other people (e.g., being pushed by another person) had a primary role in causing imbalance and initiating the fall. After fall initiation, participants contacted objects in 60% of falls, with intentional hand contacts to objects via reach-to-grasp or bracing being the most common type of interaction (Probability ± SE = 0.32 ± 0.01), followed by unintentional impacts to the torso (0.21 ± 0.01) and head (0.16 ± 0.01). Intentional hand contact to an object was more common during forward than backward falls (p < 0.001), while head and torso contacts to objects were more common during backward and sideways falls than forward falls (multiple p values ≤ 0.003). The hand most often contacted chairs, wheelchairs or couches, followed by tables or counters, walls, other people, walkers, and handrails. The head, torso, and shoulder most often contacted a wall. CONCLUSIONS: Most falls in long-term care involved contacts with objects other than the ground, indicating that complex environments often accompany falls in long-term care. Higher probabilities of intentional hand contacts in forward falls, versus unintentional head and torso impacts in backward and sideways falls may reflect the influence of being able to visualize and adjust one's falling patterns to nearby objects.


Assuntos
Acidentes por Quedas , Assistência de Longa Duração , Gravação em Vídeo , Humanos , Acidentes por Quedas/prevenção & controle , Masculino , Feminino , Idoso , Assistência de Longa Duração/métodos , Idoso de 80 Anos ou mais
11.
BMC Geriatr ; 24(1): 727, 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39223513

RESUMO

BACKGROUND: During the COVID-19 pandemic, patients with Alzheimer's disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes. METHODS: Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January-December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths - due to COVID and non-COVID causes - and changes in care use in the beneficiary's state of residence. RESULTS: Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49). CONCLUSIONS: Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.


Assuntos
COVID-19 , Demência , Telemedicina , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Idoso , Estados Unidos/epidemiologia , Feminino , Masculino , Telemedicina/tendências , Demência/epidemiologia , Demência/mortalidade , Demência/terapia , Idoso de 80 Anos ou mais , Medicare/tendências , Visita a Consultório Médico/tendências , Visita a Consultório Médico/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Assistência de Longa Duração/tendências , Assistência de Longa Duração/estatística & dados numéricos
13.
BMJ Open ; 14(8): e089939, 2024 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-39174072

RESUMO

INTRODUCTION: First language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting in multiple communication interactions where language poses a barrier. Although there are a myriad of cultural-language translation apps and devices available, there is a gap in both research and practice on the acceptability and feasibility of these digital resources within the context of long-term care and community settings for older immigrant adults, from a cultural relevance and digital health equity perspective. Our paper outlines a scoping review protocol to examine the state of the literature on the extent to which cultural-language translation apps are used in long-term care settings and community-based elder care. We will also examine the extent to which such apps bridge or further gaps in equitable, accessible and acceptable care for older immigrant adults with limited English language proficiency. METHODS AND ANALYSIS: This scoping review protocol will employ an adapted five-stage framework outlined by Arksey and O'Malley guided by enhancements recommended by Levac et al and Colquhoun et al. Using the Joanna Briggs Institute's population, concept and context framework, we defined the scope of the scoping review by identifying the target population, concepts for investigation and the context within which the research is situated. We will conduct a search of the literature from 2005 to 2024 using five bibliographic databases from health sciences (Healthstar OVID, MEDLINE OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO), engineering (Engineering Village Elsevier) and a cross-disciplinary database (Web of Science Clarivate). The research team will adopt a critical, equity-focused approach for the scoping review by integrating Richardson et al's framework for Digital Health Equity into our analysis of the findings. This will ensure that health and social equity perspectives are integrated within our methodology and analytical lens. Our analysis will specifically examine selected studies for their engagement with health equity and their ability to address issues such as ageism, ableism and the digital divide within geriatric care. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review as it involves secondary analysis of published works and no primary data collection involving human subjects. Findings of the review will be shared with community partners and disseminated through publications, conferences and peer-reviewed publications.


Assuntos
Emigrantes e Imigrantes , Assistência de Longa Duração , Aplicativos Móveis , Humanos , Idoso , Projetos de Pesquisa , Literatura de Revisão como Assunto , Barreiras de Comunicação
14.
Healthc Manage Forum ; 37(1_suppl): 62S-67S, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39194281

RESUMO

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.


Assuntos
Currículo , Assistência de Longa Duração , Profissionais de Enfermagem , Atenção Primária à Saúde , Profissionais de Enfermagem/educação , Humanos , Desenvolvimento de Programas , Competência Clínica
15.
BMC Public Health ; 24(1): 2104, 2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39103811

RESUMO

The Medicaid Aging Waiver program (MAW) subsidizes the cost of long-term care (LTC) at home or in communities to satisfy older people's increasing desire to age in place. The MAW program might be health improving for older people by allowing them to age at home. However, less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. I use policy expenditure across states over time linked with detailed health information from the Health and Retirement Study (HRS) to identify the associated effects of MAWs on health outcomes of older adults who are at risk of needing LTC and who are resources constrained to be potentially eligible for Medicaid. Overall, the findings suggest that the MAW program is beneficial to health: a $1,000 increase in MAW spending for each older person results is associated with a 1.4 percent improvement in self-reported health status, a 1.5 percent reduction in functional mobility limitations, a 1.6 percent decrease in Instrumental Activities of Daily Living (IADL) limitations, and a 1.7 percent improvement in negative psychological feelings. For older people who are most likely not eligible for MAWs, such as those who are wealthy or in good health and do not require LTC, these health-improving effects have not been observed.


Assuntos
Vida Independente , Assistência de Longa Duração , Medicaid , Humanos , Estados Unidos , Idoso , Masculino , Feminino , Assistência de Longa Duração/economia , Idoso de 80 Anos ou mais , Nível de Saúde , Serviços de Assistência Domiciliar/economia , Atividades Cotidianas
16.
BMC Health Serv Res ; 24(1): 901, 2024 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-39113065

RESUMO

BACKGROUND: The COVID-19 pandemic wreaked havoc on long-term care facilities (LTCFs). Some LTCFs performed better than others at slowing COVID-19 transmission. Emerging literature has mostly described infection prevention and control strategies implemented by LTCFs during the pandemic. However, there is a need for a comprehensive review of factors that influenced the performance of LTCFs in containing COVID-19 spread to inform public health policy. OBJECTIVE: To build on the existing literature, we conducted a scoping review of factors that influenced LTCF performance during the COVID-19 pandemic using a multidimensional conceptual framework of performance. METHODS: We followed the Joanna Briggs Institute's methodology for scoping reviews. We queried CINAHL, MEDLINE (Ovid), CAIRN, Science Direct, Scopus, and Web of Science for peer-reviewed literature in English or French published between January 1st, 2020 and December 31st, 2021. Retrieved records were screened for context (COVID-19 pandemic), population (LTCFs), interest (internal and external factors that influenced LTCF performance), and outcomes (dimensions of performance: equity, accessibility, reactivity, safety, continuity, efficacy, viability, efficiency). Descriptive characteristics of included articles were summarized. Dimensions of performance as well as internal (e.g., facility characteristics) and external (e.g., visitors) factors identified to have influenced LTCF performance were presented. RESULTS: We retained 140 articles of which 68% were classified as research articles, 47% originated in North America, and most covered a period between March and July 2020. The most frequent dimensions of performance were "efficacy" (75.7%) and "safety" (75.7%). The most common internal factors were "organizational context" (72.9%) and "human resources" (62.1%), and the most common external factors were "visitors" (27.1%) and "public health guidelines" (25.7%). CONCLUSIONS: Our review contributes to a global interest in understanding the impact of the COVID-19 pandemic on vulnerable populations residing and working in LTCFs. Though a myriad of factors were reported, a lack of randomized controlled trials makes it impossible to establish causality between the identified factors and LTCF performance. The use of a multidimensional framework can be recommended to evaluate healthcare system performance not merely in terms of efficacy and safety, but alongside other critical dimensions such as efficiency and equity. TRIAL REGISTRATION: Research Registry ID: researchregistry7026.


Assuntos
COVID-19 , Assistência de Longa Duração , COVID-19/prevenção & controle , COVID-19/epidemiologia , Humanos , SARS-CoV-2 , Pandemias/prevenção & controle , Controle de Infecções/métodos , Controle de Infecções/organização & administração
17.
Med Anthropol ; 43(6): 482-494, 2024 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-39145723

RESUMO

This ethnographic exploration of death in the Peruvian context draws on fieldwork among abandoned-both by their families and the state-older adults in a shelter for the homeless in Lima, Peru. I examine the conditions and local forces that shape the ways people at this institution socially and physically die. My argument is that people in this long-term care facility who have lived entire lives on the margins, usually, end up having irrelevant deaths to their families, other residents of the institution, and the Peruvian state. At this shelter, dying in an irrelevant way means dying without companionship from family members and receiving poor and flawed care from the institution that shelters them.


Assuntos
Antropologia Médica , Humanos , Peru/etnologia , Feminino , Idoso , Masculino , Pessoas Mal Alojadas , Populações Vulneráveis , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Assistência de Longa Duração , Instituição de Longa Permanência para Idosos
18.
Res Social Adm Pharm ; 20(11): 1064-1069, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39187425

RESUMO

BACKGROUND: The impact of Home Medicines Reviews (HMRs) on long-term health outcomes among individuals receiving long-term in-home aged care services is unknown. OBJECTIVES: To examine associations between HMR provision and hospitalization, long-term care facility (LTCF) entry and mortality among older people receiving long-term in-home aged care services. METHODS: This retrospective cohort study included individuals aged 65-105 years from three Australian states who accessed in-home aged care services between 2013 and 2017. Using propensity score matching, HMR recipients (n = 1530) were matched to individuals who did not receive an HMR (n = 1530). Associations between HMR provision and outcomes were estimated using multivariable regression models. RESULTS: Over a median of 414 days (interquartile range 217-650) of follow-up, HMR provision was not associated with hospitalizations for unplanned events (subdistribution hazard ratio (sHR) 1.04, 95%CI 0.96-1.14), falls-related hospitalizations (sHR 0.97, 95%CI 0.83-1.13), LTCF entry (sHR 0.97, 95%CI 0.83-1.13), or all-cause mortality (adjusted HR 0.86, 95%CI 0.72-1.01). CONCLUSIONS: In a cohort of older people receiving long-term in-home aged care services, no differences in unplanned hospitalizations, falls, LTCF entry or mortality were observed those with HMRs compared to those that did not receive an HMR.


Assuntos
Serviços de Assistência Domiciliar , Hospitalização , Assistência de Longa Duração , Humanos , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais , Hospitalização/estatística & dados numéricos , Austrália , Estudos Retrospectivos
19.
Int J Nurs Stud ; 158: 104862, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39098084

RESUMO

BACKGROUND: In home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types. METHODS: A retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan-Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management. RESULTS: Of the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively (p = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services (p < .05), and 4.0 % and 8.2 % using community-based day care services (p < .05), respectively. CONCLUSIONS: Advanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.


Assuntos
Serviços de Assistência Domiciliar , Assistência de Longa Duração , Humanos , Estudos Retrospectivos , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais , Japão , Pontuação de Propensão
20.
Artigo em Inglês | MEDLINE | ID: mdl-39101529

RESUMO

BACKGROUND: Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs. METHODS: This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged≥65 years in 2010 over an 8-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A 2-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit. RESULTS: The mean age of the 8 429 participants was 73.7 years (standard deviation [SD] = 6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4 877.0 (SD = 19 082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were -USD 1 089.9 (95% CI = -1 888.5 to -291.2) for dental preventive visits, -USD 806.7 (95% CI = -1 647.4 to 34.0) for treatment visits, and -USD 980.6 (95% CI = -1 835.7 to -125.5) for preventive or treatment visits. CONCLUSIONS: Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce LTCI costs.


Assuntos
Seguro de Assistência de Longo Prazo , Assistência de Longa Duração , Humanos , Masculino , Idoso , Feminino , Japão , Assistência de Longa Duração/economia , Seguro de Assistência de Longo Prazo/economia , Estudos de Coortes , Saúde Bucal/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Assistência Odontológica para Idosos/economia , Assistência Odontológica para Idosos/estatística & dados numéricos , Idoso de 80 Anos ou mais , Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , População do Leste Asiático
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA