Perception of domestic risks among carers for dependent older persons.

BACKGROUND: Despite growing interest for home care, little evidence exists on the perception of domestic risk among carers for dependent older persons. This study aims to characterize the risks to which carers of aging dependent individuals are exposed, and to determine whether these risk dimensions are predictive for effective support, for burden, and for psychological distress. METHODS: Seventy care partners were questioned about the risk situations identified at the homes of the old people they care for, about the burden they felt in their role, and about their feelings of psychological distress. Securing was evaluated by means of sensibility measures, and overprotection was evaluated by means of specificity measures. RESULTS: Risk rates were high for loneliness of the old people, wandering, burns, and unsatisfactory health monitoring. There was very little overlap between identification of the risks and implementation of solutions by the caregiver, except for the risks that involved heat. The distinction between accurate securing and overprotection is especially important, because the burden of care partners was linked to uncontrolled domestic risks. CONCLUSION: Typologies of reactions to risk, characterized by a signal detection approach, could contribute to a better understanding of the situations experienced by care partners, especially situations of neglect and of overprotection.

Exercise Interventions With Trained Home Helpers for Preventing Loss of Autonomy and Falls in Community-Dwelling Older Adults Receiving Home Heath Physical Therapy T4H: A Randomized Controlled Pilot Study.

BACKGROUND AND PURPOSE: Older adults at risk for falls live independently in the community in their own home and have rehabilitation needs. However, little is known about whether home coaching of older adults can decrease falls at home. We sought to determine whether a novel program for preventing falls and a loss of exercise capacity, the T4H program, in which home helpers act as exercise coaches by using an information technology (IT) device, was acceptable and feasible. METHODS: Between February 2015 and October 2015, we performed a cluster randomized controlled trial in which home helpers either assisted older adults 75 years and over, to participate in the T4H program, or provided standard home help over 3 months. We assessed levels of acceptability and satisfaction among the older adults and home helpers with regard to the exercise program and the technologies used. To measure efficacy, the main outcome measures for the older adults were the absence of falls requiring medical or paramedical care, unplanned hospitalizations, walking ability in a Timed Up and Go test (TUG), and self-care ability by the Barthel Index at the 3-month follow-up visit. RESULTS AND DISCUSSION: Overall, 35 older adults were included, aged 89 years and with 68.6% women. Eighty-five percent of the respondents were pleased or very pleased to have participated in the T4H exercise program, 70% were satisfied with the IT devices, and 92% were satisfied with their home helper's level of involvement. Two of the 4 home helper respondents were satisfied or very satisfied with the exercise program, and 2 were moderately satisfied. The proportions of older adult participants with no falls or no unplanned hospitalizations were higher in the T4H group (92.3% and 85.7%, respectively) than in the control group (81.8% and 71.4%, respectively), although these intergroup differences were not statistically significant. The T4H and control groups did not differ significantly with regard to the TUG time (median [IQR]: 27.6 seconds [17.9-58.6] vs 30.7 seconds [19.7-57.2], respectively) or the Barthel Index (median [IQR]: 90 [75-95] and 90 [75-95], respectively). CONCLUSIONS: The novel T4H home help model was feasible and was associated with a high level of participant satisfaction. We observed a trend toward fewer falls and hospitalizations and better quality of life in the older adults.

Vocally disruptive behaviors management in older people with dementia.

Although shouting is a common psycho-behavioral symptom in geriatric institutions, the question of its assessment and treatment remains seldom studied and has rarely been the subject of specific recommendations. The combination of the focus group method and brainstorming has emerged as a methodology both relevant and feasible in geriatric facility to identify the coping strategies used by professionals and generalize guidelines for clinical observation and vocally disruptive behaviors management (shouting). The standardized gathering of professional experiences in nursing homes and their analysis with reference to results of the literature enabled the development of an analytical and clinical decision making diagram that can be an operational tool to cope with the occurrence of shouting in older people with dementia. Five types of triggers/aggravating shoutings emerged: 1) physical or moral pain and emotional reactions, 2) presence of sensory loss, 3) social isolation, under-stimulation or hyper sensitivity to stimulation and care, 4) reminiscences and 5) re-emergence of painful memories and loss of language skills. These factors have been associated with five methods of intervention : 1) pharmacological treatments, 2) animations, such as listening to music, physical activity and workshops using therapeutic mediation, 3) family or animal support and use of interventions to provide relaxation or stimulation, 4) interventions to deal with sensory deficits and 5) interventions modifying the environment.

Make a gesture and I will tell you what you are miming. Pantomime recognition in healthy subjects.

The present paper deals with the question of how people recognize tool-use/transitive actions performed by others. The direct-matching hypothesis assumes that transitive gestures produced by others are recognized by directly activating the same gesture engrams used for making the gesture oneself. By contrast, the context hypothesis posits that the observation of the gesture alone is not sufficient, and that additional contextual information is necessary for recognizing the action. The aim of the present paper is to decide between these two hypotheses. To achieve this purpose, we asked healthy older adults (performers) to mime the use of tools (Experiment 1a). Performance was videotaped and presented to healthy younger adults (observers) in two conditions: (1) Naming the tool associated with the gesture made by the performer (naming condition); (2) Choosing the correct name from 10 alternatives (choice condition). Our results indicated that the performance in the naming condition was relatively poor, emphasizing that people are far from perfect at recognizing pantomimes without contextual information. We also found a great variability among observers, suggesting that the same gesture could evoke different tool-use actions. The performance was better in the choice condition. So, observers benefited from the introduction of tool names. This pattern of results could also be explained by a sequence effect, a lexical-decision effect or an item-selection effect. Experiments 1b and 2 ruled out these possibilities. In short, these points make it difficult to believe that people recognize the actions performed by others by directly activating gesture engrams. Our findings are more consistent with the context hypothesis.