A protocol for stakeholder engagement in deliver-EE: A pragmatic randomized comparative effectiveness trial evaluating effects of meal delivery on the ability of homebound older adults to remain in the community.

BACKGROUND: Few clinical trials include a detailed protocol for stakeholder engagement in the design and execution of the clinical trial. Deliver-EE is a pragmatic clinical trial to assess how different types of home-delivered meals can affect older adults' health and well-being. We present the protocol for stakeholder engagement in this national, multi-site trial and initial findings from our efforts. METHODS: Twenty-nine participants were recruited to two stakeholder advisory panels. The "Lived Experience Perspectives" panel is defined as the clients, caregivers, and meal delivery drivers with first-hand knowledge and lived experiences with meal delivery. The "System Perspectives" panel is defined as representatives from the larger financial, clinical, regulatory, and operational environments in which meal delivery to homebound older adults operate. Together, these two groups holistically represent interested parties that coordinate the interdependent elements of meal delivery to homebound older adults in order to: 1) inform our understanding of what matters most to older adults, their families, and the larger health and social care systems; 2) provide strategies to overcome challenges conducting the study; 3) enhance dissemination and uptake of study findings; and 4) identify opportunities for future research. RESULTS: Although stakeholder partners share a common goal of using home-delivered meals as a method to improve outcomes for homebound older adults, individuals have different goals for participating as advisors in this research. CONCLUSIONS: Understanding what individual stakeholders hope to gain from their participation is critical in designing an effective engagement protocol and critical for meaningful and rigorous stakeholder engagement in clinical trials.

Professional Care in Home for Children and Teenagers with Special Health Needs: An Integrative Review / Assistência profissional no cuidado domiciliar de crianças e adolescentes com necessidades especiais de saúde: revisão integrativa / Atención profesional en atención domiciliaria para niños y adolescentes con necesidades especiales de salud: una revisión integradora

Objective: Analyzing the results of scientific publications on professional home care for children and teenagers with special health needs. Materials and method: An integrative review with articles published between 2009 and 2020 conducted in the BDEnf, Lilacs, Medline/PubMed databases and in the SciELO electronic library. The data were analyzed in four stages: data reduction; display of the data; comparison of data; drawing and verification of completion. Results: There were identified 5,641 articles; after the application of the inclusion and exclusion criteria and disposal of duplicates, 637 articles were chosen for the reading of titles and abstracts, of which 61 were selected for full reading and of these, 28 composed the final sample. The offer of remote support actions and concern in training caregivers regarding the technical-scientific aspects of home care was identified, in addition to promoting the improvement of the quality of life of children/teenagers and their families. A gap was evidenced regarding the identification and management of pain by home service professionals. Conclusions: The performance of home services to this specific population focuses on the demands of care with health technologies and on promoting symptom relief, reducing the workload of caregivers and assisting in dehospitalization.

Objetivo: analisar os resultados de publicações científicas acerca da assistência domiciliar profissional às crianças e adolescentes com necessidades especiais de saúde. Materiais e método: revisão integrativa, com artigos publicados entre 2009 e 2020, realizada nas bases de dados BDEnf, Lilacs, Medline/PubMed e na biblioteca eletrônica SciELO. Os dados foram analisados em quatro etapas: redução dos dados; exibição dos dados; comparação dos dados; desenho e verificação da conclusão. Resultados: foram identificados 5 641 artigos; após a aplicação dos critérios de inclusão e exclusão e descarte das duplicatas, foram eleitos 637 artigos para a leitura de títulos e resumos, dos quais 61 foram selecionados para a leitura na íntegra e destes, 28 compuseram a amostra final. Identificaram-se oferta de ações de suporte remoto e preocupação em capacitar os cuidadores quanto aos aspectos técnico-científicos do cuidado no domicílio, além da promoção da melhora da qualidade de vida das crianças/adolescentes e seus familiares. Evidenciou-se lacuna com relação à identificação e ao manejo da dor pelos profissionais dos serviços domiciliares. Conclusões: a atuação dos serviços domiciliares a essa população específica tem foco nas demandas de cuidados com as tecnologias em saúde e na promoção de alívio dos sintomas, diminuindo a carga de trabalho dos cuidadores e auxiliando na desospitalização.

Objetivo: Analizar los resultados de publicaciones científicas acerca de la atención domiciliar profesional a niños y adolescentes con necesidades especiales de salud. Materiales y método: Una revisión integradora con artículos publicados entre 2009 y 2020 realizada en las bases de datos BDEnf, Lilacs, Medline/PubMed y en la biblioteca electrónica SciELO. Se analizaron los datos en cuatro etapas: reducción de los datos; presentación de los datos; comparación de los datos; diseño y verificación de la conclusión. Resultados: Se identificaron 5 641 artículos; luego de la aplicación de los criterios de inclusión y exclusión y descarte de los duplicados, se seleccionaron 637 artículos para la lectura de títulos y resúmenes, de los que 61 se seleccionaron para la lectura integral y de estos 28 compusieron la muestra final. Se identificaron la oferta de acciones de soporte remoto y la preocupación en capacitar los cuidadores en cuanto a los aspectos técnico-científicos del cuidado en el domicilio, además de la promoción de la mejoría de la calidad de vida de niños/adolescentes y sus familiares. Se evidenció la laguna en relación con la identificación y el manejo del dolor por los profesionales de los servicios domiciliares. Conclusiones: La actuación de los servicios domiciliares a esta población específica enfoca en las demandas de cuidados con las tecnologías en salud y promoción de alivio de los síntomas, disminuyendo la carga de trabajo de los cuidadores y auxiliando en la deshospitalización.

Effects of a Video-Based mHealth Program for Homebound Older Adults: Study Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Although homebound older adults are among the highest users of hospital services, the existing health and social services that are provided to them in the community are limited and fragmented. This study attempts to bring this group of older adults to providers' attention by designing a health-social-oriented self-care mobile Health (mHealth) program and subjecting it to empirical testing. The aim of this study is to shift the current reactive, cure-oriented approach to a preventive and health-promoting model, empowering homebound older adults to take an active role in their health, be responsive to their care needs, and subsequently improve their holistic health. METHODS: This is a pilot randomized controlled trial. The study is supported by 5 community centers with an estimated sample size of 68 subjects. The subjects will be randomly assigned to video-based mHealth or control groups when they (1) are aged 60 or over, (2) go outdoors less than once a week in the current 6 months, (3) live within the service areas, and (4) use a smartphone. Subjects in the video-based mHealth group will receive a 3-month program comprising 2 main interventions: nurse case management supported by a social service team and video messages covering self-care topics, delivered via smartphone. The control group will receive usual care. Data will be collected at 2 time points - pre-intervention (T1) and post-intervention (T2). The primary outcome will be self-efficacy, and secondary outcomes will include health outcomes (activities of daily living, instrumental activities of daily living, and medication adherence), perceived well-being outcomes (quality of life and depression), and health service utilization outcomes (outpatient clinic, emergency room, and hospital admission). DISCUSSION: The current study will add to the knowledge gap in using mHealth supported by a health-social team to enhance quality of life and self-care and meet the needs of these particularly vulnerable older adults.

Translation and cross-cultural adaptation of the NutriQoL® questionnaire to the Portuguese language: Brazilian version / Tradução e adaptação do questionário NutriQoL® para a língua portuguesa: versão Brasileira

ABSTRACT Objective The objective of this study was to translate and cross-culturally adapt the NutriQoL® into Brazilian Portuguese. Methods The NutriQoL® comprises 17 questions that evaluate the quality of life of patients receiving home enteral nutrition therapy. The methodological procedures included the translation from the Spanish version into Portuguese by two translators, synthesis of the translations, back translation, evaluation by a committee of judges composed of 24 individuals in which a content validity index > 0.78 was considered acceptable, and generation of the pre-final version. A pre-test to analyze its semantic equivalence was administered to 12 patients receiving home enteral nutrition therapy. The final version of the questionnaire was then prepared. Results A summary version of the questionnaire was obtained using two versions of the translation. Both back translations were identical for 73.6% of sentences (n=25). Twenty-four volunteers were included in the committee of judges. The content validity index was 0.88±0.11, and 14.7% (n=5) of questions had a low content validity index and were thus reformulated. In the pre-test, 35.3% (n=12) of items obtained low levels of understanding and required adjustment. In the preparation of the final version, the inconsistencies of the items mentioned were corrected and/or adjusted. Conclusion After completing the methodological procedures, a Brazilian Portuguese version of the NutriQoL® questionnaire was obtained. Following the validation process, it can be used by dieticians and other health professionals to assess the quality of life of patients receiving home enteral nutrition therapy to contribute to improvements in care practices.

RESUMO Objetivo O intuito deste estudo foi realizar a tradução do NutriQoL para a língua portuguesa e a adaptação transcultural para o Brasil. Métodos O NutriQoL® é composto de 17 pares de perguntas que avaliam a qualidade de vida de pacientes em terapia nutricional enteral domiciliar. Os procedimentos metodológicos foram: tradução da versão em espanhol para a língua portuguesa por dois tradutores; síntese das traduções; retrotradução; avaliação, da versão traduzida, por um comitê de juízes composto por 24 indivíduos, na qual o índice de validade de conteúdo > 0,78 foi considerado, gerando a versão pré-final e realização de um pré-teste no qual a versão pré-final do questionário foi aplicada a 12 pacientes em uso de terapia nutricional enteral domiciliar para análise da equivalência semântica e elaboração da versão final do questionário. Resultados Observou-se que, a partir das duas versões traduzidas, foi possível obter uma versão síntese do questionário. As duas retrotraduções geradas foram idênticas em 73,6% das sentenças (n=25). O índice de validade de conteúdo foi 0,88 ± 0,11, e 14,7% (n=5) das questões tiveram baixo índice de validade de conteúdo, sendo então reformuladas. No pré-teste foi observado que 35,3% (n=12) dos itens obtiveram baixos índices de compreensão e necessitaram de ser reformulados. Na elaboração da versão final do questionário as inconsistências dos itens mencionados foram sanadas e/ou adaptadas. Conclusão Após conclusão dos procedimentos metodológicos, foi possível obter a versão brasileira do questionário NutriQoL® em língua portuguesa para que, após processo de validação, o instrumento seja utilizado pelo nutricionista ou demais profissionais de saúde para avaliação da qualidade de vida de pacientes em uso de terapia nutricional enteral domiciliar, a fim de contribuir com melhorias nas práticas assistenciais.

Can community pharmacy successfully bridge the gap in care for housebound patients?

BACKGROUND: There are an increasing number of older housebound patients who are not seen by the pharmacists responsible for the provision of their medications. This growing population is increasingly dependent on time-limited carers for their medication support. OBJECTIVES: To evaluate the findings of pharmacist led holistic domiciliary medicine use reviews (dMUR) targeted at this group of housebound patients, in terms of required medication support and the identification of unmet social care needs. METHODS: Patients were identified in the London Borough of Richmond (UK) who were predominantly housebound and taking multiple medications. Twelve community pharmacists visited patients and carried out interviews as part of a structured holistic dMUR, which included understanding the patients' living conditions. RESULTS: Altogether 133 patients completed the dMUR with the pharmacist. Patients had a mean age of 81.7 years (range 49-98 years) and took an average of 9.4 different medications, 3 of which being high risk. Nearly 40% had difficulties taking their medications, including a lack of dexterity or difficulty swallowing. Over a quarter (26.8%) of diabetic patients lacked monitoring. Patients were identified with a risk of falling (14.3%) and inadequate social care (11.3%). Continence, dehydration, hygiene and nutrition issues were found, often caused by mobility problems or a lack of suitable toilet facilities. A need for home modifications such as hand rails to prevent falls was also identified. CONCLUSIONS: This study highlighted the varied difficulties facing housebound patients identified during the pharmacists' visits, including a lack of social care provision and fall hazards. Domiciliary visits by pharmacists may be able to help identify the diverse care needs of isolated housebound patients helping to integrate their care requirements.

A cosmopolítica da gestação, do parto e do pós-parto: autoatenção e medicalização entre os índios Munduruku / The cosmopolitics of pregnancy, childbirth and postpartum: self-attention and medicalization among Munduruku Indians

A pesquisadora Raquel Paiva Dias-Scopel, do Instituto Leônidas e Maria Deane (ILMD/Fiocruz Amazônia), levanta questões sobre a valorização e respeito à diversidade étnica e cultural dos povos indígenas e a difícil interface com o processos de medicalização e do direito ao acesso aos serviços de saúde biomédicos. O livro é parte da Coleção Saúde dos Povos Indígenas, da Editora Fiocruz e partiu da tese de doutorado defendida em 2014 no Programa de Pós-Graduação em Antropologia Social da Universidade Federal de Santa Catarina (UFSC). Foi publicado pela primeira vez em 2015 pela Associação Brasileira de Antropologia com o título A Cosmopolítica da Gestação, Parto e Pós-Parto: práticas de autoatenção e processo de medicalização entre os índios Munduruku. No prefácio da primeira edição, sua orientadora, a doutora em antropologia e professora titular da UFSC, Esther Jean Langdon, ressalta que o conceito fundamental deste livro é da autoatenção, que aponta para o reconhecimento da autonomia e da criatividade da coletividade, principalmente da família, como núcleo que articula os diferentes modelos de atenção ou cuidado da saúde.

Visita domiciliar como ferramenta de promoção da saúde do pé diabético amputado / Home visit as a tool for promoting the health the diabetic with an amputated foot

Objetivo: descrever a experiência da visita domiciliar diária para a troca de curativo em amputação dequatro pododáctilos decorrente de complicações de pé diabético, indicando êxitos e limitações. Método:estudo qualitativo, descritivo, tipo relato de experiência. As observações e dados produzidos foramsistematizados e analisados a partir da literatura consultada na Lilacs e Scielo. Participaram da experiência,com a usuária e sua família, uma docente enfermeira e acadêmicos do curso de Enfermagem. Resultados: avisita domiciliar realizada diariamente, de segunda a sexta-feira, contribuiu para a redução da feridatraumática sob o uso de papaína a 5% em um período de dois meses, além do estabelecimento de vínculo efortalecimento das informações em educação em saúde. Conclusão: a experiência do vínculo diário e daassistência de Enfermagem holística a uma paciente em situação de vulnerabilidade foi enriquecedora paraacadêmicos que, muito mais que aprimorar técnicas e consolidar conhecimentos, aprenderam sobre o sersocial indispensável que é o enfermeiro.

It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada.

The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.

Effectiveness of Pelvic Floor Muscle Training for Urinary Incontinence: Comparison Within and Between Nonhomebound and Homebound Older Adults.

PURPOSE: To compare the effectiveness of a biofeedback-taught pelvic floor muscle training (PFMT) intervention in reducing urinary incontinence (UI) and improving general health-related and UI-specific quality of life in homebound and nonhomebound older adults. We also compared adherence rates to the prescribed PFM exercises and strategies (urge and/or stress) in the 2 groups of subjects. DESIGN: Secondary data analysis of initial 6-week PFMT intervention data from a randomized controlled trial designed to examine the efficacy of a relapse prevention intervention in sustaining improvements in UI following PFMT. SUBJECTS AND SETTING: The sample comprised 93 homebound and 185 nonhomebound community-dwelling men and women 60 years and older with urge, stress, or mixed UI at least twice a week for a minimum of 3 months. METHODS: The intervention consisted of 6 weekly in-home visits during which biofeedback via transcutaneous electromyographic patches was used to teach subjects pelvic floor muscle exercises and, as indicated, stress and/or urge suppression strategies to prevent involuntary urine loss. Incontinence severity was measured by a 1-week bladder diary at baseline and at the end of the 6-week intervention. Health-related quality of life was measured at baseline and postintervention using the Medical Outcomes Study Short Form-36 (MOS SF-36) (general health-related quality of life), and the Modified Incontinence Impact Questionnaire (MIIQ). Self-reported adherence data were collected at each intervention visit. RESULTS: At baseline, homebound subjects had significantly more severe UI, more comorbid conditions, and higher levels of functional impairment than nonhomebound subjects. Following the intervention, there was a significant reduction in the number of incontinent episodes in both homebound and nonhomebound subjects, with no significant group differences (P = .25) in the median percent reduction in UI (64.5% in homebound vs 70.4% in nonhomebound subjects). UI-specific quality of life (MIIQ total scores) improved significantly in both groups without any significant between-group differences (P = .83). There were no significant changes in health-related quality of life in either group. Pelvic floor muscle adherence rates were higher than adherence rates to strategies in both groups, with no significant group differences. CONCLUSIONS: The biofeedback-guided PFMT intervention was equally effective in reducing UI and improving UI-specific quality of life in homebound and nonhomebound community-dwelling older adults.

Sistematização da assistência de enfermagem: da teoria ao cuidado integral / Nursing care systematization: from theory to a comprehensive care / Sistematización de la asistencia de enfermería: de la teoría al cuidado integral

Objetivo: relatar a assistência de enfermagem a pacientes acamados, moradores do território adscrito a um Centro de Saúde da Família, aplicando o processo de enfermagem de acordo com a Teoria da Diversidade e Universalidade do Cuidado Cultural de Madeleine Leininger. Método: estudo descritivo, tipo relato de experiência, com cinco acamados, entre 22 e 92 anos de idade, no município de Chapecó-SC. Resultados: foram identificadas situações que requeriam manutenção, ajustamento ou repadronização de cuidados culturalmente definidos. O apoio da equipe foi fundamental na implementação da assistência domiciliar, que passou a ser registrada no prontuário eletrônico dos pacientes, favorecendo continuidade e integralidade do cuidado. Conclusão: a Sistematização da Assistência de Enfermagem apoiada na teoria do cuidado transcultural proporcionou melhorias à saúde do acamado e da sua família, motivando a adesão dos cuidadores ao plano de cuidados.(AU)

Objective: to report the nursing care for bedridden patients, residents of the territory ascribed to a Family Health Center by applying the process of nursing according to the Diversity Theory of Cultural Care Universality of Madeleine Leininger. Method: a descriptive study type experience report, with five patients bedridden, between 22 to 92 years old, in Chapecó-SC. Results: situations were identified that required maintenance, adjustment or re-patterning of culturally defined care. The support team was instrumental in the implementation of home care, which is now recorded in the electronic medical records of patients, favoring continuity and comprehensive care. Conclusion: the systematization of nursing care supported in transcultural care theory provided improvements to the health of bedridden patients and the family, motivating the adherence of caregivers to the care plan.(AU)

Objetivo: relatar la asistencia de enfermería a pacientes postrados en la cama, residentes de un territorio adscrito a un Centro de Salud de la Familia aplicando el proceso de enfermería de acuerdo con la Teoría de la Diversidad y Universalidad del Cuidado Cultural de Madeleine Leininger. Método: estudio descriptivo, tipo relato de experiencia, con cinco postrados en cama, entre 22 y 92 años de edad, en el municipio de ChapecóSC. Resultados: fueron identificadas situaciones que requerían mantenimiento, ajuste o re estandarización de cuidados culturalmente definidos. El apoyo del equipo fue fundamental en la implementación de la asistencia domiciliaria, que pasó a ser registrada en el prontuario electrónico de los pacientes, favoreciendo continuidad e integralidad del cuidado. Conclusión: la Sistematización de la Asistencia de Enfermería apoyada en la teoría del cuidado transcultural proporcionó mejorías a la salud del postrado y de su familia, motivando la adhesión de los cuidadores al plano de cuidados.(AU)

Delivery of a Vitamin D Intervention in Homebound Older Adults Using a Meals-on-Wheels Program: A Pilot Study.

OBJECTIVES: To assess the feasibility of a vitamin D intervention delivered through a Meals-on-Wheels (MOW) program to improve 25-hydroxyvitamin D (25(OH)D) concentrations and reduce falls in homebound older adults. DESIGN: Single-blind, cluster randomized trial. SETTING: MOW, Forsyth County, North Carolina. PARTICIPANTS: Community-dwelling homebound adults aged 65 to 102 (N = 68). INTERVENTION: MOW clients were randomized to vitamin D3 (100,000 IU/month; n = 38) or active placebo (400 IU vitamin E/month; n = 30) according to MOW delivery route. MEASUREMENTS: Serum 25(OH)D was assessed at baseline and 5-month follow-up; proportions of participants in 25(OH)D categories were compared using Fisher exact test. Falls were assessed using monthly fall calendars, and rate of falls was estimated using negative binomial generalized estimating equation models. RESULTS: Mean ± standard deviation 25(OH)D concentrations were 20.9 ± 11.5 ng/mL at baseline, with 57% having 25(OH)D concentrations less than 20 ng/mL. Retention and adherence were high (>90%). After the 5-month intervention, only one of 34 participants randomized to vitamin D3 had 25(OH)D concentrations less than 20 ng/mL, compared with 18 of 25 participants randomized to placebo (P < .001). In unadjusted analyses, the rate of falls over 5 months was not significantly different according to intervention group (risk ratio (RR) = 0.48, 95% confidence interval (CI) = 0.19-1.19), but after adjustment for sex, race, season of year, baseline 25(OH)D status, and history of falls, participants randomized to vitamin D3 had a lower rate of falling than those randomized to placebo (RR = 0.42, 95% CI = 0.21-0.87). CONCLUSION: A vitamin D intervention delivered through MOW was feasible, resulting in improvements in 25(OH)D concentrations and a lower rate of falls in adjusted analyses. Further research is needed to validate the reduction in falls from this type of intervention.

Fragilidad, el nuevo paradigma de atención sanitaria a los mayores / Frailty: The new paradigm of health care in the elderly

No disponible

Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study.

OBJECTIVES: To evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting. DESIGN: Randomized controlled trial. SETTING: Hospital-affiliated home healthcare setting. PARTICIPANTS: Medically frail older homebound individuals (N = 102). INTERVENTION: The 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P). MEASUREMENTS: The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits). RESULTS: Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P = .01) but did not have significantly fewer days in the hospital at 12 months after baseline. CONCLUSION: Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.

An evaluation by elderly people living at home of the prepared meals distributed by their municipality - a study with focus on the Swedish context.

Prepared meals distributed by municipalities is a service to elderly people, or persons with health related impairments, who live in their own home, have difficulties preparing their own food and cannot meet their food requirements in any other way. This study aimed to provide a brief picture of how elderly people living at home perceive the food they receive through their municipal food service and what is important to them. The data was collected using questionnaires. 274 out of 276 participants answered the questionnaire (n=173 women 62% and n=101 man 37%). The data was analyzed using Principal Component Analysis (PCA). The results showed that the elderly persons receiving meals through the service were often satisfied, especially with the size of the portions and the delivery time. Those who had been using the food delivery service for a longer time were not satisfied with the alternative dishes they were been offered. There was no significant difference between the views of either gender. Further, those who were receiving special food were, in general, unsatisfied with the meals delivered. Development of the food distribution service by systematic quality insurance and interactive knowledge exchange between the producers and consumers seems to be a way to promote a more holistic and individual adjusted service. Evaluation of the municipal FD service is a powerful tool that can contribute to the development of this service. The food service can be improved and consequently even the quality of life and health of its receivers. The present survey should be revisited and developed in order to detect differences between genders.

Physical limitations in meal preparation and consumption are associated with lower musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes in homebound older adults.

OBJECTIVES: Although homebound older adults are at increased risk for poor nutritional health and adverse nutrition-related outcomes, little attention has focused on the tasks involved in meal preparation and consumption and the influence of those tasks on dietary intake. METHODS: We examined the self-reported dietary intake from 3, 24-h dietary recalls and physical limitations in meal preparation and consumption (LMPC) activities from a randomly recruited sample of 345 homebound older men and women. Ordered logistic regression was used to examine the correlation of demographic characteristics and 6 activities with relative intakes of key musculoskeletal nutrients (calcium, vitamin D, magnesium, and phosphorus). RESULTS: At least 70% reported not meeting ⅔ recommended intakes for calcium and vitamin D; 12.5% failed to achieve ⅔ recommended intakes in at least three of the four nutrients. More than 12% of the sample reported it was very difficult or they were unable to perform at least 3 LMPC tasks. Regression results indicated that reporting the greatest LMPC increased the odds for lower intake of musculoskeletal nutrients. CONCLUSION: Independent of sociodemographic characteristics, self-reported difficulty in meal preparation and consumption was associated with lower dietary intakes of musculoskeletal nutrients. These results suggest the need to assess difficulty in meal preparation and consumption for the growing population of homebound older adults who participate in supplemental nutrition programs. This brief, 6-item measure may help identify older adults at risk of poor nutritional health and declining function.

Meals on Wheels: exploring potential for and barriers to integrating depression intervention for homebound older adults.

The purpose of this study was to explore Meals on Wheels' (MOW) organizational potential for integrating depression screening, referral, and treatment for homebound older adults. In a survey of 164 MOW administrators, MOW's current practice of depression services was examined, and the administrators' perception of MOW's organizational potential was measured focusing on external environment, financial resources, staffing/skills, and values and goals. Only 20 out of 164 MOWs provide depression screening, and 19 provide in-home counseling for their clients, while 86 provide referral services. About 64-72% of MOWs that are not current providers of screening and/or referrals want to provide the services, and 21% of those that are not current providers of in-home counseling want to provide it.

Recuperación funcional tras fractura de cadera en una población anciana, medida con el índice de Barthel / Use of the Barthel Index to measure functional recovery in an elderly population after hip fracture

Objetivo. Analizar el grado de recuperación funcional de una serie de pacientes afectados de una fractura de cadera (FC),a los 6 y 12 meses tras la fractura, usando el índice de Barthel (IB) como instrumento de medida. Material y métodos. Estudio longitudinal prospectivo no intervencionista sobre 246 pacientes mayores de 65 años que acudieron a nuestro centro tras sufrir una FC por un traumatismo de baja energía. Se determinó su edad, sexo, nivel socioeconómico, grado de independencia funcional (IB) tanto previo como a los 6 y 12 meses, y su destino al alta (domicilio, residencia privada o un hospital de crónicos concertado con la consejería) y su mortalidad a los 6 y 12 meses. Resultados. Las mujeres constituyeron el 71,5% de los casos con una edad media de 81 años. El IB medio previo a la FC fue de 77 puntos. El 70% de los pacientes deambulaban antes de la fractura. De éstos, sólo el 48% que sufrió una FC intracapsular y el 39% de los que sufrieron una FC extracapsular volvieron a caminar a la finalización del estudio (12 meses). En 35 pacientes se desestimó el tratamiento quirúrgico por causas médicas o negativa familiar. Conclusiones. Los pacientes con edad extrema, demencia, bajos niveles de formación académica, institucionalizados en centros de crónicos y no operados presentaron peor IB a los 6 y 12 meses. El estado neurológico aceptable, acudir a control en la consulta externa, el cuidado familiar y unos niveles altos de hemoglobina preoperatoria se han relacionado con una mejor la recuperación funcional en estos pacientes (AU)

Purpose. To determine how many patients were able to return to their previous independence status after a hip fracture, using the Barthel Index Scale to measure it. Materials and methods. An observational, prospective longitudinal study of 246 patients over 65 diagnosed with hip fracture. We determined age, sex, type of fracture and treatment, cultural, and economical status, independence level before and after the fracture, and mortality over 12 months. Results. Of the 246 patients studied, 71.5% were women, and the mean age was 81 years. The Barthel Index Scale before the fracture was 77. Seventy per cent of the patients were capable of walking before the fracture, but only 48% with intracapsular, and 39% with extracapsular hip fracture, reached their previous walking capability. Thirty five patients underwent nonsurgical treatment. Conclusions. We found that advanced age, dementia, lower education levels, residence-dependent patients, and those who did not have surgical treatment, had lower levels on the Barthel Index Scale at 6 and 12 months. On the other hand, the absence of neurological diseases, attending follow-up clinics, good family care, and high haemoglobin levels prior to the fracture seemed to lead to a better functional recovery (AU)