ABSTRACT
Taking into account the multiple factors/dimensions that contribute to the concept of quality of life (QoL), a pack of cards (80 cards) was developed and validated in 30 elderly patients, fifteen from the continuing care setting and fifteen from the day hospital. Twenty of the 80 cards contained words or statements indicating positive or negative affect, 20 cards were based on positive or negative life experience and 40 cards dealt with satisfaction or happiness or dissatisfaction or unhappiness relating to areas of personal or family life. The score obtained using the QoL cards correlated significantly (r = -0.96, P < 0.0001) with the score obtained on the delighted-terrible scale and with a result obtained using an analogue scale (r = 0.93, P < 0.0001). Test to retest reliability in 11 patients revealed an 'r' value of 0.99 (P < 0.0001). In addition, high correlations were noted between the total score obtained using the 80 QoL cards and the subscale scores for 'affect', 'life experience' and 'satisfaction/happiness' in the 30 patients studied initially and in the 20 patients studied subsequently.
ABSTRACT
The Functional Autonomy Measurement System (SMAF) is an instrument developed for the measurement of needs of the elderly and the handicapped. As this study shows, it can be used to demonstrate progress during rehabilitation. Of the 94 patients admitted and discharged from a 22 bed acute/rehabilitation ward for the elderly, 78 were discharged home or to their original accommodation, 7 died in hospital and 9 were transferred to a continuing care ward or a nursing home. The mean total score (admission vs. discharge: 18.06 vs. 9.18, P < 0.0001) as well as the score for subsections of Activities of Daily Living (ADL) (admission vs. discharge: 15.69 vs. 8.15, P < 0.0001), Communication (admission vs. discharge: 1.01 vs. 0.5, P < 0.0001) and Mental Function (admission vs. discharge: 1.29 vs. 0.64, P < 0.0001) showed significant improvement in the 78 patients who were discharged back to their original accommodation. Patients who died or required placement into a continuing care bed or nursing home showed no change in mean scores with treatment. The inter-observer agreement between two nurses and a doctor showed that the minor modifications to SMAF did not significantly affect the instrument.
ABSTRACT
Falls occurring in elderly in-patients during periods of hospitalization are common, and attempts have been made to predict and prevent them based on risk factor analysis. These have not looked extensively at specific elderly care wards. We have investigated in-patient falls in mixed acute and rehabilitation elderly care wards in a case-controlled study. Fifty fallers were paired with fifty non-fallers, and their risk factors for falling evaluated. Only three risk factors were significantly more common in the fallers. These were: a previous history of falls; the presence of confusion/disorientation, and needing help to toilet/incontinence/diarrhoea. Prediction of falls based on the presence of the first two of these risk factors gives a sensitivity of 68% and a specificity of 88%. A risk factor approach to the prediction of falls in an in-patient elderly care setting seems to be less practical than was previously hoped.