Falls Risks and Prevention Behaviors Among Community-Dwelling Homebound and Non-Homebound Older Adults.

The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program.

Fragilidad como predictor de episodios adversos en estudios epidemiológicos: revisión de la literatura / Frailty as a predictor of adverse events in epidemiological studies: Literature review

Diversos estudios epidemiológicos han evaluado la relación entre el estado de fragilidad con episodios adversos geriátricos en salud como la mortalidad, la discapacidad, la pérdida de movilidad, la institucionalización o las caídas, demostrando una clara asociación. Sin embargo, estos episodios han sido valorados de forma heterogénea, tanto en su número, criterios empleados y tiempo de seguimiento. Esta asociación implica que el objetivo de la atención geriátrica no debe ser solo la prevención, el diagnóstico y el tratamiento de los procesos de la enfermedad mediante el trabajo multidisciplinar y el uso de niveles asistenciales adaptados a la funcionalidad del anciano, sino la detección del estado de fragilidad entendido como un síndrome previo a la discapacidad sobre el que implementar tratamientos específicos que retarden su aparición, y las consecuencias derivadas del deterioro funcional. Otro objetivo es el apoyo a otras especialidades médicas para estadificar el nivel de riesgo en circunstancias específicas como los tratamientos del cáncer, la realización de pruebas diagnósticas o las intervenciones quirúrgicas (AU)

Several epidemiological studies have analyzed the association between frailty status and adverse geriatric health outcomes, with there being a clear relationship being demonstrated in mortality, disability, mobility loss, institutionalization and falls. However, different studies have evaluated different number of these adverse events, with different criteria, and with different follow-up periods. As a result of this relationship, the objective of geriatric medicine must not only be the prevention, diagnosis and treatment of diseases based on multidisciplinary team work and use of geriatric units according to functional status of patients, but the detection, prevention and treatment of frailty. Frailty must be considered as a pre-disability state that can be prevented and treated to delay its progression towards disability, institutionalization, and death. The characterization of frailty status can also help other medical specialties to stratify the risk of adverse health outcomes in oncology treatments, surgical interventions, or diagnostic procedures (AU)

Diferencias en la expresión del síndrome de fragilidad en varones y mujeres mayores institucionalizados sin deterioro cognitivo grave / Differences in the expression of the frailty syndrome in institutionalized elderly men and women with no severe cognitive decline

Objetivos. Estimar las diferencias entre sexos respecto a: la prevalencia del síndrome de fragilidad, su asociación con factores sociodemográficos y biopsicosociales de salud, y su impacto sobre la dependencia en una población de mayores institucionalizada sin deterioro cognitivo grave. Material y métodos. Estudio descriptivo, transversal y multicéntrico realizado en 16 residencias de Cuenca. Los mayores fueron seleccionados mediante muestreo aleatorio, cumplieron criterios de inclusión 281 residentes. Mediciones: fragilidad siguiendo los criterios de Fried, edad, género, morbilidad, síndromes geriátricos, dependencia, estado cognitivo, estado de ánimo y calidad de vida. Resultados. La prevalencia de fragilidad fue del 53,7% (60% en mujeres). Se asociaron con fragilidad: edad, enfermedades respiratorias, osteoarticulares, diabetes, ambos déficits sensoriales, ambas incontinencias, mayor consumo de fármacos, hospitalización en el último año, deterioro funcional, deterioro cognitivo y síntomas depresivos. Ser frágil se asoció de forma independiente con dependencia (OR=5,1), con mayor fuerza en varones (OR=7,3), que en mujeres (OR=3,6). Los criterios clínicos de fragilidad que mejor predijeron dependencia fueron la pérdida de energía en las mujeres (OR=4,7) y la escasa actividad física en los varones (OR=12,3). Conclusiones. La prevalencia de fragilidad encontrada en mayores institucionalizados es mayor que la descrita en la población general. Los mayores frágiles presentan peores resultados de salud en las dimensiones biológicas y psicosociales, lo que sugiere que a la afectación física acompaña una crisis de identidad. La fragilidad se expresa de forma diferente en varones y mujeres, estas presentan una mayor prevalencia, pero su impacto sobre la dependencia es menor que en los varones(AU)

Aim. To analyse the differences between men and women as regards the prevalence of the frailty syndrome, its association with different sociodemographic and bio-psychosocial health factors, and its impact on the level of dependence of institutionalised elderly men and women with no severe cognitive decline. Methods. A cross-sectional, descriptive and multicenter study was conducted in 16 nursing homes in Cuenca (Spain). A representative sample of 281 elderly who fulfilled the inclusion criteria was randomly selected. Measures: frailty following Fried's criteria, age, gender, morbidity, geriatric syndromes, level of dependence, cognitive status, mood and quality of life. Results. The overall prevalence of frailty was 53.7% (60% among women). The following criteria were associated with frailty: age, respiratory diseases, arthritis, diabetes, sensory deficits, urinary and faecal incontinences, polypharmacy, hospitalization in the past year, functional impairment, cognitive decline and depressive symptoms. The states of frailty were independently associated with dependence (OR=5.1), more strongly in men (OR=7.3) than in women (OR=3.6). Clinical criteria of frailty that best predicted dependence were: exhaustion in women (OR=4.7) and low physical activity in men (OR=12.3). Conclusions. The prevalence of frailty found among the institutionalised elderly population was greater than that expected for a general population. Older frail adults had poorer biological and psychosocial health results, suggesting that the physical decline is accompanied by an identity crisis. Frailty expresses differently in men and women. Women have a higher prevalence, but its impact on their dependence is less than men(AU)

Impacto económico del cuidado informal tras la Ley de promoción de la autonomía personal y atención a las personas en situación de dependencia / Economic impact of informal care after the establishment of the law of dependence in Spain

Fundamento: La Ley de Dependencia reconoce formalmente el papel del cuidador informal, incorporando una prestación económica para el mismo. El objetivo del trabajo es analizar el efecto de la instauración de la ley sobre la existencia del cuidado informal y evaluar el impacto económico de dicho cuidado en la ley dependiendo del financiador. Métodos: Se realizó un estudio transversal a partir de una muestra representativa de la población dependiente baremada de la provincia de Cuenca en febrero de 2009, obteniéndose información de personas con grados II y III de dependencia. Se cuantificó el impacto económico de la existencia del cuidado informal para Cuenca (muestra), Castilla-La Mancha y España mediante una simulación de prestaciones basada en el supuesto de no existencia de cuidado informal. Resultados: El 81,74% de las prestaciones de dependencia correspondió a la prestación diseñada para el cuidado informal. El coste total de las prestaciones de dependencia se redujo entre un 36,51% y un 80,53% debido a la existencia de cuidado informal, desagregado en un ahorro del 122,97-251,04% para el usuario y del 23,30-54,47% para el erario público. El copago medio estimado para el usuario fue de un 13,25% para la muestra, ascendiendo al 21,65-25,77% bajo el supuesto de extinción del cuidado informal. Conclusiones: El cuidado informal implica un importante ahorro de recursos familiares y públicos: los primeros al asumir un menor copago del teórico, trasladando dicha carga a las Comunidades Autónomas; los segundos, por el menor coste que suponen las prestaciones económicas respecto a las prestaciones de servicios(AU)

Background: The Law of Dependence keeps the informal caregiver’s role, incorporating a specific economic benefit. The aims of this work are 1) to analyze the effect of the Law on informal care existence, and 2) to value the economic impact in the Law, disaggregated by financier. Methods: A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with level II and III of dependence. A care service delivery simulation is used to quantify the economic impact of informal care to Cuenca (sample), Castilla- La Mancha and Spain. Results: Informal care delivery is assigned in 81,74% of dependency benefits. Total costs of care service delivery is reduced between 36,51% and 80,53% if informal care exits, disaggregated into savings of 122,97-251,04% for user and 23,30-54,47% for public administration. Average estimated copayment for user is 13,25% for real sample, and it rises to 25,77% when it is supposed informal care extinguishes. Conclusions: Informal care is widespread in the Law, and it implies an important household and public resources saving: for household due to the assumption a smaller copayment that theoretical established, which is assumed by Autonomous Communities; in turn, for public administration, because of the fact economic deliveries require fewer resources(AU)

The development of the residential Fire H.E.L.P. tool kit: a resource to protect homebound older adults.

This article describes the development of the Fire H.E.L.P. tool kit for training selected Meals On Wheels (MOW) staff in Texas to implement a fire safety program for homebound older adults. We used a formative evaluation approach during the tool kit's development, testing, and initial implementation stages. The tool kit includes instructional curricula on how to implement Fire H.E.L.P., a home assessment tool to determine a residence's smoke alarm needs, and fire safety educational materials. During the tool kit's pilot test, MOW participants showed enhanced fire safety knowledge and high levels of confidence about applying their newfound training skills. After the pilot test, MOW staff used the tool kit to conduct local training sessions, provide fire safety education, and install smoke alarms in the homes of older adults. We believe the approach used to develop this tool kit can be applied to education efforts for other, related healthy home topics.

Randomized control trial of the Health Empowerment Intervention: feasibility and impact.

BACKGROUND: Older adults prefer to stay in their homes for as long as possible but are often unaware of the resources in their community to help them to remain in their home. Access to resources may be important among older adults, representing a critical area for intervention. OBJECTIVES: The study aim was to evaluate the feasibility of the Health Empowerment Intervention (HEI) and to explore the impact of the HEI on the theoretical mediating variables of health empowerment and purposeful participation in goal attainment and the outcome variable of well-being with homebound older adults. METHOD: Fifty-nine eligible homebound older adults were randomly assigned to the intervention group or the comparison group. The HEI consisted of 6 weekly visits, whereas the comparison group received a weekly newsletter for 6 weeks. Participants were measured at baseline, after the 6-week protocol, and at 12 weeks. Data were analyzed using descriptive statistics, t test, chi, and analysis of covariance. RESULTS: There was a significant difference between groups in education. The participants in the intervention found the sessions to be helpful in recognizing resources. In addition, participants in the intervention group had significantly higher scores in the mediator purposeful participation in goal attainment, F(2, 83) = 3.71, p = .03. There was no significant main effect for the mediator health empowerment; however, the intervention group increased in the subscale personal growth from baseline to 12 weeks, F(1, 83) = 3.88, p = .05. DISCUSSION: This randomized control trial provided initial support for the hypothesis that homebound older adults receiving the HEI would find the intervention acceptable and have significantly improved health empowerment, purposeful participation in goal attainment, and well-being than an attentional comparison group receiving a weekly newsletter.

An innovative approach to recruiting homebound older adults.

Recruiting older adults to participate in intervention research is essential for advancing the science in this field. Developing a relevant recruitment plan responsive to the unique needs of the population before beginning a project is critical to the success of a research study. This article describes our experiences in the process of recruiting homebound older adults to test a community-based health empowerment intervention. In our study, the trust and partnership that existed between the research team and Community Action Agency facilitated the role of the home-delivered meal drivers as a trusted and untapped resource for study recruitment. Researchers can benefit from thinking creatively and developing meaningful partnerships when conducting research with older adults.

School reentry for children with acquired central nervous systems injuries.

Onset of acquired central nervous system (CNS) injury during the normal developmental process of childhood can have impact on cognitive, behavioral, and motor function. This alteration of function often necessitates special education programming, modifications, and accommodations in the education setting for successful school reentry. Special education is not necessarily a special classroom, but an individualized set of educational needs, determined by a multidisciplinary school team, to promote educational success. The purpose of this article is to inform those pediatricians and pediatric allied health professionals treating children with CNS injury of the systems in place to support successful school reentry and their role in contributing to developing an appropriate educational plan.

Reducing my risk of intrusion: an intention of old homebound women who live alone.

BACKGROUND: In assessing home safety for older persons, nurses have checked home security or assessed fear of crime but neglected to explore intentions to reduce the risk of intrusion. OBJECTIVES: To describe the intentions of old homebound women relative to reducing the risk of intrusion. METHODS: A descriptive phenomenological method was used. The 40 participants (aged 85-98 years, M = 89.6) met criteria for age, living alone, and homebound status. Over 18 months, a series of tape-recorded interviews was completed, focusing on perceptions about changes in feeling safe at home and precautions to prevent the need to reaching help quickly. Data analyzed were drawn from interviews with the 32 women who reported intentions to reduce intrusion risk. FINDINGS: Feeling safe in-place was contextual to recognizing intrusion risk and intentions to reduce the risk. Most women denied a recent change in feeling safe but reported intentions to reduce intrusion risk. The nine women who reported feeling less safe referred to various personal-social situations as explanatory. The five components of the phenomenon were keeping watch here, keeping out of harm's way here, preventing theft and vandalism here, discouraging people who might want to get in here, and keeping intruders out of here. Each component phenomenon was the umbrella for a variety of specific intentions to reduce intrusion risk. CONCLUSIONS: Each woman was intending to reduce intrusion risk in unique ways. When conducting home safety assessments, nurses should explore intentions to reduce intrusion risk and use that information as a basis for individualized interventions to promote safety, rather than relying on generic suggestions such as locking the door.

Community nurses and self-management of blood glucose.

Self-monitoring of blood glucose (SMBG) is commonly recommended to patients with diabetes, although the rationale for this is unclear. This small research project was designed to explore the reasons why nurses working in the community recommend SMBG. Seven interviews were carried out with community nurses caring primarily for housebound patients. Those interviewed believed that a sound evidence-base supported the recommendation that patients test their blood, but not urine, for glucose levels. Though nurses believed in the importance of patient choice and empowerment, the scope for these was limited among housebound patients. There was no evidence that patients understood how to respond to test results, or that comprehensive care planning was normal practice. Although small, this study suggests that nurses working in community settings may need to update their knowledge. It also suggests that a national debate is necessary to disseminate better the evidence about SMBG, and its implications for nursing practice.

Homebound older adults' experiences with the Internet and e-mail.

The purpose of this study was to explore homebound older adults' experiences with the Internet and e-mail employing the Dutch phenomenological approach. A sample of 5 homebound older adults was included. All participants were interviewed twice. Data were analyzed employing the technique recommended by Dutch phenomenologists. The analysis resulted in a total of 10 shared themes and a thick description of the homebound older adults' experiences with the Internet and e-mail. The findings indicated that all participants were faced with various challenges in learning the Internet and e-mail. Those difficulties, however, were overcome by continuous practice and support from various sources. Ultimately they found that the Internet and e-mail were excellent sources of support and enjoyment, resulting in an improved quality of life.

Ocorrência de reaçöes em pacientes pós-alta por cura de hanseníase: subsídios para implementaçäo de um programa de atençäo específica / Ocurrence of late lepra reaction in leprosy pacients: subsides for implementation of a specific care program

A hanseníase seria uma doença comum se näo fosse por seus episódios reacionais de risco de incapacidades mantendo o estigma relacionado à "lepra". Essas reaçöes e a perda potencial da funçäo neural podem ocorrer antes, durante e após o tratamento, feito com poliquimioterapia (PQT). A alta por cura se dá pelo número de doses e regularidades do tratamento, quando o paciente sai do registro ativo e dos coeficientes de prevalência. Objetivando avaliar a magnitude das reaçöes hansênicas pós-alta e as questöes operacionais referentes a qualidade da asssistência, foram revisados prontuários de 149 pacientes que receberam alta de hanseníase de 1994 a 1999, no Centro de Saúde Escola Jaraguá - UFU, realizando a ficha de investigaçäo de Intercorrências Pós-Alta por Cura do Ministério da Saúde. Destes, 34 (23 por cento) apresentaram reaçäo pós-alta, sendo 11,76(por cento) PB e 88,23(por cento) MB. Ocorreu uma média de 3 episódios por paciente dimorfo e 4 por paciente virchowiano

Computers and caregiving: reaching out and redesigning interventions for homebound older adults and caregivers.

This article discusses computer resources for homebound older adults and informal caregivers as an intervention to promote social support and mental health. Published information related to a computer network designed as an intervention for informal caregivers of persons with Alzheimer's disease is included. This information suggests that homebound older adults and informal caregivers can gain valuable information, confidence, and support by using computer resources. A review of the literature supported those findings and suggested that computer technology can facilitate continuing education and the refinement of skills for nurses. Implications for the use of computer resources in nursing education, practice, and research are presented.