Local confinement and bedridden in the context of boundedness - The development of a conceptual definition based on an integrative review / Ortsfixierung und Bettlägerigkeit im Kontext von Gebundenheit (boundedness) - Die Entwicklung einer konzeptuellen Begriffsdefinition auf Grundlage einer integrativen Übersichtsarbeit

Background: Local confinement and bedridden are important phenomena in nursing care. Nevertheless, conceptual definitions and appropriate nursing diagnoses are missing in the current nursing classification systems. Aim: The aim is to provide the basis for a conceptual definition. To this end, the current state of the German and English usage of the terms local confinement and bedridden are presented. At the same time, definitions of English-language terms, which are internationally widely recognized, are elaborated. Additionally, phenomena associated with local confinement and bedridden are recorded and delimited of each other. Method: The identification of the German and English conceptual usage takes place through an integrative literature review covering the period from 1990 to 2016. Results: There are a variety of English-language terms of location confinement and bedridden. The concepts of homebound, wheelchairbound and bedridden form of local confinement and bedridden most extensively. Instability, immobility is connected as cause and inactivity as a consequence. In contrast to this is bedrest, which is ordered and temporally limited. Conclusions: Local confinement and bedridden are to be viewed through the definition of boundedness. The antecedents (instability, immobility) must be diagnosed to derive adequate interventions to avoid or alleviate the consequences.

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)

Valores normativos de instrumentos de valoración funcional en ancianos españoles: estudio FRADEA / Normal data of functional assessment tools of the elderly in Spain: The FRADEA Study

Objetivo: Determinar los valores normativos de algunos de los diferentes instrumentos de valoración funcional más usados en España. Diseño: Estudio transversal del primer corte de una cohorte concurrente de base poblacional. Emplazamiento: Área de salud de Albacete capital. Participantes: 993 sujetos con edad igual o mayor a 70 años participantes en la cohorte FRADEA. Mediciones principales: Se recogieron cuestionarios de discapacidad y función, Barthel, Lawton e Instrumento Abreviado de Discapacidad y Función en la Edad Avanzada (SF-LLFDI), escala de deambulación de Holden (FAC), y pruebas de ejecución: velocidad de marcha (m/s), levántese y ande cronometrado (TUG) (s), tiempo de equilibrio unipodal (s), sentarse y levantarse 5 veces de una silla cronometrado (5STS) (s), Short Physical Performance Battery (SPPB), fuerza prensora (kg), y fuerza flexora codo (kg). Se describen medias, cuartiles y percentiles en la cohorte global, y en los subgrupos de hombres y mujeres con edad entre 70 y 79 o igual o mayor a 80 años. Resultados: Los cuartiles de los diferentes instrumentos fueron respectivamente Barthel (80, 95, 100), Lawton (3, 6, 8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), velocidad de marcha (0,51, 0,79, 1,00), TUG (13,8, 11,4, 9,8), tiempo de equilibrio unipodal (3, 7, 15), 5STS (16,3, 13,0, 10,7), SPPB (7, 9, 11), fuerza prensora (15, 20, 29), y fuerza flexora de codo (11, 20, 32). Los más jóvenes, los hombres y los residentes en la comunidad, presentaron mejores rendimientos en todos los instrumentos. Conclusiones: Se presentan los valores normativos de diferentes instrumentos de valoración funcional de una cohorte de ancianos de Albacete de base poblacional. Éstos pueden ser útiles para su empleo en clínica o en investigación(AU)

Objective: To determine the normal values of some of the functional assessment tools most used in Spain. Design: Cross-sectional study of the first cut of a concurrent population based cohort. Setting: Albacete city Health Area. Participants: A total of 993 subjects aged 70 years or over and participants in the FRADEA (Frailty and dependence in Albacete, Spain) cohort. Main measurements: An analysis was made of disability and function questionnaires, which included, Barthel, Lawton and Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI), Holden's Functional Ambulation Category (FAC), and functional tests: walking speed (m/s), Timed Up and Go (TUG) (sec), one-leg balance time (sec), timed 5 Times Sit to Stand Test (5STS) (seg), Short Physical Performance Battery (SPPB), grip strength (kg), and elbow flexion strength (kg). The means, quartiles and percentiles are described, in the global cohort and in the male and female sub-groups aged between 70 and 79 years or aged 80 years or over. Results: The quartiles of the different instruments were as follow: Barthel (80, 95, 100), Lawton (3, 6,8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), walking speed (0.51, 0.79, 1.00), TUG (13.8, 11.4, 9.8), one-leg balance time (3, 7, 15), 5STS (16.3, 13.0, 10.7), SPPB (7, 9, 11), grip strength (15, 20, 29), and elbow flexion strength (11, 20, 32). The younger ones, males and those living within the community showed a better performance in all the instruments. Conclusions: The normal values of a cohort of the elderly population based in Albacete using different functional assessment instruments are presented. These could be useful in clinical practice or research(AU)

Estudio de prevalencia de patologías podológicas y grado de dependencia en personas mayores de 65 años / No disponible

La prevalencia de patologías podológicas sufre un incremento desde los sesenta años de edad, de igual forma que el nivel de dependencia de las personas. En el presente estudio realizado sobre 748 pacientes mayores de 65 años de 16 municipios gallegos, valoramos la relación entre patologías podológicas y el grado de dependencia. No se observa relación directa de la mayoría de las patologías podológicas con el grado de dependencia, tan solo la onicocriptosis y otras patologías ungueales poco frecuentes muestran datos estadísticos significativos que establecen el grado de dependencia como factor predisponente(AU)

The prevalence of podiatric pathologies suffers an increase from sixty years of age, of equal form that the level of dependence of the persons. For the present study realized on 748 patients 65 and older taken in the region of Galicia we value the relation between podiatric pathologies and the degree of dependence. Is not observed direct relation of the majority of the podiatric pathologies by the degree of dependence, only the onichocryptosis and other nail pathologies slightly frequent show statistical significant information that establish the degree of dependence as predisposing factor(AU)

Déficit de autocuidado en los pacientesde 75 años y más, a los dos mesesdel alta hospitalaria / Self-care deficit in patients aged 75 years and older, two months after hospital discharge

Objetivo: determinar la evolución del déficit de autocuidado en pacientesde 75 años y más, a los dos meses del alta en el Hospital Universitario“La Paz” de Madrid.Método: estudio descriptivo longitudinal. Las variables analizadas fueron:perfil de los pacientes, modificación del déficit en los requisitos de autocuidado,modificación en la prevalencia de diagnósticos enfermeros, cuidadosde transición y red de apoyo familiar y social. La información seobtuvo a través de una entrevista en el domicilio de los pacientes. El instrumentopara la recogida de la información ha sido un documento de valoraciónenfermera orientado según el modelo de autocuidado de D. Orem.Resultados: la muestra fue de 60 pacientes, con un 23% de pérdidas. Alos dos meses del alta los pacientes mantuvieron un déficit similar en losrequisitos de autocuidado, siendo los más afectados “mantenimiento delequilibrio entre la actividad y el descanso” y “prevención de peligrospara la vida el funcionamiento y el bienestar”. Se encontraron diferenciassignificativas en ambas fases entre los diagnósticos: “deterioro dela movilidad física”, “déficit de autocuidado: vestido/acicalamiento” y“déficit de autocuidado: uso de WC”. La capacidad funcional mejorórespecto al momento del alta. Todos los pacientes tuvieron seguimientoen Atención Primaria.Conclusiones: la mejora de la capacidad funcional, transcurridos dosmeses del alta, evidencia el impacto negativo de la hospitalización en laspersonas mayores y la necesidad de cuidados de transición y recursossociales de apoyo a los cuidadores (AU)

Objective: to determine the evolution of self-care deficit in patients aged75 years and older two months after hospital discharge at the “La Paz”University Hospital of Madrid.Method: longitudinal descriptive study. The following variables wereanalysed: patient profiles, deficit modification in the self-care requirements,modification in the prevalence of nursing diagnoses, transitionalcare and family and social support network. The information was obtainedby means of an interview conducted in the patients’ homes. The instrumentused for data collection has been a nursing assessment documentbased on D. Orem’s self-care model.Results: the sample consisted of 60 patients, with a 23% dropout rate.Two months after discharge the patients maintained a similar deficit inself-care requirements, the most affected ones being “maintenance ofbalance between activity and rest” and “prevention of hazards to life,functioning and wellbeing”. Significant differences were found in bothphases amongst the diagnoses: “physical mobility deterioration”, “selfcaredeficit: dressing/grooming” and “self-care deficit: toilet use”. Functionalcapacity improved with respect to what it was at the time of discharge.All patients underwent follow-up in primary care.Conclusions: the improvement of functional capacity, two months afterdischarge, evidences the negative impact of hospitalization in elderlypatients and the need for transitional care and social supportive resourcesfor caregivers (AU)

Nivel de dependencia y percepción de salud tras la valoración enfermera / Level of dependency and perceived health nurse after the valuation

Objetivo: Identificar la capacidad funcional de un colectivode ancianos medida a través de las actividades dela vida diaria y la percepción de salud. Método: Se realizóun estudio descriptivo de carácter retrospectivo enuna residencia geriátrica con un total de 156 ancianos.La muestra estuvo compuesta por todos los residentesque en el momento del estudio estaban valorados por laenfermera. Resultados: El perfil demográfico es el de unresidente de una media superior a 75 años. El 71,3% delos residentes son mujeres. Las actividades del Índicede Barthel que reflejan mayor grado de dependencia son“lavarse” y “subir y bajar escaleras” y, la que menos,“comer”. La percepción de salud mediante las láminasde Coop-Wonca refleja una percepción “regular” o “mala”en la mayoría de los casos. A mayor grado de limitaciónfísica para las actividades de la vida diaria mayorpercepción negativa de salud. Conclusiones: El uso deinstrumentos estandarizados para la valoración geriátricaintegral nos permite detectar de manera rápida el estadodel anciano en su globalidad. De esa manera, se mejoranla calidad prestada así como la aplicación de un plande actuación interdisciplinar(AU)

To identify the functional ability of a group of elderly measuredthrough the activities of daily living and perceivedhealth. Method: A descriptive study of retrospective in a geriatricnursing home with a total of 156 elderly. The samplewas composed of all residents at the time of the studywere rated by the nurse. Results: The demographic profile isa resident of an average exceeding 75 years. The 71.3% ofresidents are women. The activities of the Barthel Index reflectinggreater reliance are “washed” and “up and downstairs” and the least “to eat”. The perception of health byCoop-Wonca reflects a perception “regulate” or “bad” inmost cases. A higher degree of physical limitations to activitiesof daily living more negative perception of health. Conclusions:The use of standardized instruments for the integratedgeriatric assessment allows us to swiftly detect thestatus of the elderly as a whole, thus improving the qualityprovided, as well as implementing an action plan interdisciplinary(AU)

El papel del médico especialista en medicina física y rehabilitación en la valoración de la discapacidad, del daño corporal y de la dependencia / No disponible

No disponible

Uso de escalas de valoración en el proyecto de ley de promoción de la autonomía personal y de atención a las personas dependientes / Use of assessment scales in the Promotion of the Personal Autonomy and Attention to the Dependent People Project of Law

La reciente aprobación en España del Proyecto de Ley de Promoción de la Autonomía Personal y de Atención a las Personas Dependientes plantea la necesidad de un sistema de valoración para personas en situación de dependencia. La valoración se fundamenta en una clara descripción de su marco conceptual, donde deben explicitarse los componentes implicados, así como la clasificación y utilidad a la que se destina. A efectos prácticos, la valoración de la discapacidad o dependencia debe centrarse en el estudio de aquellas actividades en las que una persona necesita de otra para su realización, sin perder de vista las deficiencias corporales y el contexto. Tomando como referencia la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) que establece tres formatos de valoración (cribaje y detección de casos, uso diario por profesionales de la salud y estudios de investigación) se apuesta por el uso del formato de cribaje por profesionales de salud cercanos, numerosos y con conocimiento de la comunidad, como las enfermeras, lo que permitirá priorizar y garantizar el acceso a toda la población, La derivación al órgano de valoración multiprofesional competente, permitirá la utilización del formato de uso diario para una valoración que incluya los tres componentes

The recent approval of the Promotion of the Personal Autonomy and Attention to the Dependent People Project of Law raises the necessity of an assessment system for people in dependency situation. The assessment is based on a clear description of its conceptual frame, where the involved components must be specified, as well as the classification and utilities to which it is bound. Pragmatically, the assessment of the discapacity or dependency must be centered in the study of those activities in which a person needs another one for its accomplishment, without undermining the corporal deficiencies and the context. According to the International Classification of Functioning, Disability and Health (CIF) that establishes three formats of assessment (screening and case detection, daily use by health professionals, and research studies), the authors stand for the use of the screening and case detection format by health professionals who are numerous and close to the community such as nurses. Nurses will allow to give priority and to guarantee the access to all the population. The reference to the competent multiprofessional assessment organ will allow the use of the daily use format for an assessment, including the three components

[Predictors for the onset of different types of homeboundness among community-living older adults: two-year prospective study].

BACKGROUND: Little is known about predictors for the onset of different types of homeboundness among community-living older adults. PURPOSE: This 2-year prospective study examined predictors for the onset of "type 1" and "type2" homeboundness (see definitions below) among community-living older adults. METHODS: Study subjects comprised all residents aged 65 years and over living in Yoita town, Niigata, Japan, who answered the baseline (2000) and follow-up (2002) surveys. Persons were defined as being homebound if he/she went outdoors once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e., level 3 or over). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., level 1 or 2). A stepwise, multiple logistic regression model was used to identify the most parsimonious combination of risk factors for each type of homeboundness. RESULTS: Out of 1,322 persons who were level 1,2 non-homebound at the baseline, 77.6% remained as level 1,2 non-homebound (n = 1,026), but 1.7% were "type 1" homebound (n = 22), and 4.8% were "type 2" homebound (n = 66) at follow-up. The final model for prediction of "type 1" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 2.10; 95%CI: 1.36-3.24), not having a job (OR: 4.42; 95%CI: 1.21-16.2), unable to walk 1 km (OR: 4.24; 95%CI: 1.37-13.1), and a low cognitive function identified as MMSE <24 (OR: 5.22; 95%CI: 1.98-13.8). The final model for prediction of "type 2" homeboundness at follow-up included: advanced age (OR for 5 year-increment: 1.65; 95%CI: 1.32-2.06), a depressive mode indicated by a GDS short version score >5 (OR: 2.18; 95%CI: 1.23-3.88), a low cognitive function (OR: 2.72; 95% CI: 1.47-5.05), not having close friends (OR: 2.30; 95%CI: 1.08-4.87), and not having a walking or calisthetics habit (OR: 2.21; 95%CI: 1.26-3.86). CONCLUSIONS: Reduced physical and mental functioning contribute to the subsequent occurrence of "type 1" homeboundness. Additionally, psychosocial factors are independent predictors of "type 2" homeboundness. These results suggest that different public health strategies might be required for prevention of the different types of homeboundness in Japanese older adults.

[Prognosis of different types of homeboundness among community-living older adults: two-year prospective study].

PURPOSE: This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders. METHODS: Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n = 1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline. RESULTS: At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%) . As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE < 20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05[0.54-7.75] in the fully adjusted model). CONCLUSIONS: Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

Oral health care status of homebound elderly in Japan.

We examined the present conditions of oral health care in order to contribute towards an effective system to provide oral health care for homebound elderly in Japan. A questionnaire was mailed to homebound elderly subjects (n=908) and returned by mail. A 73.6% response was achieved. The questionnaire was designed to elicit information with respect to the general condition of the subjects and independence of oral health care. About 70% of the subjects were chair- or bed-bound. Among all subjects, 37.6% required partial or full assistance on toothbrushing, 55.6% on cleaning dentures and 46.7% on eating. The degree of oral health care tended to be poor for chair- or bed-bound elderly compared with independent or house-bound elderly. Homebound elderly with lower Activities of Daily Living Scale (ADL) required more support for oral health care compared with elderly with higher ADL.

A pilot study on home visiting in Aspen Community Care Services.

The aim of this study was to test a questionnaire for more detailed management information of a community care program in rural Alberta. A total of 24 community care clients and 486 home visits to these clients were assessed. The Client Homebound Score (CHS) and the Case Management Intensity Score (CMIS) were positively associated with time spent on home visits. These scores would be useful indicators for improved resource-based planning of home visiting.

Characteristics of housebound elderly by mobility level in Japan.

The purpose of the present study was to describe characteristics of the housebound elderly by their mobility levels. Disabled elderly people in Japan were interviewed at home by nurses. Housebound status was defined as people who left the house less than once a week. Characteristics of housebound elderly were compared with non-housebound elderly by three mobility levels: (i) Non-walking group (n=72); 5 m-walking group (n=153); going-by-bus group (n=96). Housebound elderly were not found in the going-by-bus group. Among the elderly in the non-walking group, the cognitive function of the housebound elderly was significantly lower and the housebound elderly were less well cared for; however, their caregivers rated their caregiving burden significantly lower than did caregivers of the non-housebound elderly. Among those in the 5 m-walking group, the autonomy and social networks of the housebound elderly were significantly less than for the non-housebound. The characteristics of housebound elderly showed differences by mobility levels.

Home care for the frail elderly based on urinary incontinence level.

Incontinence is a common problem in the frail elderly. We conducted interviews focusing on urinary incontinence with 249 elderly clients in the home care setting, and studied differences of the needs among three (mild, moderate, and catheter) groups based on incontinence level. The mild group had the highest number of professional care needs, although their problems were not as serious as the other two groups. The moderate group required the highest amount of daily care by caregiver. A similar need pattern was shown in the moderate and catheter groups, while more diversified needs were required in the mild group. Portable toilet, rehabilitation, and short-stay services were frequently used in the mild group. The use of telephone consultation was the highest in the moderate group, and the use of doctor visit and bathing service were higher in the catheter group. The most important challenge was significantly different in each group: preventive efforts to maintain activities of daily living (ADL) in the mild group, interpersonal relationships in the moderate group, and infection control in the catheter group. Education was necessary for caregivers in all three groups. These findings help to project realistic care needs for each client based on his or her incontinence level.