Unintended weight loss in the elderly living at home: the aged in Home Care Project (AdHOC).

OBJECTIVE: To describe associations between unintended weight loss (UWL) and characteristics of nutritional status. DESIGN: A comparative cross-sectional assessment study at 11 sites in Europe. The target population was a stratified random sample of 4,455 recipients of home care (405 in each random sample from 11 urban areas) aged 65 years and older. MEASUREMENTS: the Resident Assessment Instrument for Home Care, version 2.0. Epidemiological and medical characteristics of clients and service utilisation were recorded in a standardized, comparative manner. UWL was defined as information of 5% or more weight loss in the last 30 days (or 10% or more in the last 180 days). RESULTS: The final sample consisted of 4,010 persons; 74% were female. The mean ages were 80.9 +/- 7.5 years (males) and 82.8 +/- 7.3 years (females). No associations were found between single diagnoses and UWL, except for cancer. Cancer patients were excluded from further analyses. Persons with a Cognitive Performance Scale value (CPS) superior 3 (impaired) had increased risk of UWL (OR = 2.0) compared with those scoring inferior or egal 3 (less impaired). Only in the oldest group did we find a significant association between UWL and reduction in ADL and IADL functions, comparing those who scored 3 or less with those who scored more than 3 (disabled). A binary logistic regression model explained 26% of UWL: less than one meal/day, reduced appetite, malnutrition, reduced social activity, experiencing a flare-up of a recurrent or chronic problem, and hospitalisation were important indicators. CONCLUSION: We recommend a regular comprehensive assessment in home care to identify clients with potential risk factors for weight loss and malnutrition, in particular those discharged from hospital, and those with physical dependency or cognitive problems. This study may provide incentives to create tailored preventive strategies.

Increased work-load associated with faecal incontinence among home care patients in 11 European countries.

UNLABELLED: The plurality of definition of faecal incontinence (FI) complicates the cross-national comparisons between studies conducted in the area. The aim of the study was to investigate work-load and subjective care-giver burden associated with FI, among home-care patients, in Europe. DESIGN AND METHODS: In this cross-sectional retrospective study, a random sample of 4010 RAI-HC assessments were collected during 2001-02 from home care patients aged 65 years and over (74% females; age 82.8 +/- 7.2 years) in Czech Republic, Denmark, Finland, France, Germany, Iceland, Italy, The Netherlands, Norway, Sweden and United Kingdom. RESULTS: Of the 4010 individuals, 411 (10.3%) suffered from FI (range 1.1-30.8% from site to site). The factors significantly associated with faecal incontinence were diarrhoea [odds ratio (OR) 10.3, 95% confidence interval (CI) 6.590-15.96], urinary incontinence (OR 3.99, 95% CI 2.991-5.309) and pressure ulcers (OR 3.15, 95% CI 2.196-4.512) together with severe impairments in physical (OR 4.25, 95% CI 2.872-6.295) and cognitive (OR 3.76, 95% CI 2.663-5.304) functions. High use of working hours of the visiting nurses (OR 2.04, 95% CI 1.221-3.414) and home health carers (OR 2.40, 95% CI 1.289-4.470) were additionally associated with faecal incontinence. Use of five or more medications was an inversely associated with FI (OR 0.62, 95% CI 0.473-0.820). CONCLUSIONS: The additional work load associated with faecal incontinence comprises considerable numbers of formal health care hours and should be taken into account when planning home health services for the older in home care patients.

Home care needs of extremely obese elderly European women.

OBJECTIVE: To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. STUDY DESIGN: A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'. MAIN OUTCOME MEASURES: Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. RESULTS: One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. CONCLUSIONS: Extreme obesity is a problem that increasingly affects home care of elderly women.

A longitudinal study on dying in a Norwegian hospital.

A research project conducted at a Norwegian hospital in 1977 (n = 213 deaths) was repeated in 1987 and 1997 (n = 100 deaths each year). The purpose was to discover if and how terminal care had changed during these 20 years. Data sources included case records, nurses' reports and interviews with close relatives approximately 12 weeks after death. The average stay in hospital decreased by one-third from 1977 to 1997. Active life-prolonging treatment, as defined by use of antibiotics, resuscitation and parenteral fluids, was greatly reduced from 1977 to 1987, but there was an increase in the use of such treatment in 1997. Interestingly, palliative treatments--either broadly defined as the giving of analgesics in general, or more narrowly as the giving of opiates only--have increased steadily over the years and are now offered to most patients. However, the findings demonstrated that the next-of-kin were less well informed about the patient's impending death in 1997 than in 1977.

Cancer patients who prefer to die at home. Characterizations of municipalities with several or few occurrences of home deaths.

This article presents a descriptive study based on quantitative and qualitative methods. We wished to determine factors that promote or restrict home deaths. The Norwegian Central Bureau of Statistics released non-identifiable data for the time period 1990-1994 for all municipalities in Norway. Relevant health and social data from the Norwegian Social Science Data Service for the 24 municipalities, which had more than 20% or less than 10% of the cancer patients dying in their own homes, were analysed. Key persons in the home care teams were interviewed. There were few occurrences of home deaths in municipalities with a local hospital, good capacity in nursing homes or a larger percentage of one-person households. Indicators for several occurrences of home deaths were openness, good co-operation with physicians, and a stable, flexible staff. In addition, the patient had to have a strong desire to die at home. Finally, the employees had to be professionally confident and willing to go beyond the prescribed shift hours.

Nursing students' attitudes towards assisted suicide and euthanasia--a study from four different schools of nursing.

In 1991/92, 289 students from four different schools of nursing in Norway participated in a case-related attitudes test. The nursing students answered questions concerning their personal views on the moral and legal implications of either assisting suicide or performing euthanasia. They also indicated whether they themselves were willing to perform these acts. The results were compared with responses from a study on students from other faculties in 1988. The findings suggested that nursing students were significantly (p < 0.0005) more restrictive than the other students in their attitudes towards voluntary active euthanasia (VAE). Factors that influenced the nursing students' attitudes towards VAE were measured by the index of VAE. Religious belief (p < 0.0001), conservative political view (p < 0.01), and the perception of life as meaningful (p < 0.02) were the best predictors of the dependent variable.

[Has the care of dying patients in hospitals changed? A study of terminal care at the Diaconal hospital in 1977 and 1987]. / Har omsorgen for døende pasienter i sykehus endret seg? En studie av omsorg for døende ved Diakonhjemmets sykehus i 1977 og 1987.

A research project conducted at the Norwegian Lutheran Hospital in 1977 (213 deaths) was repeated in 1987 (100 deaths). The purpose was to discover if and how terminal care had changed during the ten years. Data sources were case records, nurses' reports, interviews with closest relatives about 12 weeks after the death (response 95% in 1977 and 72% in 1987). Openness about death had not increased. There was some improvement of palliative treatment. In 1987, 79% of all terminal patients had received such treatment, compared with 51% in 1977. The percentage receiving life prolonging treatment, such as parenteral supply of fluids, had fallen from 62% in 1977 to 25% in 1987, and the percentage treated with antibiotics from 31% in 1977 to 15% ten years later.

Homecare at the end of life. A study of fifteen patients.

The study is a part of a research project on death in a sector of a large city, involved cooperation with the Franciscan Aid "home care team". The purpose was to study death in the home setting. Fifteen deaths were registered. Participant observation in the care of 14 patients were made--a total of 83 visits to homes, 2-15 visits per patient. In one case the author had contact with the relatives, after the death had occurred. Most of the patients had cancer. Their age varied from 28 to 80 years. The observations were recorded immediately after each visit. After the death of a patient a structured interview with the closest relatives and the nurse responsible were made. Their statements were used as a basis for formulating problems for the further study and the clarification of quantitative data. Results showed that the patients who chose to leave the hospital and remain at home often had negative experiences in hospital. All the patients in this study received good palliative treatment at home. All patients were also informed about their condition. One-third of the patients were readmitted to hospital during the final days.