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1.
BMC Health Serv Res ; 19(1): 752, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653231

RESUMO

BACKGROUND: People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems. National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the "missing link" for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system. METHODS/DESIGN: The study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.


Assuntos
Redes Comunitárias/organização & administração , Neoplasias/terapia , Redes Comunitárias/economia , Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Institucionalização , Estudos Longitudinais , Estudos de Casos Organizacionais , Quebeque , Projetos de Pesquisa
2.
Rev Infirm ; 68(253): 49-50, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31472788
3.
Intellect Dev Disabil ; 57(4): 263-273, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31373544

RESUMO

There are decades of research indicating ableism is extremely prominent. The aim of this study was to examine the relationships between disability prejudice and institutionalization of people with intellectual and developmental disabilities (IDD). This study had two research questions: (1) How does disability prejudice impact the number of people with IDD who are institutionalized in a state? and (2) How does disability prejudice impact spending on institutions? To do so, we utilized secondary data about state utilization of institutions (fiscal year 2015), and disability prejudice data from 325,000 people. Findings revealed, states with higher disability prejudice institutionalize more people, even when controlling for size. Moreover, states with higher disability prejudice also spend more on institutional funding, regardless of size or wealth.


Assuntos
Deficiências do Desenvolvimento , Institucionalização/estatística & dados numéricos , Deficiência Intelectual , Preconceito , Serviços de Saúde Comunitária/economia , Gastos em Saúde , Serviços de Assistência Domiciliar/economia , Humanos , Modelos Lineares , Assistência de Longa Duração/economia , Medicaid , Estados Unidos
4.
Nutrients ; 11(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277405

RESUMO

Vitamin D may play a significant role in regulating the rate of aging. The objective of the study was to assess vitamin D status and its associated factors in institutionalized elderly individuals. A total of 153 elderly individuals living in Nursing Homes (NH) were recruited into the study. Serum 25-hydroxyvitamin D [25(OH)D] concentration was used as the biomarker of vitamin D status, and it was considered as the dependent variable in the model. The independent variables were the type of NH, age-adjusted time of institutionalization, age, sex, skin color, body mass index, waist and calf circumference, physical activity practice, mobility, dietary intake of vitamin D and calcium, vitamin D supplementation, use of antiepileptics, and season of the year. Serum 25(OH)D concentrations less than or equal to 29 ng/mL were classified as insufficient vitamin D status. The prevalences of inadequate dietary intake of vitamin D and calcium were 95.4% and 79.7%, respectively. The prevalence of hypovitaminosis D was 71.2%, and the mean serum concentration of 25(OH)D was 23.9 ng/mL (95% confidence interval [CI]: 22.8-26.1). Serum 25(OH)D concentration was associated with the season of summer (p = 0.046). There were no associations with other independent variables (all p > 0.05). The present results showed that a high prevalence of hypovitaminosis D was significantly associated with summer in institutionalized elderly individuals.


Assuntos
Institucionalização , Estações do Ano , Luz Solar , Raios Ultravioleta , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Exposição à Radiação , Fatores de Risco , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico
5.
Disabil Health J ; 12(4): 712-717, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31262701

RESUMO

BACKGROUND: Legislation and court decisions in the United States mandate the right to least restrictive community living and participation for people with disabilities, yet little research has examined differences in participation across institutional and community settings, or over time in the community post-transition. OBJECTIVE: As part of a multi-site participatory action research project examining participation, we examined the differences in quality of life in institutional and community living environments among people with disabilities. METHODS: We conducted surveys with adults with disabilities between 18 and 65 years-old that transitioned from institutions to the community in the United States within the last five years. This paper reports on findings for a diverse sample of 150 participants. RESULTS: We found significant differences between ratings of institutional and community experiences, with increased reports of satisfaction, personal safety, service access, and participation in community settings. We also found significant improvements in community integration and inclusion after transition to community living, although barriers to transportation and activity access often remained. CONCLUSIONS: This study of insider experiences of previously institutionalized people with disabilities illuminates important understandings of community participation, integration, and quality of life for the disability community in the United States.


Assuntos
Participação da Comunidade , Pessoas com Deficiência , Habitação , Vida Independente , Institucionalização , Satisfação Pessoal , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desinstitucionalização , Feminino , Instalações de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Instituições Residenciais , Segurança , Inquéritos e Questionários , Transportes , Estados Unidos , Adulto Jovem
6.
Rev Esc Enferm USP ; 53: e03472, 2019 Jun 03.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166459

RESUMO

OBJECTIVE: To develop nursing diagnostic statements for institutionalized elderly people. METHOD: Descriptive study conducted with elderly subjects of a Long Stay Institution through the application of forms for the support of anamnesis and physical examination and a search of medical records. The diagnostic statements were developed based on the International Classification for Nursing Practice and categorized according to the Henderson's theoretical model. RESULTS: Participation of 203 elderly people. A total of 153 nursing diagnoses were developed and distributed as follows: 115 (75.1%) in the Biological/Physiological Component, 14 (9.1%) in the Psychological Component, 21 (13.7%) in the Social Component, and three (1.9%) in the Spiritual/Moral Component. CONCLUSION: The diagnostic statements portray situations of vulnerability to the health of institutionalized elderly that are influenced by biological, psychological, social and cultural factors and require a systematized, individualized and resolutive care for this public.


Assuntos
Institucionalização , Diagnóstico de Enfermagem/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Modelos Teóricos , Terminologia Padronizada em Enfermagem
7.
BMC Health Serv Res ; 19(1): 410, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234849

RESUMO

BACKGROUND: Due to rapidly growing number of old adults and diminishing supportive functions of family in China, the issue of willingness to use institutional care is of high priority, especially for disabled seniors. The objective of this study is to compare the willingness of institutional care and its determinants between disabled and non-disabled seniors in China. METHODS: 2493 seniors (60+) were randomly selected from a cross-sectional study conducted in three urban districts and three rural counties in Jiangsu Province. Binary logistic regression model was employed to examine differences towards the preference for institutional care between two subgroups, and to identify factors associated with willingness of institutional care between disabled and non-disabled seniors. RESULTS: Of 2493 respondents, 402 (16.1%) were disabled seniors. Overall, 14.2% of the participants had willingness for institutional care in Jiangsu, China. The willingness for institutional care among non-disabled seniors (OR = 0.513; 95%CI 0.387-9.680) was significantly lower than that among disabled ones. The preference for institutional care of both disabled and non-disabled seniors was associated with household income. The willingness of institutional care was also related to age, education and living arrangement among disabled seniors. Meanwhile, non-disabled seniors who had non-communicable diseases were found to be more likely to choose elder care in institution. CONCLUSIONS: Our findings indicated that the willingness for institutional care among disabled seniors was significantly higher than that among non-disabled ones. Household income was determinant of utilization willingness for institutionalization both in disabled and non-disable seniors. Different policies should be made or modified for disabled and non-disabled seniors separately.


Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Institucionalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
8.
Rev Gaucha Enferm ; 40: e20180377, 2019 Jun 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31188989

RESUMO

OBJECTIVE: To analyze attitudes of filial responsibility about the institutionalization of aged parents. METHODS: A qualitative descriptive study with intentional sample of 100 caregivers of aged people from two Primary Health Care Units of Porto Alegre/Brazil. The information was collected in 2014, through a semi-structured interview. Thematic analysis was carried out. The NVIVO® software version 10 was used. RESULTS: Two categories were elaborated according to the protocol questions: the possibility of institutionalization of the aged parents and expectation of care. FINAL CONSIDERATIONS: Most adult child caregivers did not consider the institutionalization of aged parents in the reason of a duty they felt to take care of their parents, and the institutionalization was considered as abandonment. Most of the adult child caregivers had an expectation to be cared by their children and perceived the institutionalization as an alternative of receiving this care. The results of the study contribute to the strengthening of the formal and informal network for the aged and their adult child caregiver.


Assuntos
Crianças Adultas/psicologia , Atitude , Institucionalização , Pais , Idoso , Cuidadores/psicologia , Filho de Pais Incapacitados/psicologia , Tomada de Decisões , Relações Familiares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Responsabilidade Social
9.
Artigo em Inglês | MEDLINE | ID: mdl-31035486

RESUMO

Patients with traumatic brain injury (TBI) often present with disabilities associated with a high burden of care for caregivers or family members at home. When family members cannot afford to care for patients with TBI, they are often required to find them residence in long-term care institutions. To date, there are no quantitative assessment tools developed to predict institutionalization. Therefore, this study analyzed the accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for predicting the institutionalization of patients with TBI. We designed a cross-sectional study using a nationwide disability database. We analyzed the data of 8630 patients with TBI with injury for more than six months from the Taiwan Data Bank of Persons with Disability during July 2012-October 2018. The demographic data and WHODAS 2.0 standardized scores of patients with TBI who resided in community and long-term care institutions were analyzed. Receiver operating characteristic curve (ROC) analysis was performed to investigate the predictive accuracy of WHODAS 2.0 for being institutionalized, and the optimal cut-off point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the participants being institutionalized. The WHODAS 2.0 scores in each domain were lower in the community group than in the institutionalized group. ROC analysis revealed the highest accuracy for the summary scores of WHODAS 2.0 (area under the curve = 0.769). Binary logistic regression revealed that age, gender, work status, urbanization level, socioeconomic status, severity of impairment, and WHODAS 2.0 domain scores were factors associated with the institutionalization status of patients with TBI. Our results suggest that WHODAS 2.0 may be a feasible assessment tool for predicting the institutionalization of patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas , Avaliação da Deficiência , Institucionalização , Adolescente , Adulto , Idoso , Estudos Transversais , Pessoas com Deficiência , Feminino , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Curva ROC , Índice de Gravidade de Doença , Taiwan , Organização Mundial da Saúde , Adulto Jovem
10.
PLoS One ; 14(5): e0216483, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31067285

RESUMO

As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19th century. Poverty was often thought to result from an individual's misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta¼ in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta¼ assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals' institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.


Assuntos
Cemitérios , Doenças Transmissíveis , Pessoas com Deficiência/história , Fraturas Ósseas , Nível de Saúde , Institucionalização/história , Prisões/história , Esqueleto , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/história , Doenças Transmissíveis/patologia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/história , Fraturas Ósseas/patologia , História do Século XIX , História do Século XX , Humanos , Masculino , Fatores Socioeconômicos , Suíça/epidemiologia
11.
Medicina (Kaunas) ; 55(5)2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31108986

RESUMO

Background and Objectives: Cerebral palsy (CP) is a set of permanent disorders that limit physical activity and increase the risk of developing other diseases, such as metabolic syndrome (MS). Adequate nutrition can contribute to the prevention of associated symptoms. The main objective of this study is to evaluate the nutritional status and the prevalence of cardiometabolic risk factors in adults with CP and Gross Motor Function Classification System (GMFCS) levels between IV and V. Materials and Methods: A sample of 41 adults with CP and GMFCS levels from IV to V were studied. The variables used in the study were age, sex, weight, height, mean age, and GMFCS level range. To evaluate nutritional status, body mass index and the Mini Nutritional Assessment (MNA), a nutritional screening tool, were used. To assess cardiometabolic risk, data on obesity, central obesity, blood pressure, fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were collected. Results: More than 80% of the population studied was malnourished or at risk of malnutrition, according to the MNA tool classification ranges, and around 35% of the studied population was within the underweight range. Regarding cardiometabolic risk factors, only one adult with CP was diagnosed with MS. Conclusions: The studied population of adults with CP and GMFCS levels between IV and V is not a population at risk of MS; however, the high prevalence of malnutrition, as well as some of the most prevalent cardiovascular risk factors, should be taken into consideration.


Assuntos
Paralisia Cerebral/dietoterapia , Síndrome Metabólica/complicações , Estado Nutricional , Adolescente , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Institucionalização/estatística & dados numéricos , Masculino , Síndrome Metabólica/dietoterapia , Pessoa de Meia-Idade , Fatores de Risco , Estatísticas não Paramétricas
12.
Maturitas ; 125: 63-69, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133220

RESUMO

INTRODUCTION: This review examines whether functional and cognitive decline and mortality after an episode of delirium are comparable between patients with and those without dementia. METHODS: MEDLINE and EMBASE were searched systematically for 'dementia' and 'delirium'. After screening of the results, studies were rated on relevance and validity and data were extracted. Cognitive decline was defined as decline in Mini-Mental State Examination (MMSE) score. Functional decline was defined as decline in Barthel Index (BI), score on the Instrumental Activities of Daily Living (IADL) or institutionalisation. RESULTS: From 5092 potentially relevant articles identified, eight studies were included in the review. The one-year mortality rate ranged from 11% to 45% in patients with dementia versus 22% to 44% in patients without dementia, and the overall absolute rate was 34% (95% CI 0.32-0.36). Pooled data did not show a significant difference between the groups. The MMSE scores and the Barthel Index had improved in both groups after six months, but scores on the Instrumental Activities of Daily Living (IADL) had declined. However, on all measurement points, patients with dementia scored significantly lower than patients without dementia. In addition, patients with dementia had a 33% risk of institutionalisation after an episode of delirium versus 20% in patients without dementia (95% CI 0.06-0.20). CONCLUSION: No significant differences were seen in mortality after delirium between patients with and without dementia. The overall one-year mortality was high (34%). Patients with dementia had significantly lower functional and cognitive scores and their risk of institutionalisation post-delirium was higher. Patients and their caregivers should be given this information, which may also be useful in advance care planning.


Assuntos
Atividades Cotidianas , Delírio/complicações , Demência/complicações , Prognóstico , Idoso , Idoso de 80 Anos ou mais , Cognição , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/mortalidade , Delírio/diagnóstico , Delírio/mortalidade , Demência/diagnóstico , Feminino , Humanos , Institucionalização , Masculino , Morbidade , Mortalidade , Estudos Prospectivos , Estudos Retrospectivos
13.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 8(1): 155-163, jan.-mar. 2019.
Artigo em Português | LILACS | ID: biblio-996375

RESUMO

O primeiro livro da coletânea Direito à Saúde, Institucionalização, reúne ensaios de expertos no tema, como profissionais ligados à gestão do sistema de saúde, à justiça e às pesquisas acadêmicas, que se voltam para um estudo do conjunto normativo encarregado de positivar o direito à saúde.


El primer libro de la colección Derecho a la Salud, Institucionalización, reúne ensayos de expertos en el tema, como profesionales ligados a la gestión del sistema de salud, a la justicia ya las investigaciones académicas, que se vuelven hacia un estudio del conjunto normativo encargado de positivizar el derecho a la salud.


The first book of the collection entitled "Right to Health, Institutionalization," brings together essays by experts on the subject, such as professionals related to health system management, justice and academic research.


Assuntos
Resenhas de Livros , Institucionalização
14.
Cochrane Database Syst Rev ; 4: CD009537, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31012953

RESUMO

BACKGROUND: Delirium is a common and distressing mental disorder. It is often caused by a combination of stressor events in susceptible people, particularly older people living with frailty and dementia. Adults living in institutional long-term care (LTC) are at particularly high risk of delirium. An episode of delirium increases risks of admission to hospital, development or worsening of dementia and death. Multicomponent interventions can reduce the incidence of delirium by a third in the hospital setting. However, it is currently unclear whether interventions to prevent delirium in LTC are effective. This is an update of a Cochrane Review first published in 2014. OBJECTIVES: To assess the effectiveness of interventions for preventing delirium in older people in institutional long-term care settings. SEARCH METHODS: We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group (CDCIG) 's Specialised Register of dementia trials (dementia.cochrane.org/our-trials-register), to 27 February 2019. The search was sufficiently sensitive to identify all studies relating to delirium. We ran additional separate searches in the Cochrane Central Register of Controlled Trials (CENTRAL), major healthcare databases, trial registers and grey literature sources to ensure that the search was comprehensive. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-randomised controlled trials (cluster-RCTs) of single and multicomponent, non-pharmacological and pharmacological interventions for preventing delirium in older people (aged 65 years and over) in permanent LTC residence. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Primary outcomes were prevalence, incidence and severity of delirium; and mortality. Secondary outcomes included falls, hospital admissions and other adverse events; cognitive function; new diagnoses of dementia; activities of daily living; quality of life; and cost-related outcomes. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes, hazard ratios (HR) for time-to-event outcomes and mean difference (MD) for continuous outcomes. For each outcome, we assessed the overall certainty of the evidence using GRADE methods. MAIN RESULTS: We included three trials with 3851 participants. All three were cluster-RCTs. Two of the trials were of complex, single-component, non-pharmacological interventions and one trial was a feasibility trial of a complex, multicomponent, non-pharmacological intervention. Risk of bias ratings were mixed across the three trials. Due to the heterogeneous nature of the interventions, we did not combine the results statistically, but produced a narrative summary.It was not possible to determine the effect of a hydration-based intervention on delirium incidence (RR 0.85, 95% confidence interval (CI) 0.18 to 4.00; 1 study, 98 participants; very low-certainty evidence downgraded for risk of bias and very serious imprecision). This study did not assess delirium prevalence, severity or mortality.The introduction of a computerised system to identify medications that may contribute to delirium risk and trigger a medication review was probably associated with a reduction in delirium incidence (12-month HR 0.42, CI 0.34 to 0.51; 1 study, 7311 participant-months; moderate-certainty evidence downgraded for risk of bias) but probably had little or no effect on mortality (HR 0.88, CI 0.66 to 1.17; 1 study, 9412 participant-months; moderate-certainty evidence downgraded for imprecision), hospital admissions (HR 0.89, CI 0.72 to 1.10; 1 study, 7599 participant-months; moderate-certainty evidence downgraded for imprecision) or falls (HR 1.03, CI 0.92 to 1.15; 1 study, 2275 participant-months; low-certainty evidence downgraded for imprecision and risk of bias). Delirium prevalence and severity were not assessed.In the enhanced educational intervention study, aimed at changing practice to address key delirium risk factors, it was not possible to determine the effect of the intervention on delirium incidence (RR 0.62, 95% CI 0.16 to 2.39; 1 study, 137 resident months; very low-certainty evidence downgraded for risk of bias and serious imprecision) or delirium prevalence (RR 0.57, 95% CI 0.15 to 2.19; 1 study, 160 participants; very low-certainty evidence downgraded for risk of bias and serious imprecision). There was probably little or no effect on mortality (RR 0.82, CI 0.50 to 1.34; 1 study, 215 participants; moderate-certainty evidence downgraded for imprecision). The intervention was probably associated with a reduction in hospital admissions (RR 0.67, CI 0.57 to 0.79; 1 study, 494 participants; moderate-certainty evidence downgraded due to indirectness). AUTHORS' CONCLUSIONS: Our review identified limited evidence on interventions for preventing delirium in older people in LTC. A software-based intervention to identify medications that could contribute to delirium risk and trigger a pharmacist-led medication review, probably reduces incidence of delirium in older people in institutional LTC. This is based on one large RCT in the US and may not be practical in other countries or settings which do not have comparable information technology services available in care homes. In the educational intervention aimed at identifying risk factors for delirium and developing bespoke solutions within care homes, it was not possible to determine the effect of the intervention on delirium incidence, prevalence or mortality. This evidence is based on a small feasibility trial. Our review identified three ongoing trials of multicomponent delirium prevention interventions. We identified no trials of pharmacological agents. Future trials of multicomponent non-pharmacological delirium prevention interventions for older people in LTC are needed to help inform the provision of evidence-based care for this vulnerable group.


Assuntos
Delírio/prevenção & controle , Assistência de Longa Duração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Delírio/induzido quimicamente , Delírio/epidemiologia , Idoso Fragilizado , Humanos , Incidência , Institucionalização , Reconciliação de Medicamentos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Rev Assoc Med Bras (1992) ; 65(3): 394-403, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994839

RESUMO

OBJECTIVE: To propose a program of physical-cognitive dual task and to measure its impact in Chilean institutionalized elderly adults. METHOD: Experimental design study with pre and post-intervention evaluations, measuring the cognitive and depressive levels by means of the Pfeiffer test and the Yesavage scale, respectively. The program was applied for 12 weeks to adults between 68 and 90 years old. The statistical analysis was based on the nonparametric Wilcoxon test for paired samples and was contrasted with its parametric version. The statistical software R was used. RESULTS: Statistically significant differences were obtained in the cognitive level (p-value < 0.05) and highly significant (p-value < 0.001) in the level of depression with both tests (parametric and nonparametric). CONCLUSION: Due to the almost null evidence of scientific interventions of programs that integrate physical activity and cognitive tasks together in Chilean elderly adults, a program of physical-cognitive dual task was proposed as a non-pharmacological treatment, easy to apply and of low cost to benefit their integral health, which improves significantly the cognitive and depressive levels of institutionalized elderly adults.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Disfunção Cognitiva/terapia , Transtorno Depressivo/terapia , Terapia por Exercício/métodos , Saúde Mental , Avaliação de Programas e Projetos de Saúde , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Chile , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo/fisiopatologia , Feminino , Habitação para Idosos , Humanos , Institucionalização , Masculino , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
16.
Geriatr Psychol Neuropsychiatr Vieil ; 17(2): 153-162, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30944084

RESUMO

OBJECTIVES: Outcome in hip fracture patients tends to be poor, with an associated death rate of 20 to 33%. The primary aim of our monocentric retrospective study was to compare mortality rates one year after surgery in patients with extracapsular fracture versus patients with intracapsular fracture of the proximal femur. Our secondary aims were the evaluation of functional independence and the rate of institutionalization one year after surgery. METHODS: We compared two groups of 100 patients. The first group had an average age of 83.2 years, and the patients underwent total hip replacement for intracapsular fracture. Patients in the second group, who underwent osteosynthesis for extracapsular fracture, were aged 83.6 years on average. RESULTS: One year post-surgery, there was not a significant difference in mortality between the two groups (23% for extracapsular fracture vs 22% for intracapsular fracture). The rate of independent walking was significantly better in the intracapsular fracture group (42.3% vs 27.3%, p=0.047), and the rate of institutionalization was significantly higher in the extracapsular fracture group (35.8% vs 17.3%, p=0.043). CONCLUSION: Elderly patients with hip fracture are prone to poor outcomes. When compared with osteosynthesis, total hip replacement does not lead to higher mortality rates though it is a more complex surgery. Our findings raise questions regarding of treatment for extracapsular fracture and the choice between osteosynthesis or total hip replacement with a reconstruction of the proximal femur.


Assuntos
Fraturas do Quadril/mortalidade , Fraturas do Quadril/patologia , Articulação do Quadril/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/cirurgia , Humanos , Vida Independente , Institucionalização/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Caminhada
17.
J Appl Res Intellect Disabil ; 32(4): 932-941, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30950144

RESUMO

BACKGROUND: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. METHODS: The study reports on an ethnographic study using the field-notes and the 26 semi-structured interviews with detained women and staff on three wards. RESULTS: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. CONCLUSION: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.


Assuntos
Institucionalização , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Tratamento Psiquiátrico Involuntário , Pessoas com Deficiência Mental/psicologia , Pessoas com Deficiência Mental/reabilitação , Adulto , Inglaterra , Feminino , Humanos , Legislação como Assunto , Programas Nacionais de Saúde , Autonomia Pessoal , Pesquisa Qualitativa
18.
Brain Behav ; 9(5): e01281, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30941926

RESUMO

Polymerase gamma (POLG) is an enzyme responsible for the replication and repair of mitochondrial DNA. Mutations in POLG may cause variable clinical manifestations, including parkinsonism, epilepsy, cerebellar ataxia, neuropathy, and progressive external ophthalmoplegia. However, mutations of this gene are rare in patients with typical Parkinson's disease (PD). We report a man (current age: 59 years) without any underlying disease presenting with right-hand tremor at the age of 39 years, followed by slow movement, rigidity, and postural instability. He developed motor fluctuation and levodopa-induced dyskinesia 8 years later. At the age of 58 years, cognitive decline and visual hallucination ensued; he was institutionalized thereafter. We used multiplex ligation-dependent probe amplification, which demonstrated no large deletions or duplications of relevant PD genes. Next, targeted sequencing panel covering 51 genes causative for PD was applied for the proband; it revealed a heterozygous missense substitution R964C in POLG and a heterozygous missense substitution L444P in GBA. The patient's father, who had been diagnosed as having PD and type 2 diabetes mellitus at the age of 70 years, demonstrated identical mutations. This is the first report of familial PD combined with POLG R964C and GBA L444P mutations. Two pathogenic gene mutations potentially cause double hit in pathological neurodegeneration. This finding extends our understanding of the PD genotype-phenotype correlation.


Assuntos
Disfunção Cognitiva , Polimerase do DNA Mitocondrial/genética , Glucosilceramidase/genética , Alucinações , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Estudos de Associação Genética , Alucinações/diagnóstico , Alucinações/etiologia , Humanos , Institucionalização , Masculino , Pessoa de Meia-Idade , Destreza Motora , Mutação , Doença de Parkinson/genética , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Doença de Parkinson/terapia
19.
Rev Esc Enferm USP ; 53: e03458, 2019 Mar 28.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942298

RESUMO

OBJECTIVE: To identify the best available evidence on the efficacy of Reminiscence Therapy in cognition, depressive symptoms and quality of life in elderly individuals with cognitive impairment. METHOD: The methodology proposed by the Joanna Briggs Institute was used. Studies focused on group Reminiscence Therapy aimed at institutionalized elderly people with cognitive impairment aged 65 or over were considered. The critical analysis, extraction and synthesis of results was performed by two independent researchers. RESULTS: Four randomized clinical trials and two quasi-experimental studies (n=296) were included. Given the heterogeneous characteristics of studies found, it was impossible to perform a meta-analysis. Of the six studies included, two presented statistically significant results for efficacy in cognition, and three for efficacy in reducing depressive symptoms. In none of the studies was evaluated the elderly's quality of life. CONCLUSION: Reminiscence Therapy has potential efficacy for maintaining cognition and decrease of depressive symptomatology in the target population.


Assuntos
Disfunção Cognitiva/terapia , Depressão/terapia , Psicoterapia de Grupo/métodos , Idoso , Cognição , Humanos , Institucionalização , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Farm. hosp ; 43(2): 53-55, mar.-abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182590

RESUMO

Objetivo: Analizar la interacción levofloxacino-acenocumarol en ancianos y determinar la influencia de la hipoalbuminemia en el incremento del international normalized ratio. Método: Estudio observacional retrospectivo en ancianos institucionalizados que recibieron simultáneamente acenocumarol y levofloxacino. Se analizó la variación del international normalized ratio durante el tratamiento con levofloxacino mediante la prueba t-Student. Se estudió la relación entre la albuminemia y la variación del international normalized ratio mediante el coeficiente de correlación de Pearson. Resultados: La media del international normalized ratio previa al tratamiento con levofloxacino fue de 2,5 (desviación estándar 0,6) y durante el tratamiento fue de 4,7 (desviación estándar 1,9) (p < 0,05). En el 54,3% de los casos el valor del international normalized ratio fue igual o superior a 4,5. La prueba de Pearson no mostró asociación lineal entre la albuminemia y el incremento del international normalized ratio (R = -0,16). Conclusiones: En más de la mitad de las ocasiones, el international normalized ratio alcanzó valores de relevancia clínica (≥ 4,5). No se evidenció influencia de la hipoalbuminemia en el incremento del international normalized ratio


Objective: To analyze the interaction between acenocoumarol and levofloxacin in the elderly. We also assessed how hypoalbuminemia affects international normalized ratio variation. Method: Retrospective study carried on elderly institutionalized patients who were prescribed levofloxacin concomitantly with acenocoumarol. International normalized ratio variation during levofloxacin treatment was analyzed with the t-Student test. Correlation between albuminemia and international normalized ratio variation was calculated using Pearson's correlation coefficient. Results: The mean international normalized ratio previous to treatment with levofloxacin was 2.5 (standard deviation: 0.6) and during treatment it was 4.7 (standard deviation: 1.9) (p < 0.05). In 54.3% of the cases, the international normalized ratio value was equal to or greater than 4.5. Not linear association between albuminemia and international normalized ratio increase was found using Pearson's test (R = -0.16). Conclusions: In more than half of the occasions international normalized ratio raised to clinically rellevant values (≥ 4.5). No influence of hypoalbuminemia in the increase in international normalized ratio was shown


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Acenocumarol/efeitos adversos , Anticoagulantes/efeitos adversos , Levofloxacino/efeitos adversos , Coagulação Sanguínea , Interações de Medicamentos , Institucionalização , Coeficiente Internacional Normatizado , Estudos Retrospectivos , Albumina Sérica/análise
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