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1.
Clin Interv Aging ; 14: 1783-1795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695348

RESUMO

Objective: To explore variation in medication regimen complexity in residential aged care facilities (RACFs) according to resident age, length of stay, comorbidity, dementia severity, frailty, and dependence in activities of daily living (ADLs), and compare number of daily administration times and Medication Regimen Complexity Index (MRCI) as measures of regimen complexity. Methods: This study was a cross-sectional analysis of baseline data from the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial. The SIMPLER study recruited 242 residents with at least one medication charted for regular administration from 8 RACFs in South Australia. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Dementia severity was assessed using the Dementia Severity Rating Scale. Frailty was assessed using the FRAIL-NH scale. Dependence in ADLs was assessed using the Katz ADL scale. Results: The median age of participants was 87 years (interquartile range 81-92). Over one-third of participants (n=86, 36%) had 5 or more daily medication administration times. The number of daily administration times and MRCI scores were positively correlated with resident length of stay (rs=0.19; 0.27), FRAIL-NH score (rs=0.23; 0.34) and dependence in ADLs (rs=-0.21; -0.33) (all p<0.01). MRCI was weakly negatively correlated with CCI score (rs=-0.16; p=0.013). Neither number of daily administration times nor MRCI score were correlated with age or dementia severity. In multivariate analysis, frailty was associated with number of daily administration times (OR: 1.13, 95% CI: 1.03-1.24) and MRCI score (OR: 1.26, 95% CI: 1.13-1.41). Dementia severity was inversely associated with both multiple medication administration times (OR: 0.97, 95% CI: 0.94-0.99) and high MRCI score (OR: 0.95, 95% CI: 0.92-0.98). Conclusion: Residents with longer lengths of stay, more dependent in ADLs and most frail had the most complex medication regimens and, therefore, may benefit from targeted strategies to reduce medication regimen complexity.


Assuntos
Demência , Fragilidade , Preparações Farmacêuticas , Atividades Cotidianas , Fatores Etários , Idoso de 80 Anos ou mais , Moradias Assistidas , Comorbidade , Estudos Transversais , Demência/complicações , Feminino , Fragilidade/complicações , Humanos , Tempo de Internação , Assistência de Longa Duração , Masculino , Sistemas de Medicação , Preparações Farmacêuticas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Austrália do Sul
3.
Sensors (Basel) ; 19(18)2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31540042

RESUMO

During the last decades there has been a rapidly growing elderly population and the number of patients with chronic heart-related diseases has exploded. Many of them (such as those with congestive heart failure or some types of arrhythmias) require close medical supervision, thus imposing a big burden on healthcare costs in most western economies. Specifically, continuous or frequent Arterial Blood Pressure (ABP) and electrocardiogram (ECG) monitoring are important tools in the follow-up of many of these patients. In this work, we present a novel remote non-ambulatory and clinically validated heart self-monitoring system, which allows ABP and ECG monitoring to effectively identify clinically relevant arrhythmias. The system integrates digital transmission of the ECG and tensiometer measurements, within a patient-comfortable support, easy to recharge and with a multi-function software, all of them aiming to adapt for elderly people. The main novelty is that both physiological variables (ABP and ECG) are simultaneously measured in an ambulatory environment, which to our best knowledge is not readily available in the clinical market. Different processing techniques were implemented to analyze the heart rhythm, including pause detection, rhythm alterations and atrial fibrillation, hence allowing early detection of these diseases. Our results achieved clinical quality both for in-lab hardware testing and for ambulatory scenario validations. The proposed active assisted living (AAL) Sensor-based system is an end-to-end multidisciplinary system, fully connected to a platform and tested by the clinical team from beginning to end.


Assuntos
Moradias Assistidas , Coração/fisiologia , Monitorização Fisiológica/instrumentação , Telemedicina/instrumentação , Algoritmos , Eletrocardiografia , Humanos , Aplicativos Móveis , Processamento de Sinais Assistido por Computador , Interface Usuário-Computador
4.
Dement Geriatr Cogn Disord ; 47(3): 157-163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31247628

RESUMO

BACKGROUND: People have various and changing needs as they age, and the number of people living with some form of dementia is steadily increasing. Smart homes have a unique potential to provide assisted living but are often designed rigidly with a specific and fixed problem in mind. OBJECTIVES: To make smart-ready homes and communities that can be adaptively and easily updated over time to support varying user needs and to deliver the needed assistance, empowerment, and living independence. METHOD: The design and deployment of programmable assistive environment for older adults. RESULTS: The use of platform technology (a special form of what is known today as the Internet of Things or IoT) has enabled the decoupling of goal setting and application development from sensing and assistive technology deployment and insertion in the assistive environment. Personalising a smart home or changing its applications and its interfaces dynamically as the user needs change was possible and has been demonstrated successfully in one house - the Gator Tech Smart House. Scaling up the platform technology approach to a planned living community is underway at one of UK's National Health Services (NHS) Healthy New Town projects. CONCLUSIONS: There is a great need to integrate technology with living spaces to provide assistance and independent living, but to smarten these spaces for lifelong living, the technology and the smart home applications must be flexible, adaptive, and changeable over time. However, people do not just live at home, they live in communities. Looking at the big picture (communities), as well as the small (homes), we consider how to progress beyond smart-ready homes towards smart-ready communities.


Assuntos
Moradias Assistidas/organização & administração , Demência/terapia , Equipamentos de Autoajuda/tendências , Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Assistência à Saúde , Humanos , Vida Independente , Medicina Estatal , Reino Unido
5.
Geriatr Nurs ; 40(3): 338-341, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31202425

RESUMO

A total incontinence management program will benefit a community's administration, nurses, caregivers, families and most importantly, residents. An incontinence program helps reduce the risk of incidences such as agitation, urinary tract infection, falls and skin complications which assisted living and memory care communities are trying to prevent. The correct evaluation tools increase the likelihood of successful outcomes because the program has to be the right program for the resident. After evaluation of the level of incontinence, the resident can then be enrolled. This article provides a practical toolkit for assessment of a resident in assisted living general or memory care populations in addition to the different types of programs a resident can enroll into after evaluation completed.


Assuntos
Moradias Assistidas , Enfermagem Geriátrica , Inquéritos e Questionários , Incontinência Urinária/enfermagem , Idoso , Cuidadores , Feminino , Humanos , Infecções Urinárias/prevenção & controle
6.
Gerontologist ; 59(3): e207-e222, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31099851

RESUMO

BACKGROUND AND OBJECTIVES: This paper critically reviewed the scientific literature on recreational activity (RA) behaviors in assisted living (AL) communities. RESEARCH DESIGN AND METHODS: A search of three databases yielded 70 quantitative, qualitative, and observational articles that met criteria for inclusion. RESULTS: AL residents participated in various types of RA, however, did so infrequently. Individual, interindividual, environmental, and relocation factors influenced RA behaviors, and participation may relate to positive consequences for residents and AL communities. This review identified multiple limitations in the literature related to construct definitions, measurement protocols, and incomplete or absent theoretical frameworks. DISCUSSION AND IMPLICATIONS: To address these limitations, the current review proposes a multivariate measurement model and an interdisciplinary theoretical model of factors relating to RA, consistent with an ecological framework. The proposed models appreciate individual psychological factors that influence the multiple facets of human choice and behavior, as well as the interaction between individuals and the unique sociophysical environment of AL. This paper concludes with recommendations for future research, emphasizing studies that have applied implications for practice and policy.


Assuntos
Moradias Assistidas , Recreação , Idoso , Moradias Assistidas/organização & administração , Moradias Assistidas/estatística & dados numéricos , Humanos , Modelos Teóricos
7.
J Gerontol Nurs ; 45(5): 23-29, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31026329

RESUMO

The purpose of the current project was to determine the effectiveness of training and communication tools used as intervention strategies to reduce unnecessary emergency department transfers of assisted living facility (ALF) residents. Two communication protocols (SBAR and STOP and WATCH) were introduced to standardize clinical communication among licensed practical nurses (LPNs) and clinical providers. Twenty-nine LPNs working in an ALF with 172 units were recruited. LPNs participated in an intervention intended to improve knowledge on geriatric syndromes. Pre- and postintervention testing revealed improved LPN knowledge of geriatric syndromes. A satisfaction survey indicated positive LPN acceptance of the standardized communication tools. Through daily auditing of charts, adherence with use of the SBAR tool was 87%. This evidence-based, educational intervention project aimed to improve nursing staff geriatric knowledge, monitor nurse adherence to using the SBAR and STOP and WATCH tools, and assess overall satisfaction with use of SBAR. [Journal of Gerontological Nursing, 45(5), 23-29.].


Assuntos
Moradias Assistidas/normas , Serviços Médicos de Emergência/normas , Enfermagem Geriátrica/educação , Enfermagem Geriátrica/normas , Recursos Humanos de Enfermagem no Hospital/educação , Transferência de Pacientes/normas , Melhoria de Qualidade/normas , Adulto , Idoso , Comunicação , District of Columbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
8.
Drugs Aging ; 36(6): 571-579, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30949985

RESUMO

BACKGROUND: One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time. OBJECTIVE: The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. METHODS: Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. RESULTS: Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. CONCLUSIONS: The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.


Assuntos
Moradias Assistidas , Doença das Coronárias/prevenção & controle , Instituição de Longa Permanência para Idosos , Casas de Saúde , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Doença das Coronárias/epidemiologia , Estudos Transversais , Demência/epidemiologia , Uso de Medicamentos/tendências , Feminino , Finlândia , Humanos , Masculino , Prevenção Secundária/tendências , Acidente Vascular Cerebral/epidemiologia
9.
BMC Geriatr ; 19(1): 97, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940078

RESUMO

BACKGROUND: There is lack of adequate training and policy support for employed care workers (CWs) employed in the South African (SA) older persons' sector. Existing literature neglects the influence of training and policy support on CWs' experiences in long-term care (LTC) for older adults in residential care facilities (RCFs). We investigated the ways in which CWs' experiences are rooted in the lack of adequate training and policy support. METHODS: Qualitative data was collected through focus group (FG) interviews with 32 CWs employed in RCFs in the City of Cape Town. Data was also collected using semi-structured interviews with representatives of five RCFs for older adults and four training organisations providing CW training in the City of Cape Town, South Africa. RESULTS: Despite some positive caregiving experiences, CWs face role ambiguity and experience care work as a 'career-less job'. They also face poor employment conditions, negative interpersonal relations at work, and role overload. They are not coping with the demands of LTC due to role overload, and lack of basic caregiving skills, coping skills and socio-emotional support. Their motivation to cope and provide quality care is hamstrung by their experiences of role ambiguity, poor employment conditions, negative interpersonal relations at work, and lack of career growth opportunities. CONCLUSIONS: Findings suggest that CWs' experiences derive from the policy and structural context of caregiving. Policy inadequacies and lack of structural support create conditions for adverse conditions which negatively impact on CWs motivation and ability to cope with the demands of LTC. Lack of policy implementation presents structural barriers to quality LTC in the older persons' sector. Implementation of policies and systems for professionalising care work is long overdue.


Assuntos
Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , Instituição de Longa Permanência para Idosos/normas , Assistência de Longa Duração/psicologia , Assistência de Longa Duração/normas , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas/tendências , Feminino , Pessoal de Saúde/tendências , Instituição de Longa Permanência para Idosos/tendências , Humanos , Relações Interpessoais , Assistência de Longa Duração/tendências , Masculino , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , África do Sul/epidemiologia
10.
Kobe J Med Sci ; 64(5): E180-E188, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30988265

RESUMO

PURPOSE: This study assessed the symptoms, treatment, social systems use, and perception of living conditions of patients with young-onset Parkinson's disease (YOPD), and investigated the support needed by them. METHOD: Among the 252 people who completed our questionnaire, we defined YOPD patients as those diagnosed as young onset or those with onset at ≤40 years. The data were compared with others. RESULTS: There were 24 patients with YOPD (9.5%) (average age: 61.7 years), with an average disease duration 6.4 years longer (p < 0.01) and time until diagnosis 0.7 years longer (p < 0.1) than those of other patients. This group took 1.6 times more types of medicines, and time to their next appointment was 8.6 days shorter than that of other patients (p < 0.05). Patients with YOPD had more pulsive walking and more sweating (p < 0.05), and more motor fluctuation (p < 0.1). More patients with YOPD had a physical disability certificate but felt they were not obtaining the required services (p < 0.05). 45.0% of the YOPD group wanted to work more, more used information and communication equipment (p < 0.05), and more felt their medications were adequate (p < 0.1). CONCLUSIONS: Increased awareness of YOPD is needed. YOPD patients have motor fluctuation because of the longer disease duration. Thus, the support of doctors and nurses, and frequent examination visits, are indispensable for controlling symptoms to achieve middle age developmental tasks. Increased support for care-giving, leisure-time activities, and work is also necessary and may help maintain the desire to work in this group.


Assuntos
Idade de Início , Doença de Parkinson/terapia , Sistemas de Apoio Psicossocial , Adulto , Idoso , Moradias Assistidas , Conscientização , Cuidadores , Família , Feminino , Humanos , Japão , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Transtornos Motores/fisiopatologia , Transtornos Motores/terapia , Doença de Parkinson/fisiopatologia , Condições Sociais , Inquéritos e Questionários
11.
BMC Med ; 17(1): 49, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30813926

RESUMO

BACKGROUND: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. METHODS: A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls. RESULTS: Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was £15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY. CONCLUSIONS: Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736 .


Assuntos
Terapia por Exercício/métodos , Qualidade de Vida/psicologia , Gravação em Vídeo/métodos , Moradias Assistidas , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
13.
Geriatr Nurs ; 40(2): 225-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30879705

RESUMO

The Assisted Living (AL) nurse competencies article identifies the application of Benner's theoretical framework (novice to expert) and a sample structure for several key domains of nursing practice knowledge from the AL Nursing: A Manual for Management and Practice. On behalf of the American Assisted Living Nurse Association (AALNA), the co-authors seek feedback on the proposed structure for identifying important nurse competencies for the Assisted Living nurse community/facility leader.


Assuntos
Moradias Assistidas , Competência Clínica/normas , Modelos de Enfermagem , Recursos Humanos de Enfermagem/organização & administração , Humanos , Desenvolvimento de Pessoal/organização & administração
14.
Ann Allergy Asthma Immunol ; 122(5): 486-491, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30831256

RESUMO

BACKGROUND: We describe a multifaceted home environmental intervention project involving low-income older adults with asthma who have a greater risk of asthma-related respiratory impacts because they spend up to 90% of their time in the home where many allergens and respiratory irritants are found. Although sufficient evidence suggests that home interventions are effective in improving health of children with asthma, the Task Force on Community Preventive Services has stated that evidence is insufficient for the effectiveness of home interventions on adults with asthma. OBJECTIVE: To evaluate the hypothesis that multifaceted home environmental interventions improve the respiratory health and reduce asthma triggers for older adults with asthma. METHODS: We conducted community health worker-led interventions in the homes of 86 low-income older adults (age 62 or older) diagnosed with asthma, residing in public and private subsidized housing in Lowell, Massachusetts, from 2014 to 2017. Health and environmental assessment at baseline and follow-up 1 year later included collecting data on respiratory health, quality of life, medication use, doctor/emergency room/hospital visits, using the St. George Respiratory Questionnaire and Asthma Control Test and evaluation of asthma trigger activities and exposures through questionnaires and home surveys. Interventions included education on asthma and environmental triggers and environmental remediation. RESULTS: Statistically significant reductions in self-reported environmental asthma triggers and health improvements were found in the following areas: doctor visits, use of antibiotics for chest problems, respiratory symptoms and quality of life indicators, and asthma control (ACT score). CONCLUSION: Our results provide evidence that multifaceted home interventions are effective in improving the environmental quality and respiratory health of an older adult population with asthma.


Assuntos
Asma/psicologia , Recuperação e Remediação Ambiental/métodos , Conhecimentos, Atitudes e Prática em Saúde , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas , Asma/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Pobreza , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Inquéritos e Questionários
15.
J Aging Stud ; 48: 1-8, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832925

RESUMO

Dominant approaches to relational aggression among older adults tend to conceptualize the problem as a behavioral or interpersonal issue, and can inadvertently infantilize the phenomenon as 'bullying.' In this article we use a narrative approach and the conceptual lens of precarity to develop an in-depth, theoretically informed analysis of relational aggression between older women in low-income assisted living. The analysis of the narratives of tenants (and a manager) indicated that past life experiences and intersecting threats to power and identity shaped and could intensify tenants' interpretations of and reactions to others' actions and comments. Conflicts over a) unequal distributions of caring labor, b) control of social activities, and c) access to appreciation are complex and rational responses to precarious contextual conditions. Findings contribute empirically to the body of research on relational aggression among older adults, expanding this field through connecting it to critical gerontological conceptualizations of precarity. Preventing relational aggression requires increased public investment in formal social supports for older adults, challenging dominant discourses that privilege independence, and recognizing how the legacies of past disadvantage and contextual precarity (as opposed to mental illness or dementia) shape social interactions with and responses to others.


Assuntos
Agressão , Moradias Assistidas , Instituição de Longa Permanência para Idosos , Relações Interpessoais , Modelos Psicológicos , Pobreza , Idoso , Feminino , Humanos , Manitoba , Saúde da Mulher
16.
Geriatr Nurs ; 40(4): 417-423, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30853130

RESUMO

Excessive daytime sleepiness (EDS) is prevalent in older adults; however, data are lacking that examine EDS across living environments. The aims of this secondary data analysis were to identify the prevalence and predictors of EDS among older adults receiving long-term services and supports (LTSS) in assisted living communities (ALCs), nursing homes (NHs), and the community. Participants (n = 470) completed multiple measures including daytime sleepiness. Logistic regression modeling was used to identify EDS predictors. Participants were primarily female and white with a mean age of 81 ± 9 years. The overall prevalence of EDS was 19.4%; the prevalence differed across living environment. Older adults in ALCs and NHs had higher odds of EDS than those living in the community. Also, depressive symptoms and number of bothersome symptoms predicted EDS. Upon admission for LTSS, evaluating older adults, especially those in ALCs and NHs, for depression and bothersome symptoms may reveal modifiable factors of EDS.


Assuntos
Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Pacientes Internados/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso de 80 Anos ou mais , Moradias Assistidas/estatística & dados numéricos , Depressão/psicologia , Feminino , Humanos , Vida Independente/estatística & dados numéricos , Pacientes Internados/psicologia , Masculino , Casas de Saúde/estatística & dados numéricos , Prevalência , Estados Unidos
17.
Sensors (Basel) ; 19(4)2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30781852

RESUMO

BACKGROUND: Ambiguities and anomalies in the Activity of Daily Living (ADL) patterns indicate deviations from Wellness. The monitoring of lifestyles could facilitate remote physicians or caregivers to give insight into symptoms of the disease and provide health improvement advice to residents; Objective: This research work aims to apply lifestyle monitoring in an ambient assisted living (AAL) system by diagnosing conduct and distinguishing variation from the norm with the slightest conceivable fake alert. In pursuing this aim, the main objective is to fill the knowledge gap of two contextual observations (i.e., day and time) in the frequent behavior modeling for an individual in AAL. Each sensing category has its advantages and restrictions. Only a single type of sensing unit may not manage composite states in practice and lose the activity of daily living. To boost the efficiency of the system, we offer an exceptional sensor data fusion technique through different sensing modalities; Methods: As behaviors may also change according to other contextual observations, including seasonal, weather (or temperature), and social interaction, we propose the design of a novel activity learning model by adding behavioral observations, which we name as the Wellness indices analysis model; Results: The ground-truth data are collected from four elderly houses, including daily activities, with a sample size of three hundred days plus sensor activation. The investigation results validate the success of our method. The new feature set from sensor data fusion enhances the system accuracy to (98.17% ± 0.95) from (80.81% ± 0.68). The performance evaluation parameters of the proposed model for ADL recognition are recorded for the 14 selected activities. These parameters are Sensitivity (0.9852), Specificity (0.9988), Accuracy (0.9974), F1 score (0.9851), False Negative Rate (0.0130).


Assuntos
Atividades Cotidianas , Moradias Assistidas/tendências , Técnicas Biossensoriais/métodos , Idoso , Cuidadores , Humanos
18.
J Public Health Dent ; 79(3): 198-206, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30741490

RESUMO

OBJECTIVES: The specific aims of this study were to describe the baseline oral health status of persons residing in North Carolina assisted living facilities and determine how identified oral health problems vary according to resident and facility demographic variables. METHODS: This cross-sectional descriptive epidemiologic study used a statewide random sample of 40 assisted living facilities and a convenience sample of 854 assisted living residents. Dental hygienists and dentists conducted oral screenings on residents using the Association of State and Territorial Dental Director's Basic Screening Survey for Older Adults tool. RESULTS: Nearly one-third of participants were younger than 65. Overall, poorer oral health was noted for non-Hispanic black residents, Medicaid recipients, residents of small facilities (20-60 beds), and residents of facilities located in the Coastal Plains region of the state. Oral health also worsened with increasing length of residence yet seemed to improve with age. The overall rate of edentulism was 29 percent, half of whom did not have complete dentures. Nearly half (48.6 percent) of residents had untreated decay. CONCLUSIONS: There is a need for policy and public health programming that addresses the broad racial and socioeconomic factors that contribute to disparities among the institutionalized. Furthermore, the oral health disparities between institutionalized and community-dwelling older adults reflect the need for policy that requires and ensures access to a minimum level of oral health care throughout the duration of a resident's stay. Programming to support such policy should include development of an oral health workforce that is competent in geriatric oral health care.


Assuntos
Moradias Assistidas , Idoso , Estudos Transversais , Nível de Saúde , Humanos , Medicaid , North Carolina , Saúde Bucal
19.
Gerodontology ; 36(2): 142-148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30724388

RESUMO

INTRODUCTION: The aim of the study was to describe the oral health status of persons with different cognition and dental-related functions (DRFs). METHODS: The present study was a secondary analysis of data collected for a cross-sectional study of residents in three assisted living facilities in North Carolina. The participants were aged 50 years or older, had normal to severely impaired cognition and spoke English. Upon obtaining informed consent, an oral assessment was completed by a trained geriatric dentist. A research team member who was blind to the oral examination outcomes then used the Minimum Data Set Cognition Scale to assess participants' cognition and the dental activities test to evaluate oral self-care and other DRFs. Descriptive statistics were used to describe the demographic, cognitive, functional and oral health status of the study participants. The impacts of cognitive and functional status on oral health measures were examined using simple linear regression models, negative binomial and zero-inflated negative binomial models. RESULTS: A total of 91 long-term residents from three long-term care facilities participated in the study. Oral hygiene and gingival health were significantly associated with cognition (P = 0.056 and P = 0.017, respectively) and DRFs (P = 0.013 and P = 0.008, respectively). Residents with poor cognitive and dental-related function also presented with poor oral hygiene and gingival health. CONCLUSION: The study results suggest that oral hygiene and gingival health were significantly associated with cognition and DRFs.


Assuntos
Moradias Assistidas , Cognição , Estudos Transversais , North Carolina , Casas de Saúde , Saúde Bucal
20.
BMC Geriatr ; 19(1): 46, 2019 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777017

RESUMO

BACKGROUND: The majority of institutionalized older adults do not exercise, despite the many health benefits. The current study investigated whether a framed intervention can motivate older adults in assisted living facilities (ALFs) to perform functional resistance exercises. It was hypothesized that repeated framing of these exercises from a prevention perspective (e.g., to avoid health deterioration) would nurture the development of controlled motivation to exercise. By contrast, repeated framing of the exercises from a promotion perspective (e.g., to improve health) was expected to lead to higher exercise frequencies over time and to foster the development of autonomous motivation. Autonomous motivation was hypothesized to predict higher exercise frequencies over time. METHODS: A total of 111 residents, aged 65+ years (M = 81.4 y; SD = 6.4 y) participated in the study. These participants received a printed three-week individual program with a standard session of eight functional resistance exercises. Four weekly sessions were recommended. Participants were semi-randomized into three framing conditions: neutral (i.e., control), prevention or promotion. They received condition-specific written and spoken messages about the exercises at the beginning of the intervention. The spoken messages were repeated at the end of each week. Participants kept a checklist with their weekly exercise frequency and at corresponding points in time, they completed a questionnaire about their levels of autonomous and controlled motivation to exercise. RESULTS: Across conditions and time points, the exercise frequencies and the levels of autonomous motivation were generally high, whereas the levels of controlled motivation were generally low. Contrary to the expectations, there were no significant framing effects. However, higher levels of autonomous motivation predicted higher exercise frequencies. During the final exercise week, this was especially the case for intrinsic regulation (i.e., for the sake of the activity). CONCLUSIONS: This study indicates that older adults who live in ALFs can be motivated to perform functional resistance exercises. Given the importance of intrinsic regulation, we advise to create an exercise atmosphere that allows for immediate, positive experiences and in which the basic psychological needs for autonomy, competence and relatedness are satisfied. TRIAL REGISTRATION: ClinicalTrialsID NCT02780037 (23 February 2016).


Assuntos
Moradias Assistidas , Intervenção Médica Precoce/métodos , Exercício/psicologia , Motivação , Treinamento de Resistência/métodos , Idoso , Idoso de 80 Anos ou mais , Exercício/fisiologia , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Motivação/fisiologia , Satisfação Pessoal , Inquéritos e Questionários
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