Abstract
BackgroundIn Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met.MethodsIn this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the “Timed Up-and-Go” test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant.ResultsOf 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in <10% of the patients.ConclusionsWe identified a very frail group of home-dwelling patients. For this group, resources for home nursing should probably be used in a more flexible and pro-active way to aim for preserving functional status, minimize symptom burden, and prevent avoidable hospitalisations.
Highlights
In Norway, as in many Western countries, a shift from institutional care to home care is taking place
Many suffer from an unstable health characterized by several chronic diseases, functional impairments and polypharmacy [2]
The team defined what should be regarded as a minimal justifiable level of nursing care in relation to the recorded cognitive functioning, muscle function, mobility, activities of daily living (ADL) functioning, diagnoses and drug use
Summary
In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. Many suffer from an unstable health characterized by several chronic diseases, functional impairments and polypharmacy [2]. They are at high risk for developing additional functional decline, and may be good candidates for preventive and early interventions [3]. In this patient group, symptoms of new diseases or worsening of existing diseases may be vague and uncharacteristic. Philip and co-workers reported that many hospital-based as well as community-based interventions developed may prevent hospital admittance of frail elderly persons [11]
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