Dependence In Older People Research Articles

Coimpairments as predictors of severe walking disability in older women.

Severe disabilities are common among older people who have impairments in a range of physiologic systems. It is not known, however, whether the presence of multiple impairments, or coimpairments, is associated with increased risk of developing new disability. The aim of this study was to determine the combined effects of two impairments, decreased knee-extension strength and poor standing balance, on the risk of developing severe walking disability among older, moderately-to-severely disabled women who did not have severe walking disability at baseline. The Women's Health and Aging Study is a 3-year prospective study with 6 semi-annual follow-up data-collection rounds following the baseline. At baseline, knee-extension strength and standing balance tests took place in the participants' homes. 758 women who were not severely walking disabled at baseline. Severe walking disability was defined as customary walking speed of < 0.4 meters/second and inability to walk one quarter of a mile, or being unable to walk. Over the course of the study, 173 women became severely disabled in walking. The cumulative incidence of severe walking disability from the first to the sixth follow-up was: 7.8%, 12.0%, 15.1% 19.5% 21.2%, and 22.8%. In Cox proportional hazards models, both strength and balance were significant predictors of new walking disability. In the best balance category, the rates of developing severe walking disability expressed per 100 person years were 3.1, 6.1, and 5.3 in the highest- to lowest-strength tertiles. In the middle balance category, the rates were 9.6, 13.2, and 14.7, and in the poorest balance category 21.6, 12.7, and 37.1, correspondingly. The relative risk (RR) of onset of severe walking disability adjusted for age, height, weight, and race was more than five times greater in the group with poorest balance and strength (RR 5.12, 95% confidence limit [95% CI] 2.68-9.80) compared with the group with best balance and strength (the reference group). Among those who had poorest balance and best strength, the RR of severe walking disability was 3.08 (95% CI 1.33-7.14). Among those with best balance and poorest strength, the RR was 0.97 (95% CI 0.49-1.93), as compared with the reference group. The presence of coimpairments is a powerful predictor of new, severe walking disability, an underlying cause of dependence in older people. Substantial reduction in the risk of walking disability could be achieved even if interventions were successful in correcting only one of the impairments because a deficit in only one physiologic system may be compensated for by good capacity in another system.

Dependency in older people recently admitted to care homes

Dependency in older people recently admitted to care homes

Dependency in older people recently admitted to care homes.

to investigate dependency and general health status of a cohort of older people admitted to residential or nursing homes for long-term care. we assessed 308 people aged over 65 years within 2 weeks of admission for long-term care to one of 30 nursing or residential homes in north-west England. Dependency was assessed using the Barthel activities of daily living index and the Crichton Royal Behaviour Rating Scale. We collected information from the homes' records on diagnosed conditions and current medication. 50% of the cohort were in a 'low dependency' band (Barthel score 13 - 20): 31% of those in nursing homes and 71% of those in residential homes. In nursing homes, low-dependency residents were more likely to be self-funding than those with higher dependency. Of a number of broad diagnostic groupings, only a diagnosis of dementia was associated with nursing- rather than residential-home admission. Of 47 residents who scored 9 or less on the Mini-Mental State Examination (indicating severe cognitive impairment), 85% had no diagnosis of dementia, neurological disorder or other psychiatric disorder. the high proportion of new admissions of subjects with low dependency needs raises questions about the effective targeting of resources and about management of the boundary between home-based and institutional care. The existence of an important group of self-funded, low-dependency new admissions to nursing homes suggests a need to provide better assessment and placement services for those who are financially independent of local authorities. Many new admissions had conditions which might benefit from rehabilitation but there were almost no therapy staff in the studied homes. In some cases where severe cognitive impairment was evident, there was no evidence that the result of any formal pre-admission psychiatric evaluation had been communicated to nursing or care staff.

The relationship between the cost of community care and the dependency of old people

In this paper the relationship between resource use, costs and dependency is examined for a ‘captured population’ of old people living in the community but attending day hospital care. Dependency is measured using a Guttman (activities of daily living) based scale. Resource use is assigned by category of dependency and an opportunity cost methodology is used to estimate the cost of care. The results generally confirm that the overall cost of care increases with dependency, though there are exceptions to this trend when each component of care is analysed separately. For instance, not all elements of day hospital provision increase as dependency gets worse, as witnessed by the relatively low provision of paramedical care to old people in the highest category of dependency. The results also confirm that community care is not a cheap option. Once informal care is quantified and valued, the cost rises accordingly. Moreover, if persons living in the community are attending day hospital or have occasional in-patient stays in acute hospitals, costs will rise even more. This is not an argument against community care. Rather, it is to emphasize that while it may be better for some dependent old people to live at home it is not necessarily cheaper. This will come as no surprise to the many carers of old people whose work has rarely been satisfactorily taken into account in comparative analyses of the cost of care.

Learning and Memory Impairment in Older, Detoxified, Benzodiazepine-Dependent Patients

The effects of benzodiazepine dependence on the ability to learn and remember new material (determined with the Auditory-Verbal Learning Test) were studied in 20 detoxified, benzodiazepine-dependent patients who were 55 years of age or older and in a drug-dependence rehabilitation program. The patients were matched approximately for age, sex, and IQ with 20 detoxified, alcohol-dependent patients in the same rehabilitation program and 22 control subjects from a community sample. Neuropsychologic testing was performed a mean of 6 to 10 days after the patients had been completely detoxified from the addicting substance. The benzodiazepine-dependent patients had more difficulty with tests of learning and short-term and delayed recall than did the alcohol-dependent or control group. The difference between the benzodiazepine-dependent patients and the control group was statistically significant. The results suggest that benzodiazepine dependence in older people can cause memory impairment that persists into the early drug-free period.

The financing of long term care in Ireland

Major changes are proposed for the financing and regulation of the nursing home sector in Ireland. For the first time the payment of public subvention is to be related explicitly to the means and dependency of old people. More detailed proposals have, however, yet to be worked out. This paper reviews the proposed developments and makes concrete recommendations with respect to the means testing of income and assets. The Issue of consumer sovereignty is also considered. Finally, the necessity for a co-ordinated and Integrated policy with respect to the financing, regulation and organisation of public and private care is stressed, particularly as a means of improving the quality of service provision.

Socio-economic change and cultural continuity in the lives of the older Tswana

The rural villages of Botswana have a disproportionate number of children and aged resulting from out-migration of able-bodied adults for wage employment. The social position of the rural based aged people, as perceived by urbanites and villagers, was determined through ethnographic interviews and participant observation. The traditional elder contributory roles of childcare and agriculture for women and political and pastoral involvement by men have been modified, still allowing the active old to participate in community life as elders. Social old age occurs when dependency created by physical limitations outweighs contributions possible with body mobility. Minimal economic support provided by adult children to aged parents has been substituted for the fuller traditional expression of filial piety. Grandchildren provide physical care. Low incomes, inexperience with the large numbers of aged and consequent lack of behavioral norms place social emphasis on the economic dependency of old people rather than on the social and service needs as perceived by the socially old individuals, themselves.

Private nursing homes: contribution to long stay care of the elderly in the Brighton Health District.

Two surveys of private nursing homes, designated geriatric wards, and a sample of social service part III homes were carried out in the Brighton Health District using questionnaires supplemented (in the second survey) by some interviews. The dependency of old people in the private nursing homes was more like that of long stay hospital patients rather than that of residents in social services homes. In the private nursing homes, however, a smaller proportion of patients were in the medium to heavy nursing category (178 (31%) compared with 158 (63%) in the hospital long stay wards) and a larger proportion in the heavy nursing category (170 (30%) compared with 44 (17%) in the long stay wards). Of the patients in private nursing homes, 401 (82%) were local residents, 488 (86%) were long stay, and 459 (88%) were women; their mean age was 88 years. Two thirds of the patients were over 80. There were no significant differences between the private nursing homes and the wards in nursing workloads or staffing, except for a slightly higher provision of state registered nurses in the private sector. In the private nursing homes 348 (63%) of the patients had fees paid by private funds, 26 (5%) were in contract beds paid for by the National Health Service, and 176 (32%) were subsidized by the Department of Health and Social Security. Private nursing homes make a substantial contribution to the care of the elderly in the Brighton Health District, and the health authority should develop a more active partnership with this sector.