Dependent Elderly Persons Research Articles

Significados de violência familiar contra o idoso na perspectiva de profissionais da Atenção Primária à Saúde

O presente estudo de cunho qualitativo buscou analisar os significados atribuídos à violência familiar contra o idoso, por profissionais que atuam na atenção primária à saúde. Participaram 10 profissionais com diferentes formações, de uma unidade de saúde de referencia para idosos, sendo os dados coletados por meio de entrevistas semiestruturadas e analisados segundo os princípios da Grounded Theory. Os dados foram integrados e organizados em categorias, subcategorias e elementos de análise. Os resultados evidenciaram que os participantes demonstraram a expectativa de que a família funcione como amparo e proteção e que a violência familiar é o que fere esse princípio. O significado de violência familiar contra o idoso mostrou-se alicerçado na ideia "do idoso frágil e dependente", limitando a visualização de casos que não se enquadram nesse perfil.

The Long-Term Care System for the Elderly in Belgium

This report describes the organisation of the Belgian long-term care system. It can be characterised as a mixed system, with extensive public care provision and the substantial support of informal care provided mainly within the family. While the current volume and quality of services appears to be adequate, the future increase in the number of dependent elderly persons over the next two decades as a result of demographic ageing can be expected to become a serious challenge, in terms of both the required formal and informal care capacity and financing.

Wellbeing and Dependency Among the European Elderly: The Role of Social Integration

This study aims at highlighting the importance of social integration for the wellbeing of dependent elderly persons living at home. This question is important because, as we can observe, social activities are not a priority for social policies regarding the dependent elderly in Europe. Here it is shown that social activities and contacts improve the wellbeing of the dependent elderly. Therefore, as depression is one of the factors leading to a dependency situation, attaching greater importance to social measures that encourage greater social integration of the dependent elderly should stimulate a decrease in their rates of depression, and consequently, allow a reduction in their demand for care too. The data used in this study stem from the European Community Household Panel (ECHP). The major results of this analysis are: health perception is strongly and positively correlated with satisfaction with the main activity. The importance of the correlation decreases somewhat, however, when social integration variables are included in the model. Except for ‘owning a telephone’, these latter variables have equally significant effects on satisfaction with the main activity. Dependent elderly persons who are members of a club, those who often meet their friends and relatives and those who often talk with their neighbors declare a higher satisfaction level than the rest. Satisfaction is largely correlated with the country of residence. Dependent elderly persons from southern countries and from Ireland declare to be less satisfied with their main activity than those from northern or Central Europe. In terms of housing, having a comfortable dwelling leads to higher satisfaction while living in a household consisting of several persons leads to a lower satisfaction. The standard of living is linked with satisfaction: both household and personal income increase satisfaction. Lastly, dependency-related social benefit transfers have no effect on satisfaction with the main activity.

Violencia del compañero íntimo: estudio con profesionales de enfermería

Aim Describe gender-based violence by intimate partners against female nurses in a sample of nurses in Andalucia, Spain. Design Descriptive transversal study. Setting Hospitals and primary health care districts in Andalucia. Participants Six hundred and twenty-two female nurses that wok as nurses in the eight provinces in Andalucia (Spain). Measures Social-demographic characteristics and presence of abuse (psychological, physical and sexual). Results 78.5% of the nurses were married or with a regular partner and had the economic income based on both salaries; 71.1% had a child or an elderly dependent person. It was proved that there can be a statistical association between abuse and: marital status; life together; familiar economic support and children and/or dependent elderly person. The average age was 42.5 ± 8.1 years old (22-62 years) and presented statistical age differences comparing both groups: abused (average 44 years) and non-abused (average 41.8 years). Between the married couples studied, 21.7% of them belong to the social class I and 16.9% to the social class II. Between all studied nurses, 33.0% suffered abuse, among which 75.1% were psychologically abused. Of all the abuse cases 60% were less severe and 40% more serious. Conclusions It was confirmed the presence of intimate partner violence (IPV) against nurses, which was predominantly psychological abuse, but others classes of abuse were present too.

Avaliação da qualidade de vida de idosos dependentes residentes em domicílio

The aim of this study is to assess the quality of life of dependent elderly persons living at home. This is an analytical study with a cross-sectional design. The sample was composed of 117 dependent elderly individuals enrolled in the Family Health Units of Jequiezinho, Bahia. The instruments used were Questionnaire assessment of the Quality of Life of the World Health Organization (WHOQOL-OLD) and Barthel`s Index; sociodemographic and health data were also collected. The mean age was 80.79 (± 9.77) years, with a predominance of women (70.09%), illiterates (63.25%), widows (46.15%) and family income between 1 and 3 minimum monthly wages (US$245.00-$735.00) (53.80%). Health problems were present in 93.16% of the elderly, the most frequent pathology being arterial hypertension (23.10%). Quality of life was most compromised in the social participation (32.03 points) and sensory functioning (40.76 points) domains. Thus, it is scientifically and socially important to assess the quality of life of the elderly in order to create intervention alternatives and propose health-related actions and policies to meet the demands of the aging population.

The Correlation of Home Care With Family Caregiver Burden and Depressive Mood: An Examination OF Moderating Functions

Amid long-term care expansion in response to a fast-growing aging population and a concomitant increase in dependency rate, home care provides a means of delivering support, under the policy tenet of “aging in place”. As supply rises, the potential function it may perform necessitates increased scrutiny. Few studies have examined home care in terms of its role as a buffer, capable of mitigating the impact of care stressors on the caregiver, such as burden or depressive mood. This study aimed to fill the gap. Data from 1,586 dependent elderly persons and their caregivers in the Pilot Program for Long-term Care Development in Taiwan in 2003 were analyzed. Hierarchical regression was used by entering respondent characteristics, the disabilities of the aged as stressors, home care as social support, and their interactions in sequential blocks. The results indicated that home care can moderate the effects of instrumental activities of daily living (IADL) on caregiver depressive mood. It was unable to moderate the effects of activities of daily living (ADL) and cognitive deficit on depressive mood. It also failed to moderate the effects of ADL, IADL and cognitive deficit on caregiver burden. The lack of a moderating effect of home care on most interaction terms may be the result of a low rate of service use. Despite low utilization, its ability to mitigate the negative impact of IADL on depressive mood reaffirms the necessity to conceptualize formal care as a type of social support and to examine its moderating function.

O uso da conferência familiar na resolução de conflitos de uma família com idosa dependente

A conferência familiar constitui-se em uma estratégia importante na abordagem a famílias com pessoas idosas dependentes. Uma equipe de saúde da família do Centro de Saúde da Família Francisco Domingos da Silva, Fortaleza, Ceará, realizou conferência familiar de uma família com uma idosa dependente de cuidados. Encontramos falta de envolvimento e resistência dos filhos no cuidado da idosa e sobrecarga do cuidador, que desejava internar a mãe em um asilo. Com o objetivo de esclarecer sobre direitos e deveres dos familiares de idosos dependentes e buscar soluções para uma melhor distribuição de tarefas na atenção à saúde da paciente, foi realizada a conferência familiar. Os próprios familiares relataram a importância do encontro e o papel dos profissionais na adoção de medidas que melhoraram a situação de convivência e a dinâmica familiar.

Les soins de longue durée aux personnes âgées: Choix d'un système clinico-administratif dans le contexte d'un réseau de soins intégrés

ABSTRACTFor the past 10 years, in long-term care systems, we have witnessed the accelerated deployment of casemix management systems. A casemix is formed by clusters, defined by individual characteristics that explain similar resource use. However, certain questions regarding the development of these systems must be raised. Moreover, none of these systems was developed in the context of an integrated care organization that can track the progress of a dependent elderly person through every kind of care arrangement available—from own home, through intermediate facility, to long-term care institution. This article emphasizes the necessity of being well informed about the features of existing systems, in order to choose or develop the system that best answers the goals of a particular health care system. Finally, it underlines important elements that should be considered in each step of the development of a casemix system in this context.

Long-term care for the elderly: choice of a clinical managerial system in the context of an integral care network

For the past 10 years, in long-term care systems, we have witnessed the accelerated deployment of casemix management systems. A casemix is formed by clusters, defined by individual characteristics that explain similar resource use. However, certain questions regarding the development of these systems must be raised. Moreover, none of these systems was developed in the context of an integrated care organization that can track the progress of a dependent elderly person through every kind of care arrangement available-from own home, through intermediate facility, to long-term care institution. This article emphasizes the necessity of being well informed about the features of existing systems, in order to choose or develop the system that best answers the goals of a particular health care system. Finally, it underlines important elements that should be considered in each step of the development of a casemix system in this context.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

Circadian rhythm abnormalities of wrist activity of institutionalized dependent elderly persons with dementia.

The study objective was to clarify the descriptive characteristics of circadian rhythm abnormalities of wrist activity of the institutionalized elderly with dementia. We studied 82 elderly persons with dementia who were institutionalized in a long-term medical care facility. The ambulatory continuous monitoring of their wrist activity was conducted for 7 days at 1-minute intervals. The time series data were analyzed using the double-plotted chronogram, spectral analysis was performed using the fast Fourier transformation and periodogram analysis was performed as well. The frequency of circadian rhythm abnormalities of wrist activity rhythm in elderly persons with dementia was 57.3% (47 out of 82). The abnormalities were classified into four categories: severely impaired circadian rhythm type with no boundary between day and night, free-running rhythm type, decreased circadian amplitude type, and accentuation of ultradian rhythm type. This four-category classification system provides a scientific approach for studying the mechanisms of circadian activity rhythm abnormalities of elderly persons with dementia.

Medication administration hassles reported by family caregivers of dependent elderly persons.

Even under the new long-term care mantra for increased home- and community-based care options, attention to and an understanding of the ways that family caregivers are managing complex care for dependent elderly persons, for example, with medication administration, have been slow to materialize. Twenty-three family caregivers completed semistructured, face-to-face interviews to capture the shared and idiosyncratic experiences of individuals responsible for all aspects of medication administration regimens for elderly, dependent family members. Data analysis consisted of content analysis of the verbatim interview transcripts. This article reports an emerging typology of caregiver medication administration hassles derived from the interviews. Based on 122 separate accounts, three categories of medication administration hassles were identified. The categories (with the percentage of all accounts represented by the category) include (i) scheduling logistics (29.5%), (ii) administration procedures (31.9%), and (iii) safety issues (38.6%). Primary care providers must continually reevaluate and simplify medication regimens for dependent elderly persons in the care of family members, and the family caregivers must be given adequate training and access to ongoing information support systems to help them perform safe and effective medication administration responsibilities.

高齢者ケアプラン策定に関する一考察 高齢者アセスメント表の補綴領域への活用

It is necessary for the dependent elderly and/or resident in nursing home to undergo comprehen-siveassessment as the basis for developing a plan of care that helps them to attain or maintain the highestpracticable physical, mental, and psychosocial activity possible. Minimum Data Set (MDS) and matching Resident Assessment Protocols (RAPs) is one of the effective resident assessment means used worldwide. Inthe RAPs, “Dental Care” is also included, but no evaluation of masticatory function is considered.In this study, 36 dependent elderly persons residing in a geriatric hospital were evaluated “Autonomy Score, ”“MDS/RAPs, ”“Denture Score, ”“Voluntary maximal clenching force, ” and “Chewing Score.”The correlation between “Denture Score” and “Noncongenitiveness/Dementia, ”“Mood State, ”“Feedingby Tube, ”“Pressure Ulcer” in the RAPs by simple regression analysis was statistically significant (p<0.05).From the results of this investigation, it was suggested that MDS/RAPs could be useful for screening thenecessity of prosthodontic treatment for the elderly.

Causes of Strain Affecting Relatives of Swedish Oldest Elderly

We examined determinants of carer strain in a random sample of 170 relative of dependent elderly persons in Sweden aged 80 years or more. These persons were interviewed at home by means of the Sickness Impact Profile (SIP). Carer strain was assessed in interviews with carers who bore the main responsibility for care of an elderly relative. The response rate was 92%. Multiple logistic regression showed that cohabitation of carer and recipient was the sociodemographic variable most significantly associated with various stress factors and consequences or manifestations of stress; strain connected with ADL assistance given to the elderly person, strain arising from the elderly person's uncooperative or recalcitrant attitude or behaviour, worsening of the elderly-carer relationship, and encroachment on the carer's social life. Correlations between strain and various categories of physical and mental impairment were much lower, and in some respects were even negative. We conclude that support programs for relatives caring for dependent elderly persons should aim primarily at creating continuous relief for the carers and improving their opportunities for contact with other people generally.

Differences between Anglo-Celtic and Italian Caregivers of Dependent Elderly Persons: a Pilot Study

This paper describes a preliminary investigation of differences in family caregiving in Australia. Forty-eight Italian-born family caregivers of dependent elderly persons were compared with 461 caregivers of Anglo-Celtic origin on measures reflecting psychological health and well-being, and on a range of socio-demographic variables. The latter had participated in the national Caring for Family Caregivers (CFC) group programme; the former are residents of the Melbourne metropolitan area. Statistical tests were conducted on measures which included the Affect Balance Scale (Bradburn and Noll 1969) and the Spielberger State and Trait Anxiety Inventory (Spielberger et al. 1983) and its translation (Pedrabassi and Santinello 1989). Findings indicated that Italians reported experiencing significantly less trait anxiety than Anglo-Celtic caregivers. Furthermore, significantly more Italians used community supports, were employed full-time, had lower levels of education, and reported better levels of general health than Anglo-Celtics. Implications for research and practice are drawn.

Predictors of anxiety in family caregivers*

The present study builds on the foundation laid in caring for family caregivers of dependent elderly persons through psycho‐educational support. After briefly tracing the development of the programme and its associated evaluation research, an investigation of sociodemographic variables as predictors of caregivers' anxiety is described. In line with previous literature on caregiver stress, it was found that 461 caregivers' pretreatment negative emotional responses were closely related to high levels of anxiety in their particular situations. Less expected were the findings that length of caregiving, relationship to caregiver of care‐recipient, residential arrangements, age of caregiver and disability of care‐recipient did not contribute significantly to the regression analysis. Even more remarkable was the finding that the strongest predictors of anxiety were the combined factors of masculine gender, unemployment and involvement in fewer than the median number of caregiving responsibilities. Implications and recommendations for research and practice are drawn.

Caring for Family Caregivers of Dependent Ageing Persons: Process and Outcome Evaluation

Two research issues are examined with a view to establishing the viability of a model for disseminating support for family caregivers of dependent elderly persons through psychoeducation in small group settings. Continuing program effectiveness through multiple leadership is described. Secondly, the improved psychological well‐being of 432 caregiver participants is demonstrated in terms of their altered affect balance and levels of state anxiety. The relevance of the model to community‐based age care is discussed. A coordinated and collaborative approach to research and practice is advocated.

Will Resources for Elder Care Be Scarce?

One of the major issues in the debate about the future of care is how to keep costs under control while meeting growing demands for care. Addressing that, especially on an international scale, is far from easy How are we to determine what the demands for care will most likely be? Even if it is not possible to estimate the future number of dependent elderly persons with any precision, it is hard to ignore the most probable scenario: a substantial increase in the number of the oldest old. What factors--demographic, cultural, economic--will shape the future use of care services, and how much reliance should policy-makers place on long-term projections of population, status, and need for services? What instruments are available to different societies and governments to control the cost of care? These are the sorts of questions we must try to answer in determining whether, and to what extent, we face a growing scarcity of resources as the elderly population grows. Countries participating in the project Ethics and the Care of the Elderly have totally different care systems. The Western European welfare states (the United Kingdom, Germany, Sweden, Belgium, and the Netherlands) have a mixed system of government regulation and free market elements, while the Eastern European countries (the Czech Republic and Hungary) are rebuilding their care systems in the post-communist era. And the United States is looking to reform its strongly market oriented care system. Yet despite substantial differences among the participating countries, we can identify various conceptual frameworks of factors that determine the use of care services. But a single, generally accepted theory about the use of services is not available so far. This sets limitations on the possibilities of predicting the future needs for services. For this reason, projections of service utilizations are often limited to demographic projections. These kinds of projections will be presented for the Netherlands and Sweden. The outcomes are discussed in terms of trends in utilization patterns and government policies. A Conceptual Framework for the Use of Health Services There is a long tradition of research aimed at explaining the use of care. In these studies a wide range of factors was found to influence service use on both the demand side and the supply side. The most important determinant of service utilization is status, both as perceived by the individual and as revealed by diagnoses. On the demand side of service use the central questions addressed by these studies are: what factors (apart from status) influence the use of services, and why does one person with a problem visit a professional caregiver while another person with the same problem does not? Different studies assess the importance of secondary variables differently. Depending on the approach taken by a particular study, the relevant factors pertain to any of four domains: the demographic (age, sex, socioeconomic status, income), the social-psychological (motivation, personality, medical knowledge, attitudes toward health, satisfaction with caregivers, the health belief model), the sociocultural (norms and values in one's own group, religion, nationality, and ethnicity), and the financial-economic (health insurance system, out-of-pocket payments).[1] Often factors from several areas are combined into one model, which may also include factors on the supply side of service use, such as ratios of personnel to patients or distance to service location. The aim is to explain as much variance in service utilization as possible.[2] By taking into account both services and social services it appears that the most important variables on the demand side of service use are: age, sex, household composition, education, income, housing, social network, domestic skills, development of technologies to enable care recipients to live independently for longer, and attitudes toward and illness. …

Are There Limits to Solidarity with the Elderly?

In most European countries health care, including care for the elderly, is based on the principle of solidarity. This principle is premised on deliberate and freely chosen unity among certain people, groups, or populations. It involves not only an awareness of unity, but also acceptance of the consequences of unity.[1] This choice was once limited to members of an individual's immediate group, for instance family, village, or social class. This played an important role in the history of health insurance: workers, employees, or civil servants united voluntarily in sickness funds to safeguard themselves against the financial risks of disease and physical or mental handicap. Solidarity was not limited to health insurance, but was a basic principle in other social security schemes as well, like pension systems, unemployment insurance, and disability insurance and workers' compensation. In sociology and gerontology there is a debate as to whether solidarity, including solidarity across generations, still exists in our modern society.[2] In view of the breakdown of traditional bonds and groups, solidarity is said to have melted away as a unifying force within society. In fact, solidarity has not disappeared but rather has been transformed into another structure. The traditional solidarity of class and neighborhood has given way to a new dependency on bureaucratic structures of the state and other social institutions (for example, insurance companies). Instead of the personal relations that were dominant in traditional society (horizontal dependency), individuals are nowadays dependent on each other by way of collective arrangements of the state (vertical dependency).[3] These arrangements safeguard individuals against the uncertainties of human existence, for example, as a result of natural causes (disease, handicaps) or social causes (loss of income). Moreover, as society has changed into a loose community of individuals or small groups protected by the collective arrangements of the state, the old group solidarity of care and concern has been replaced by a new solidarity of interests that cuts across social categories. People now are sharing certain risks jointly with individuals belonging to other social categories out of clear self-interest. Such solidarity is not a consciously chosen unity with people in the same group, but a compulsory recognition of mutual self-interest enforced by the state. Nowadays, solidarity means the obligation to share the financial risks of illness and handicap with others not necessarily of one's own social group. In exchange for meeting their obligation to pay a premium, people have access to a broad package of health care services. Blaming the Elderly? Solidarity of interests is based on the principle of reciprocity: people share risks that are common to each other. The more commonplace the risk, the broader the base of solidarity. For uncommon risks or risks that are the result of irresponsible behavior, there is only a narrow base. In an era of limited resources, general solidarity across interest groups is giving way to a tendency to blame those whose irresponsible behavior or excessive claims for health care services effectively limit others' access to care. It is not unlikely that the elderly will be victimized in this way. Historically, attitudes toward the elderly have never been very positive and will almost inevitably become more negative in times of scarce resources. Because of their increasing demand for care and their dependency on others, the elderly are seen more and more as a burden on society. They occupy an increasing number of beds in the hospitals, which in some cases results in waiting lists for younger patients. Premiums for health insurance are rising, partly at least in order to pay the increasing costs of care for the elderly. The scarcity of institutional care and home care is putting pressure on families and neighbors to take care of dependent elderly persons informally. …

Support for caregivers of dependent elderly: A support group can help a dependent elderly person by helping a caregiver overcome feelings of social isolation

The sharing of feelings and the sense of affiliation with and support from others was felt to be the most beneficial aspect of the group participation. Emotions described by participants included revitalization, dissipation of tension and guilt, and a renewal of their sense of identity. Attendance at the group created a social outlet that helped several members feel more socially integrated. Participants began to understand that appropriate attention to their own needs improved their outlooks and brought new energy to their role as caregivers. Nurses planning to study the impact of support groups should consider using a research design, a longitudinal design, to examine changes in caregiver stress occurring with alterations in the care receiver's illness, and to address the economic impact of support groups in reducing health care cost.