Home Care Assistance Research Articles

Using ontologies for structuring organizational knowledge in Home Care assistance

Purpose Information Technologies and Knowledge-based Systems can significantly improve the management of complex distributed health systems, where supporting multidisciplinarity is crucial and communication and synchronization between the different professionals and tasks becomes essential. This work proposes the use of the ontological paradigm to describe the organizational knowledge of such complex healthcare institutions as a basis to support their management. The ontology engineering process is detailed, as well as the way to maintain the ontology updated in front of changes. The paper also analyzes how such an ontology can be exploited in a real healthcare application and the role of the ontology in the customization of the system. The particular case of senior Home Care assistance is addressed, as this is a highly distributed field as well as a strategic goal in an ageing Europe. Materials and methods The proposed ontology design is based on a Home Care medical model defined by an European consortium of Home Care professionals, framed in the scope of the K4Care European project (FP6). Due to the complexity of the model and the knowledge gap existing between the – textual – medical model and the strict formalization of an ontology, an ontology engineering methodology (On-To-Knowledge) has been followed. Results After applying the On-To-Knowledge steps, the following results were obtained: the feasibility study concluded that the ontological paradigm and the expressiveness of modern ontology languages were enough to describe the required medical knowledge; after the kick-off and refinement stages, a complete and non-ambiguous definition of the Home Care model, including its main components and interrelations, was obtained; the formalization stage expressed HC medical entities in the form of ontological classes, which are interrelated by means of hierarchies, properties and semantically rich class restrictions; the evaluation, carried out by exploiting the ontology into a knowledge-driven e-health application running on a real scenario, showed that the ontology design and its exploitation brought several benefits with regards to flexibility, adaptability and work efficiency from the end-user point of view; for the maintenance stage, two software tools are presented, aimed to address the incorporation and modification of healthcare units and the personalization of ontological profiles. Conclusions The paper shows that the ontological paradigm and the expressiveness of modern ontology languages can be exploited not only to represent terminology in a non-ambiguous way, but also to formalize the interrelations and organizational structures involved in a real and distributed healthcare environment. This kind of ontologies facilitates the adaptation in front of changes in the healthcare organization or Care Units, supports the creation of profile-based interaction models in a transparent and seamless way, and increases the reusability and generality of the developed software components. As a conclusion of the exploitation of the developed ontology in a real medical scenario, we can say that an ontology formalizing organizational interrelations is a key component for building effective distributed knowledge-driven e-health systems.

Perceptions of informal care givers: Health and support services provided to people with multiple sclerosis

Purpose. About 30% of people with multiple sclerosis (MS) need some form of home care assistance, with 80% of that assistance provided by informal or unpaid care givers. This study focuses on the care givers to 530 more disabled people with MS, with the objective to learn more about informal care giving to people with greater dependency and need for assistance.Method. The data presented in this study were collected in a national survey of 530 informal care givers to people with MS who have greater levels of physical dependency.Results. About 70% of informal care givers responded that assisting the person with MS perform daily activities or personal care took up the largest amount of their care giving time. Care givers also reported a range of home and community-based services that would make care giving easier or improve the care provided. However, informal care givers generally reported low satisfaction with health insurance coverage of these services, especially coverage by health maintenance organizations and other managed care plans.Conclusions. Lack of health insurance coverage of needed home and community-based services can reduce the quality of informal care provided, as well as increase the burden of informal care giving.

The role of ontologies in supporting distributed medical systems

Introduction: The K4, Care European Project proposes a standard model for home-care (HC) assistance of elderly chronic patients (ECP), coordinating all professionals and institutions involved in HC for proper assistance. The model is supported by a distributed multi agent platform (MAP), a metaphor of the HC itself. Every person involved is represented by an intelligent agent interacting with other agents, representing other colleagues. Warnings are sent to the corresponding agent when required by other agents for some action to complete a medical service. Correct transferring of the HC knowledge to the MAP is a key issue. Methods: The actor profile ontology (APO) was build to determine the behaviour of MAP: the services to be provided have been specified by combinations of simpler actions; liabilities, responsibilities and access rights of every kind of professional involved in HC is specified, as well as interaction between different professionals. Agents are created according to APO definitions. Results: A prototype is implemented where physicians, nurses, social workers, carers... coordinate through their personal agents for HC of ECP, according to APO. The platform is currently being tested with real patients in Pollenza (It). Conclusion: Ontologies allow knowledge transmission to a computer application. APO provides high flexibility to mid and log-term evolution of HC, as changing it automatically changes the system behaviour. The basic structure of an ontology to support distributed medical complex systems is identified and this structure is easily exportable to other kind of medical systems, like hospital management or provision of dependency services.

Knowledge-based provision of home care e-services for the elderly and disabled

Introduction: Elderly chronic patients are an increasing population using more and more national health services all around Europe. One way to better manage this social and economic challenge is to improve home care through the introduction of information and communication technologies (ICTs). Description: The K4Care European research project has developed a web-based multi-agent platform providing the medical and manage- ment e-services required in a home care system. Due to the comorbidity of the typical patients of this application, the tool allows medical practitioners to define fully personalised care treatments (Individual Intervention Plans). Each of them involves the execution of diverse actions from different actors of the system. Every actor deals with an intelligent agent of the K4Care platform. Agents coordinate their activities autonomously in order to efficiently execute these personalised plans under the supervision of practitioners. Moreover, all the behaviour of the system is guided dynamically by the organisational and medical knowledge represented in the form of ontologies and formal intervention plans. Conclusion: The prototype developed in the K4Care project can be taken as a proof-of-concept of the viability of improving home care assistance in the near future by using a combination of artificial intelligence methodologies, medical knowledge and ICTs.

Informal care giving to more disabled people with multiple sclerosis

Purpose. About 30% of the people with multiple sclerosis (MS) require some form of home care assistance and 80% of that assistance is provided by informal or unpaid care givers. This study focusses on the care givers for 530 more disabled people with MS, with the objective of learning more about informal care giving to people with greater dependency and need for assistance.Method. The data presented in this study were collected in a national survey of 530 people who provided informal care to more disabled people with MS.Results. Almost half of these care givers reported that they provided more than 20 h of care per week to the person with MS, with more than 9 in 10 shopping for groceries, doing indoor housework, preparing meals or providing transportation for the person with MS. More than 4 in 10 employed care givers reduced the amount of time worked in the previous 12 months because of their care giving responsibilities. Although more than half of the MS care givers in our study reported that care giving was demanding, time consuming or challenging, about 90% of these MS care givers were happy that they could help. About two in three of these MS care givers found that care giving was rewarding, with more than 8 in 10 proud of the care they provided.Conclusions. More than a quarter of the informal care givers to people with MS thought they would benefit from treatment or counselling provided by mental health professionals. Not only it is necessary to provide access to mental health services for people with MS, but it is also important to assure that their informal care givers also have access to appropriate mental health care, given the scope of their care giving responsibilities.

Staff training improved oral hygiene in patients following stroke

Reports were identified using the Cochrane Stroke Group and Oral Health Group trials registers, the Cochrane CENTRAL trial register, Cochrane Library, Medline, Cinahl, Research Findings Electronic Register, National Research Register, ISI Science and Technology Proceedings, Dissertation Abstracts and Conference Papers Index, and the reference lists from relevant papers. Authors and researchers in the field were also contacted. Randomised controlled trials (RCT) that evaluated one or more interventions designed to improve oral hygiene were selected. Trials based on a mixed population were included, provided it was possible to extract data specific to individuals post-stroke. Two review authors independently classified identified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. Clarification was sought from study authors when required. Eight eligible RCT trials were identified but only one provided stroke-specific information. In it, an oral healthcare education training programme delivered to nursing homecare assistants was compared with a delayed training intervention in the control group. Comparisons were made at 1 and 6 months after the intervention, using primary outcome measures of dental plaque and denture plaque, and three secondary outcomes. The data available for the 67 individuals who had suffered a stroke (obtained from the larger cluster-RCT) showed that denture plaque scores were significantly reduced up to 6 months (P<0.00001) after the intervention. Staff knowledge (P 0.0008) and attitudes (P 0.0001) towards oral care also improved significantly despite high staff turnover rates. Based on one study with a small number of stroke survivors, providing specialist oral care training for carers in a nursing-home setting improves their knowledge of and attitudes towards the provision of oral care. In turn, residents\[primes] dentures were cleaner, although other oral hygiene measures did not change. Further evidence relating to oral care interventions is severely lacking, in particular with reference to care in hospital for those following stroke.

K4care: a new intelligent system for home care

The K4CARE project (FP6-IST-4 IST-2004- 026968) is a EC project about the development, integration and use of several Information and Communication Technologies (ICT) and intelligent Computer Science (CS) technologies in the framework of Home Care (HC). The main objective of the K4CARE project is to improve the capabilities of the new EU society to manage and respond to the needs of the increasing number of senior population requiring a personalized HC assistance. K4CARE will develop: a model for HC service which can be shared by the EU countries; an Electronic Home Care Record; a telematic and knowledge-based CS platform; a multi-agent system; Actor Profile Ontologies for representing the profiles of the subjects involved in the K4CARE model; Case Profile Ontologies for representing symptoms, diseases, syndromes; Formal Intervention Plans. The K4CARE project is developed by thirteen EU partners: eight centres with geriatric, medical and healthcare competencies and five ICT and CS centres

Barriers to Workers' Compensation and Medical Care for Injured Personal Assistance Services Workers

Objectives. We documented barriers to workers' compensation and injury-related medical care faced by homecare or Personal Assistance Services (PAS) workers. We explored differences between independent providers and agency-employed workers. Methods. We conducted in-depth, semi-structured interviews with a diverse sample of 38 injured workers. Participants were primarily female and racial-ethnic minorities. Results. Most participants (82%) were independent providers. Common barriers to reporting injury included commitments to clients and financial pressure. Unlike agency employees, many independent providers knew little about workers' compensation eligibility and injury reporting procedures, and frequently were given “the runaround” by the social service bureaucracy when they attempted to report injury and access injury-related medical care. Among independent providers, delays in filing a claim and receiving timely medical attention were common. Conclusions. The lack of a traditional employment infrastructure has important implications for vulnerable workers' health and the sustainability of consumer-directed PAS programs. We provide recommendations for improving workers' access to workers' compensation and injury-related medical care.

Independência funcional e os fatores que a influenciam no âmbito de assistência domiciliária ao idoso

Resumo Objetivo Verificar os fatores associados à independência funcional de idosos em assistência domiciliária. Método Estudo clínico quantitativo, descritivo-analítico com corte transversal realizado por meio de investigação de 80 prontuários de idosos atendidos em programa de assistência domiciliária. Resultados A amostra de idosos foi composta por uma maioria feminina (76,3%), viúva (57,5%), idade avançada (83,36 ± 7,67) e acamada (50%). Os idosos em geral apresentaram baixa pontuação na MIF total (61,08 ± 33,10), MIF motora (41,03 ± 24,38) e MIF cognitiva (20,05 ± 10,77), revelando uma dependência funcional. A presença de várias co-morbidades associadas e polifarmácia tiveram correlação positiva fraca significante com a piora na pontuação da MIF cognitiva. A presença de doenças da pele e/ou tecido subcutâneo, transtornos mentais e estar acamado foram fatores associados à piora na pontuação da MIF total, motora e cognitiva. A presença de doenças do sistema nervoso esteve associada ao declínio da MIF total e motora. Conclusões O reconhecimento dos fatores associados ao declínio funcional (classes específicas de doenças, polifarmácia e tipo de locomoção) pode conduzir os profissionais a uma intervenção que assista aos principais problemas, antes mesmo que eles se instalem e venham a prejudicar a qualidade de vida dos idosos.

Home care assistance and the utilization of peritoneal dialysis

Peritoneal dialysis (PD) may be declining because the elderly often have barriers to self-care PD. The objective of this study was to determine whether the availability of home care increases utilization of PD. In 134 incident chronic dialysis patients (median age 73), 108 (81%) had at least one medical or social condition, which was a potential barrier to self-care PD. Eighty percent of patients living in regions where home care was available were considered eligible for PD compared to 65% in regions without home care (P=0.01, adjusted). Each barrier reduced the probability of being eligible for PD by 26% (odds ratio 0.74, per condition, P=0.02) adjusted for age, sex, predialysis care, in-patient start, and availability of home care. In regions with and without home care, 59 and 58% of eligible patients choose PD when they were offered it (P=NS). The utilization of PD in the incident end-stage renal disease (ESRD) population living in regions with and without home care was 47 and 37%, respectively (P=0.27). The mean rate of home care visits over the first year was 4.3 per week (maximum available was 14 per week). Of the 22 assisted patients, 15 required chronic support, five graduated to self-care, and two started with self-care but later required assistance. Adverse events were similar between assisted PD and traditional modalities. Barriers to self-care PD are very common in the elderly ESRD population but home care assistance significantly increases the number of patients who can be safely offered PD.

Managements' perception of community nurses' decision-making processes when referring older adults to an emergency department

In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nurses' exposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them.

AN INTELLIGENT DIABETES MOBILE CARE SYSTEM WITH ALERT MECHANISM

Diabetes mellitus is a kind of chronic disease which can be effectively prevented and controlled only if the blood glucose level of the patient is constantly monitored, and the health education and professional medicine care is fully supported. In this paper a role-based intelligent diabetes mobile care system with alert mechanism in full diabetic care environment is proposed and implemented. The roles in our system include patients, physicians, nurses, and home care assistants. Each of the roles uses a mobile device such as a PDA with GSM module or a mobile phone to communicate with the server so that he or she can go around without restrictions. Our system provides alert management by using an automaticl urgency strategy to assure the information correctness and notification completeness so as to improve the quality of diabetes care. The reliability test and performance test have also shown that our system can provide fast and reliable assistance to the diabetes patients. With the help of our system, it is possible to set up a whole intelligent diabetes care chain in the care center.

Refusing to serve nurses in uniforms is ridiculous

I am writing in response to ‘Retailers asked not to serve nurses in uniform’ (news April 27). This is the most crazy thing I have heard. First, as a district nurse, obviously I wear my uniform to drive around in and sometimes I call in at shops or to get petrol. Second, because nurses’ uniforms are not exclusive to nurses this rule could really become a bit of a farce. The home care assistants who wear the same uniform will be refused service in a shop when they are doing their clients’ shopping.

Ethnic differences in social network help-seeking strategies among Latino and Euro-American dementia caregivers

This research explores the help-seeking behavior of Euro-American and Latino caregivers who provide homecare assistance to an older adult with dementia. A community sample of 89 caregiver-care recipient pairs (39 Latino and 50 Euro-American) was interviewed. Descriptive, bivariate, and multivariate analyses were conducted to examine ethnic differences in use of an informal social network for help with caregiving tasks. Caregiver experiences that may impact help-seeking behaviors such as perceived availability of support network, satisfaction with support received and caregiver distress were also considered. Latino caregivers reported less help-seeking than did the Euro-American caregivers. Overall, ethnicity accounted for 16% of the variation in help-seeking behaviors. Ethnicity accounted for a significant portion of the variation in most of the help-seeking characteristics examined even after adjusting for socioeconomic variables. In the multivariate model, the effects of ethnicity on help-seeking persisted, while the effects of other likely predictors did not. The size of social network may not be synonymous with the seeking of support by caregivers. Likewise, higher levels of distress among Latino caregivers did not result in increased help-seeking behaviors. There remains a need to identity what other factors may contribute to the cultural variability in caregivers’ use of informal support.

Nutritional status, well-being and functional ability in frail elderly service flat residents.

To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents. Cross-sectional and prospective study. Two municipal service flat complexes. A total of 80 residents (median age 85.5 (79-90) y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1 y later. Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively. In all, 30% of the frail and chronically ill service flat residents were assessed as malnourished and 59% were at risk of malnutrition. The malnourished residents had worse cognitive conditions (P<0.001) and well-being (P<0.05), lower functional ability (P<0.01) and they had a greater need for daily assistance (P<0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0) h. Five subjects classified as malnourished at baseline had lost a median of -9.6 kg (range -11.0 to +7.3 kg) (P<0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished. Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired well-being, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable.

Midwifery and the Medicalization of Childbirth: Comparative Perspectives

PARTIAL CONTENTS: Preface Acknowledgments About the Editors General Introduction (Van Teijlingen el al.) Sociological Factors Affecting the Medicalisation of Midwifery (Lowis & McCafffery) Part One: Toward Sociology Of Midwifery Part Two: Medicalisation Of Childbirth And Midwifery Introduction: History of Midwifery (Van Teijlingen) Midwives & maternity care in the Roman world (French) Early Modern Midwifery A Case Study (Weisner) Louyse Bourgeois and the Emergence of Modern Midwifery (Kalisch el al.) Is Childbirth any Place for a Woman? The Decline of Midwifery in Eighteenth-Century England (Schnorrenberg) Perrette The Midwife... (Forbes) The Decline of The Midwife (Donnison) 'The Different Stages of the Elimination of Midwives in Quebec' (Laforce) 'Midwife Regulation, Education, & Practice in the Netherlands'... (Van Lieburg & Marland) Midwifery in Contemporary Western Societies (Porter) Models of Midwifery Care... (McKay) Maternity Home Care Assistants in the Netherlands (Van Teijlingen) The Role and Responsibilities of the Midwife in Scotland (Askham & Barbour) Domino Delivery... (Beck) Changing Childbirth? (Porter) An exception to the Canadian Case: Autonomous Midwifery at the Margins (Benoit) Medical Models and Midwifery: The Cultural Experience of Birth (Lichtman) Index.

Dependent seniors: families and caregivers

This article focuses on health care for dependent seniors in relation to chronic illnesses. Expectations about family support for the dependent elderly are related to the role of family caregivers, but care requires support from the public and private sectors. Governments throughout the developed countries are examining their role in the provision of social welfare programs, especially in the public health sector. To recommend home care and family assistance, the context of changing family structures, the type of care needed, and professional follow-up must be taken into account.

The cost effectiveness of a pharmacist reviewing medication among the elderly in the community

Aims : The study aims to assess the cost effectiveness of medication review and advice by a consultant pharmacist to elderly people living in the community in Australia. Method : The quality of life and cost of health and social services for a cohort of elderly patients seen by an aged care assessment team (ACAT) was measured at initial referral and at one month follow up. Sites in Melbourne and Ballarat were chosen and analysed separately. A second subsequent cohort was assessed by a team, which included a pharmacist who provided advice to the team and the patient's GP. Quality of life was measured using the SF‐36 and the AQoL. Results: Patients seen by an ACAT had a quality of life considerably below full health. Overall there was no significant change in quality of life in either group by either measure. The additional cost of the pharmacist was less than 77 per patient. Compared to no intervention, there was some evidence of an increase in the cost of prescription Pharmaceuticals, and a reduction in home care assistance and medical care costs in Melbourne but not in Ballarat. Cost data were highly skewed however, making statistical tests of cost differences problematic. The addition of a pharmacist may be cost reducing in some settings especially if inpatient episodes for assessment and treatment can be avoided, but the study was not able to demonstrate a statistically significant reduction in overall costs associated with pharmacist review and advice.

Stem Cell Transplants for Multiple Sclerosis Provide New Options for Patients and New Challenges for Home Care

Multiple sclerosis (MS), a chronic disease of the central nervous system, had few treatment options until recently. Stem cell transplantation, originally used for cancer patients, may provide an opportunity for MS patients to stop the progressive course of their disease. This article describes the experience of an early participant in a stem cell transplant study at the Fred Hutchinson Cancer Research Center in Seattle. The procedure includes extensive outpatient evaluation, an inpatient stay, and a lengthy recovery period. A strong caregiver network and professional home care assistance provide the needed support system during this process.

The value of home care assistance

The value of home care assistance