Housebound Older People Research Articles

Living with falls: house-bound older people's experiences of health and community care.

Despite world-wide emphasis on falls prevention, falls and their consequences remain a major health issue for older people, and their health care providers. Many systematic reviews have been undertaken to evaluate the impact of intervention programmes on falls reduction, however, relatively little research provides a voice for older people's own perceptions of such programmes. To readdress this imbalance the current research utilized a purposive sampling method to recruit a hard to reach group of older people who had received a post-fall health and social-care programme to investigate their experiences of the programme. Semi-structured interviews with eight housebound people aged over 65 who had fallen were undertaken, and data analysed using interpretative phenomenological analysis. Four themes were identified: losing independence; losing confidence; losing social identity; managing a changed self. Despite a tailored intervention programme minimal improvement in participants' psychological adjustment to falls was noted. Outcomes from this study are of interest to health and social-care staff who deliver falls prevention programmes. Staff need to enhance constructive adjustment to the older person's altered circumstances and ensure behaviours do not exacerbate their clients' loss of independence. This should assist older people's ability to positively manage their sense of self, allowing them to find continuing meaning in their daily lives.

Undernutrition and housebound older people

AbstractAim: This paper outlines approaches to dealing with undernutrition in the older person.Method: A series of case studies is presented to expose principles of practice for management of undernutrition in the older person.Results: Screening is a necessary first step. A more in‐depth assessment of those at‐risk may reveal contributory factors that if addressed, would result in better nutritional health outcomes. Preservation of muscle mass through adequate caloric and protein intake and exercise is important. Nutritional supplementation has been shown to reduce mortality risk and improve weight. A daily multivitamin may offer some benefit. Weight loss is also seen commonly in older people with dementia. There is a need to understand why this occurs as this could guide management strategies. There is also a need to consider conservative management when dysphagia occurs in the later stages of dementia. Percutaneous endoscopic gastrostomy feeding may not necessarily have that much to offer.Conclusion: In older people, the prevalence of undernutrition increases with increasing frailty. If not treated, undernutrition is costly both to the individual and society.

Promoting influenza vaccination in older people: rationale and reality

Influenza is a serious, preventable disease for older people. Vaccination saves lives and reduces healthcare costs. The UK should be vaccinating 85% of risk groups by 2010. The uptake of vaccination is influenced by four factors: the socioeconomic status of patients; the system of vaccination; vaccine mistrust and fear of side-effects; and health beliefs. An effective vaccination programme needs to target and be sensitive to the particular needs of older people. It should include a combination of strategies to promote vaccination (flyers, personal invitations; doctor's recommendation); acknowledgement of lay beliefs; special clinics organized around older people; and special arrangements for housebound older people and those living in care homes.

Nursing management of constipation in housebound older people.

In this article two algorithms are suggested for use by district nurses in the management of constipation in dependent older people at home. Prescribing for this group of patients requires a complex assessment of medical and social factors as 24-hour supervision is not always available and local health and social service resources may impact on the level of care that is available in terms of the provision of food and drink and the taking of medicines.

Attributional Style, Efficacy, and the Enhancement of Well-Being Among Housebound Older People

This study examines the effects of an intervention that involves the compilation of a book of wartime experiences on a group of housebound older people who live in the community with the support of social services. Using the theoretical framework of the Hopelessness Theory of Depression (Abramson, Metalsky, & Alloy, 1989), we examine the impact of attributional style (Abramson et al., 1989) and efficacy (Bandura, 1977; Houston, 1995) on changes in psychological well-being following the intervention. Prior to the intervention, participants completed a newly constructed Extended Attributional Style Scale for the Elderly and the General Health Questionnaire (Goldberg & Hillier, 1979). Following the intervention there was a significant improvement in psychological well-being across the sample-those with depressogenic styles and low efficacy and those with high efficacy and nondepressogenic styles reported most improvement. The findings indicate that a relatively small-scale intervention can have a significant impact on the well-being of older people living alone in the community.

Secondary hyperparathyroidism in patients from Western Australia with hip fracture: relationship to type of hip fracture, renal function, and vitamin D deficiency.

To determine the frequency of vitamin D deficiency and secondary hyperparathyroidism in Australian hip fracture patients living in the community. A total of 283 consecutive patients with hip fracture admitted over a 15-month period to a university teaching hospital in Western Australia. Included were residents of hostels for the elderly, and excluded were nursing home residents and those with malignant fractures. Data collected included biochemistry (25 hydroxyvitamin D, parathyroid hormone and creatinine levels), measurements of function and disability (Barthel Index, Frenchay Activity Index), sunshine exposure, and basic demographics. Vitamin D deficiency occurred in 31.7% and secondary hyperparathyroidism occurred in 17.7% of cases. The major determinants of vitamin D deficiency were outdoor sunshine exposure, ambient daily sunshine, and disability (low Frenchay Activity Index or ADL difficulty). Secondary hyperparathyroidism was related to older age, renal dysfunction, and vitamin D deficiency. Secondary hyperparathyroidism was associated with an excess of trochanteric over subcapital hip fractures. Secondary hyperparathyroidism appears to be a heterogeneous condition, caused in approximately equal proportions by vitamin D deficiency and renal dysfunction, that may confer increased cortical bone fragility and trochanteric fractures. Renal dysfunction in old age may be an important additional determinant of senile osteoporosis, which has implications for preventive therapy. Vitamin D deficiency occurs in disabled and, presumably, housebound older people despite near optimal climatic conditions.