Institutionalized Elderly People Research Articles

Fear of COVID-19 among professional caregivers of the elderly in Central Alentejo, Portugal

The coronavirus disease 2019 (COVID-19) has infected many institutionalised elderly people. In Portugal, the level of pandemic fear among professional caregivers of the elderly is unknown, as are its predictive factors. This study aimed to investigate predictors of fear of COVID-19 among workers caring for institutionalised elderly people in nursing homes. This is a cross-sectional study using multiple linear regression applied to a population of 652 caregivers located in 14 municipalities in Central Alentejo, Portugal, at March 2021. The criterion variable was the fear of COVID-19. Standardised regression coefficients showed that the higher the level of education, the lower the level of fear (β = − 0.158; t = − 4.134; p < .001). Other predictors of the level of fear were gender, with women having higher levels (β = 0.123; t = t = 3.203; p < 0.001), higher scores on COVID-19-like suspicious symptoms (β = 0.123; t = 3.219; p < 0.001) and having received a flu vaccine (β = 0.086; t = 2.252; p = 0.025). The model explains 6.7% of the variation in fear of COVID-19 (R2Adj = 0.067). Health literacy can minimise the impact on the physical and mental health of these workers. In Central Alentejo, caregivers of the elderly play a fundamental role in social balance. Further studies are needed to better understand the factors that can improve their personal and professional well-being.

Reliability of the Spanish Version of the Movement Imagery Questionnaire-3 (MIQ-3) and Characteristics of Motor Imagery in Institutionalized Elderly People.

Motor imagery (MI) training is increasingly used to improve the performance of specific motor skills. The Movement Imagery Questionnaire-3 (MIQ-3) is an instrument for assessing MI ability validated in Spanish although its reliability has not yet been studied in the elderly population. The main objective of this study was to test its reliability in institutionalized elderly people. Secondarily, we studied whether there are differences according to gender and age in MI ability (measured by the MIQ-3) and in temporal congruency (measured by mental chronometry of elbow and knee flexion-extension and getting up and sitting down from chair movements). The subjects were 60 elderly, institutionalized, Spanish-speaking individuals without cognitive impairment or dementia, and aged between 70 and 100 years. Cronbach’s alpha showed high internal consistency in the internal visual and external visual subscales and moderate in the kinesthetic subscale. The intraclass correlation coefficient showed good test-retest reliability for all three subscales. Mixed factorial analysis of variances (ANOVAs) showed that MI ability decreased with increasing age range, the imagery time decreased concerning the execution of the same movement, and there were no gender differences in either IM ability or temporal congruence. The Spanish version of the MIQ-3 is a reliable instrument for measuring MI ability in institutionalized elderly.

Drug Interaction in Institutionalized Elderly People

Drug Interaction in Institutionalized Elderly People

Cognitive Status and Nutritional Markers in a Sample of Institutionalized Elderly People.

BackgroundSince many of the risk factors for cognitive decline can be modified by diet, the study of nutrition and its relationships with cognitive status in aging has increased considerably in recent years. However, there are hardly any studies that have assessed cognitive status using a comprehensive set of neuropsychological tests along with measures of functional capacity and mood and that have related it to nutritional status measured from several nutritional parameters that have shown its relationships with cognitive function.ObjectiveTo test the differences in depressive symptomatology and in several measures of nutritional status between three groups classified according to their cognitive status (CS hereafter).MethodOne hundred thirteen participants from nursing homes in Galicia, Spain, underwent a comprehensive neuropsychological examination, including a general screening test (MMSE) and tests for different cognitive domains along with measures of activities of daily living (ADL) and assessment of depressive symptomatology (GDS-SF). According to established clinical criteria, participants were divided into three CS groups, Cognitively Intact (CI), Mild Cognitive Impairment (MCI), and All-Cause Dementia (ACD). Nutritional status was also examined using blood-derived measures, body mass index (BMI) and a nutritional screening test (MNA-SF). Differences between CS groups in all nutritional variables were studied by one-way ANOVAs with post-hoc Bonferroni correction or Kruskal-Wallis with Games-Howell post-hoc correction when appropriate. Multinomial logistic regression was also applied to test the association between nutritional variables and CS.ResultsDifferences between CS groups were statistically significant for depressive symptomatology, vitamin A and D, albumin, selenium (Se), uric acid (UA), and BMI. The results of multinomial logistic regression found positive associations between groups with better CS and higher concentrations of vitamins A and D, transthyretin (TTR), albumin, Se, and UA, while negative associations were found for BMI.ConclusionHigher serum levels of vitamin A, vitamin D, TTR, albumin, Se, and UA could act as protective factors against cognitive decline, whereas higher BMI could act as a risk factor.

PERIODONTAL STATUS OF INSTITUTIONALIZED ELDERLY

Impaired general health in institutionalized elderly has an impact on oral health and dental status, especially on periodontal health and oral hygiene. The periodontal health of institutionalized elderly people is influenced by a number of other factors such as: multimorbidity, dependence in maintaining oral hygiene, limited abilities and mobility and the use of numerous medications. Progression of periodontal disease is characterized by the presence of increased destruction of periodontal tissues. The destruction of periodontal tissues is seen through the presence and increased clinical loss of the attachment, but also through the presence of gingival recession and resorption of the alveolar bone. The most common form of periodontal disease in older adults is chronic periodontitis. Due to the chronicity of this disease, most of the detected periodontal disorders are due to the accumulation of the disease over time. The interaction of the highly prevalent xerostomia and the inability to maintain oral hygiene at a satisfactory level in institutionalized elderly leads to an increased incidence of dental plaque. Due to that, the elderly have an increased risk of manifesting dental caries and periodontal diseases. Taking into account the aforementioned facts about oral health, the presence of numerous dental and oral problems, as well as the increased health needs and impaired health in institutionalized elderly people, the aim of this paper was to assess periodontal health among institutionalized elderly people over 65 years of age. Assessment of periodontal status among institutionalized elderly was done by using the Ramfjord Periodontal Disease Index. The research was conducted in the period from April to July 2018 in the Department “Mother Teresa”, part from the Gerontological Institute “Thirteenth November” - Skopje. It included a total number of 75 people over the age of 65 who were accommodated in the department and gave their consent to participate in the research. The dental clinical examination was performed in the long-term care institution, in the office or in the rooms of the institutionalized elderly or in a room determined for that purpose. The examination of the subjects was performed on a patient sitting on a chair, lying in bed or placed in a wheelchair. For the examination a dental probe, a dental mirror and disposable gloves and a portable lamp for artificial illumination were used. The average number of present (remaining) teeth in the respondents was 5.81± 7.34 (range 0-24, with Confidence interval from 4.09 to 5.52).The mean value of the simplified OHI Green Vermilion index obtained for the presence of dental plaque was 2.33 ± 0.51 (range from 1.33 to 3.00, with Confidence interval from 2.15 to 2.51). The average value for the Ramfjord index (for assessment of periodontal health) was 4.57 ± 0.74 (range 2.5 to 6.00, with Confidence interval 4.33 to 4.82). Most of the subjects after the appropriate analysis had moderately advanced periodontitis (68.42% of the subjects). Based on the obtained data and subsequent analysis of the results we had found high percentage of people with unsatisfactory oral hygiene and high prevalence of periodontal disease.

Can Music Therapy Improve the Quality of Life of Institutionalized Elderly People?

Introduction: The current population has new characteristics that require changes to be made in the public health system. In the case of the elderly, the concrete aspects of their health must be known to improve the system, in search of a better quality of life and as much independence as possible. Method: The aim of this study was to verify the efficiency of a music therapy program with institutionalized elderly participants to avoid depressive symptoms and improve social interaction and creativity. This is a group case study that uses a pretest–post-test descriptive design. The program was divided into sixteen sessions, two sessions each week. As inclusion and exclusion criteria, physical dependency and cognitive state were used. Results: The results present an improvement in the physical dimensions of quality of life and an increase in creativity and social interaction. It is recommended that the sessions in the program, aiming to achieve a greater efficiency, are extended because the elderly have very ingrained habits and routines that are very hard to eliminate. Discussion and conclusions: Music therapy, a non-pharmacological and worthwhile treatment, is a therapeutic option with proven benefits. Music therapy has the potential to improve health and quality of life in the elderly and also foster the amelioration of various chronic illnesses, such as depression.

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study.

Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.

Sexuality of elderly people living in CHSLDs in Quebec, between neglect and recognition

Despite the popular belief that sexuality disappears with age, research shows that it is an important focus for many people over 60. Contemporary realities observed among this population reveal real needs for affection and sexual desires that translate into various practices. This does not exclude residents of long-term care centres (CHSLD). However, a certain number of barriers to the expression of sexuality by elderly people in institutions keep the staff and the residents themselves in the perception of implicit asexuality. Since the mission of a CHSLD is to provide a temporary or permanent substitute living environment whose guiding principles relating to integrity, freedom and dignity help to prevent phenomena often associated with collective residential environments, the protection of personal spaces is a first step in recognising residents' sexual needs.

Physical and Cognitive Functioning of Institutionalized Elderly People in Rural Areas. Preventive Actions Using Physical Activity and Music Therapy.

Background: Comprehensive geriatric evaluation should include a functional and cognitive assessment to guide the intervention of interdisciplinary teams. The aim of this study was to analyze the physical capacities of institutionalized elderly people and to describe the preventive actions of physical activity and music therapy as non-invasive preventive pharmacological treatments given their importance for the cognitive and functional performance of elderly people. An observational and descriptive cross-sectional study was carried out. The participants in the study were 109 elderly people institutionalized in three residential centers with a mean age of 83.41 years (SD = 8.72). Findings: Most of the residents had very impaired physical faculties. However, cognitive impairment was not very high. Most residents (55.04%) had some form of dementia and/or high blood pressure (54.12%) followed by pathologies such as diabetes (27.52%), heart failure (17.43%), Parkinson’s disease (9.17%) and chronic obstructive pulmonary disease (8.25%). There were no differences in cognitive or physical capacity among the residents according to sex, age, or education and only those who had worked in the service sector had less cognitive capacity than those who had worked in the agricultural sector or as housewives. Applications: Facilitate the creation and development of programs based on physical activity and music therapy in residential centers that can prevent and improve pathologies on the elderly.

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People.

Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.

Association between root/coronal caries and individual factors in institutionalised elderly using ICDAS severity and activity

BackgroundCaries in the elderly has been associated with dependence, oral-health status and -care practices. This cross-sectional study aimed to investigate the association between root/coronal caries and individual factors among institutionalised elderly people in Bogotá, Colombia, using the International Caries Detection and Assessment System severity and activity criteria (ICDAS).MethodsA total of 226 institutionalised elderly were clinically examined for root and coronal caries in 40 institutions. Caries risk was assessed with Cariogram, and demographics, oral health knowledge and practices, oral health-related quality of life and denture-use habits using a questionnaire.ResultsParticipants (mean age: 80.1 ± 9.3 years; 63.7% female) presented a mean number of 10.8 ± 7.3 teeth and 19.4 ± 18.8 exposed root surfaces. Prevalence of Coronal-ICDAS caries experience (C-ICDAS DF) was of 100% and of 54.4% for C-ICDAS D; mean number of C-ICDAS DFS was 16.76 ± 27.36, with 50.9% of subjects having ≥ one active C-ICDAS DS. Prevalence of Root Caries Index was of 49.1% and of R-ICDAS DF of 46%; mean number of R-ICDAS DFS was 2.03 ± 2.78, with 40.3% of subjects having ≥ one active R-ICDAS DS. Most individuals had a systemic condition (94.2%) and required oral-hygiene assistance (58%). Logistic regression analyses showed significant associations (p < 0.05): for coronal active caries when having over six teeth (OR: 2.7), and for root caries, when having coronal caries (OR: 2.41), being a man (OR: 1.95), and having over 14 teeth (OR: 0.30). Those presenting with > eight exposed root surfaces were 4.04 more likely to have root caries and 2.4 times more likely to have active root caries.ConclusionIn the institutionalised elderly population in Bogotá significant associations were found, both for the presence as for the activity status of root and coronal caries, with individual clinical factors including coronal caries, exposed root surfaces and number of teeth.

Effects of Exercise Intervention on Cognitive Function in Institutionalized Elderly People with Dementia: A Systematic Literature Review and Meta-analysis

Effects of Exercise Intervention on Cognitive Function in Institutionalized Elderly People with Dementia: A Systematic Literature Review and Meta-analysis

Sodium and Potassium Intake in Residents of Retirement Homes.

Excessive salt intake and its impact on health is a public health problem in many regions of the world. The currently estimated dietary intake of salt among free-living adults is well above the WHO recommendations. Over the years, the number of residents in retirement homes has increased. Besides this, the nutrition of elderly people may be affected by physiological changes that occur with aging. The question is whether residents of retirement homes receive a more balanced diet, or whether the trend of excessive salt consumption continues even among institutionalised elderly people. Salt and potassium intake were assessed by measuring sodium and potassium excretion over 24 h in urine collected from a sample of residents of three retirement homes in the Goriška region, Slovenia. The average salt intake was 8.3 (2.9) g/day, which was significantly higher (p < 0.001) in men than in women (10.1 (3.1) vs. 7.3 (2.2) g/day, respectively). The estimated total daily potassium intake was 2.6 (0.6) g/day in men and 2.0 (0.8) g/day in women (mean 2.2 (0.8) g/day). The ratio of sodium to potassium was 1.53 (0.48). The salt intake among residents of retirement homes in the Goriška region, especially in men, exceeds the WHO recommended daily intake of <5 g. The mean daily potassium intake was below the WHO recommendations of 3.5 g/day.

Level of Stress and Coping Strategies among Institutionalised and Non-Institutionalised Elderly

Objective: The objective of the study is to assess and compare the level of stress and coping strategiesexperienced by the institutionalized and non-institutionalized elderly.Methods: A descriptive comparative research design and convenient sampling was used in this study, withthis technique the researcher selected 70 sample from community (Nayarambalampanchayath) and 70samples from two old age homes. Demographic Proforma, Sheldon Cohen Perceived Stress Scale and theDeakin Coping Scale were used to assess and compare the level of stress and level of coping.Result: Among institutionalized elderly people 18.6% are having no stress, 32.9% are having mild stress.37.1% are having moderate stress and 11.4%are having severe stress .Among non institutionalized elderly37.1% are having no stress,55.7% are having mild stress,7.1% are having moderate stress and none ofthem having severe stress. While considering level of coping among institutionalized elderly people 21.4%members coping strategies are not effective,50% are having effective coping strategies and 28.6 are havingmost effective coping strategies. Among institutionalized elderly 18.6 are having not effective copingstrategies,62.9% are having effective coping strategies and 18.6% having most effective coping strategies.There is a significant correlation between stress and coping among institutionalized elderly.Conclusion: The feeling of loneliness along with the natural age related decline in physical and psychologicalfunctioning makes elderly prone to psychological disturbance,so institutionalized elderly feels moremoderate and severe stress than non institutionalized elderly.

Prevalência de depressão entre idosos institucionalizados

Este trabalho tem por objetivo geral realizar uma pesquisa sobre a prevalência de depressão entre idosos institucionalizados. Trata-se de uma revisão de literatura, do tipo integrativa. Para busca e seleção dos estudos utilizou-se as seguintes bases de dados: Pubmed, Scielo e Science direct, totalizando 10 artigos, publicados entre os anos de 2016 a 2019. Verificou-se que há um grande percentual de depressão entre os idosos institucionalizados, o que foi evidenciado nos estudos analisados, onde encontrou-se altas taxas de depressão entre os mesmos, o que pode ser decorrente da sensação de rejeição por familiares e amigos, bem como o impedimento de realizar atividades diárias e de lazer que lhes trazem satisfação, entre diversos outros fatores. Conclui-se que é alta a prevalência de depressão entre esses idosos institucionalizados. É necessário entender os principais fatores que levam os mesmos ao quadro de depressão, para que haja desenvolvimento de ações específicas no intuito de melhora da qualidade de vida.

Drug safety among institutionalized elderly people: potential interactions

ABSTRACT Objective: to identify the drug interactions among institutionalized elderly. Method: retrospective and documentary study with a quantitative approach developed in two Long Stay Institutions for Elderly, located in northeastern Brazil. Drug interactions were identified by using Drug-Reax® software from the Micromedex database, and they were classified by severity, start time, and documentation. Result: in the 286 analyzed prescriptions, 136 drug interactions were detected in both institutions, most of them classified as severe. The average number of drugs prescribed by the elderly was 4.5. In the analysis of Pearson's correlation, the number of drug interactions showed a statistically significant correlation with the time of institutionalization and with the amount of drugs administered on the day. Conclusion and implications for practice: the high consumption of drugs and serious drug interactions detected with significant clinical repercussions was evidenced in the study. Knowledge of these interactions is essential for the establishment of preventive safety measures in pharmacotherapy.

Drug safety among institutionalized elderly people: potential interactions

ABSTRACT Objective: to identify the drug interactions among institutionalized elderly. Method: retrospective and documentary study with a quantitative approach developed in two Long Stay Institutions for Elderly, located in northeastern Brazil. Drug interactions were identified by using Drug-Reax® software from the Micromedex database, and they were classified by severity, start time, and documentation. Result: in the 286 analyzed prescriptions, 136 drug interactions were detected in both institutions, most of them classified as severe. The average number of drugs prescribed by the elderly was 4.5. In the analysis of Pearson's correlation, the number of drug interactions showed a statistically significant correlation with the time of institutionalization and with the amount of drugs administered on the day. Conclusion and implications for practice: the high consumption of drugs and serious drug interactions detected with significant clinical repercussions was evidenced in the study. Knowledge of these interactions is essential for the establishment of preventive safety measures in pharmacotherapy.

Interobserver analysis of safety practices and behaviors adopted by elderly people to prevent falls.

Objective:determine the psychometric properties of the safety practices and behaviors dimension of the Scale of Practices and Behaviors of Institutionalized Elderly People to Prevent Falls in a sample of elderly people with cognitive decline.Method:methodological study, with a quantitative approach, to assess the psychometric properties of the mentioned scale in a sample with 102 elderly people with cognitive decline who lived in two long-term care institutions for the public in this age group. Internal consistency evaluation was carried out by calculating the Cronbach’s alpha coefficient; interobserver reliability was expressed by Cohen’s kappa coefficient; and temporal stability, by obtaining Spearman correlation. Compliance with all ethical procedures was observed.Results:the dimension of safety practices and behaviors showed α = 0.895 for its 11 items. Seven out of the 11 items reached good to excellent agreement among the experts for interobserver reliability. Kappa index values indicated that the instrument is valid and reliable. Safety practices and behaviors were influenced by institutionalization time, being at least 85 years old, and gait skills.Conclusion:the results pointed out that the instrument has good reproducibility and is valid and reliable, which allows its use in clinical practice in elderly people with cognitive decline as well as in research.

Solidão no Idoso Institucionalizado com Dependência Funcional

Both the quantity and the quality of the social relations that we establish affect mental and physical health. With longevity increasing year by year, the cases of loneliness in the elderly have also increased, bringing consequences for the general health and well-being of the elderly. Studies also indicate that institutionalized elderly people are also subject to the occurrence of loneliness. It was our objective to evaluate the presence of loneliness in institutionalized elderly with functional dependence; describe the degree of loneliness in the elderly; describe the degree of dependence in the elderly. This is a descriptive cross-sectional study with institutionalized elderly from a northern region of Portugal; a convenience sample was used (n= 135). A questionnaire was used to collect data on sociodemographic characterization, Barthel Index, and UCLA Solitude Scale. Most of the sample is independent or with mild dependence. As far as loneliness is concerned, the average score is 47.77 points. The presence of loneliness seems to manifest more in the elderly with severe dependence. A relationship with statistical significance was found between gender and loneliness, showing higher values of loneliness in men.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain

This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.