Institutionalized Elderly People Research Articles

Assistive technology in elderly care.

New developments in assistive technology are likely to make an important contribution to the care of elderly people in institutions and at home. Video-monitoring, remote health monitoring, electronic sensors and equipment such as fall detectors, door monitors, bed alerts, pressure mats and smoke and heat alarms can improve older people's safety, security and ability to cope at home. Care at home is often preferable to patients and is usually less expensive for care providers than institutional alternatives.

Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people.

The loss of teeth is known to influence the mastication of foods and nutritional status. Therefore, we hypothesize that poor dentition status can impair the systemic health of the aged. To clarify the influence of dentition status on deterioration in physical ability, mental impairment, and mortality, we conducted a six-year prospective cohort study of the institutionalized elderly living in 29 of the 30 institutions for the elderly in Kitakyushu, Japan. Bivariate analysis revealed that worse dentition status at baseline led to significantly worse physical and mental impairment, and higher mortality. In a multiple logistic regression analysis, the physical ability of edentulous subjects without dentures significantly deteriorated compared with that of dentate subjects with 20 or more teeth. The six-year mortality rate of the edentulous subjects without dentures was significantly higher than that of the subjects with 20 or more teeth. Poorer dentition status, especially edentulousness without dentures, may therefore be related to deterioration in the systemic health of the aged.

Utility of an ADL Index for Institutionalized Elderly People: Examining Possible Applications for Independent Elderly People.

Utility of an ADL Index for Institutionalized Elderly People: Examining Possible Applications for Independent Elderly People.

Prevalence of urinary incontinence among institutionalized patients: a cross-sectional epidemiologic study in a midsized city in northern Italy

Objectives. To determine the prevalence of urinary incontinence among institutionalized elderly people. Methods. A cross-sectional study was conducted on 839 subjects, resident in 14 residential or nursing homes. A questionnaire was administered to the study population and their clinical records were reviewed. Results. The overall prevalence of urinary incontinence was 54.5%, higher in women (59.8%) than in men (39.2%). The prevalence increased significantly with age, from 26.5% in subjects 65 years old or younger to 73.7% in subjects 95 years old or older; with worsening of mental status, from 36.2% in well-oriented subjects to 76.7% in poorly oriented subjects; and with worsening of mobility, from 23.8% in self-sufficient subjects to 82.1% in bedridden patients. The prevalence was significantly associated with parity, from 54.1% in nulliparous women to 65.4% in multiparous women. Urinary incontinence was also associated with urinary tract infection, constipation, and fecal incontinence. Conclusions. The results of our study are in accordance with other similar studies. That more than one half of the elderly residents of nursing and residential homes have urinary incontinence shows the relevance of this condition. We believe that urinary incontinence in institutionalized elderly people can be managed essentially by measures of tertiary prevention, aimed at reducing the handicapping conditions and at slowing down the process of self-sufficiency impairment.

Folate Status Worsens in Recently Institutionalized Elderly People without Evidence of Functional Deterioration

Objective: To follow folate status, hematological and cognitive changes during the first year of institutionalization among elderly subjects.Design: Prospective study.Setting: Long-stay unit of the Dijon University Geriatric Hospital.Subjects: Twenty women and four men older than 65 years admitted consecutively.Main outcome measures: Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating levels of folate, vitamin B-6, total homocysteine (tHcy), blood counts and cognitive performance were determined in parallel.Results: From d 1 to d 360, mean folate and vitamin B-6 intakes remained below the French RDA and mean folate intakes decreased significantly (Δ = −10.2%, p <0.05). Mean plasma or erythrocyte folate decreased significantly (Δ = −33.7%, p <0.05 and Δ = −30.2%, p <0.001, respectively) from d 1 to d 360; no significant change was observed for the other blood parameters. The incidence of folate deficiency increased (8% vs. 37% for plasma folate <6.8 nmol/L and 8% vs. 17% for erythrocyte folate <340 nmol/L) from d 1 to d 360. Mean plasma pyridoxal 5′-phosphate (PLP) remained <20 nmol/L during the one-year follow-up. There was no difference between genders for plasma tHcy. Although mean plasma tHcy was <14 μmol/L, plasma tHcy was >14 μmol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Hct <35% in women and Hct <40% in men), but the anemia was normocytic (MCV <100 fL). Subjects had a moderate dementia at admission, and no change was observed during the study.Conclusions: Subjects were already vitamin B-6 deficient at admission. Folate status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deterioration. Plasma tHcy didn’t appear to be an earlier predictor of folate deficiency.

Oral Microbial Flora in Institutionalized Elderly People

Oral Microbial Flora in Institutionalized Elderly People

Outcomes of a 12-week Functional Exercise Programme for Institutionalised Elderly People

The aim of this study was to investigate the effect of a 12-week exercise programme on the functional status of institutionalised elderly people. Fifteen subjects from two residential homes were assigned to either a control or an exercise group: six exercisers (mean ± sd) 88 ± 5 years and nine controls, 87 ± 4 years. The exercise sessions were carried out twice a week for 12 weeks. The variables measured were distance walked in 15 seconds, single and triple chair rise, and timed stair ascent and descent (all timed using a stopwatch). The exercise sessions consisted of a seven-minute warm-up, a circuit (including walking, chair rising, stair ascent and stair descent) and a ten-minute cool-down. Paired sample and two sample t-tests were used to assess changes. The exercise group improved significantly in all variables post-intervention, while the control group improved significantly in timed stair ascent and timed single chair rise. The exercise group did not significantly improve over the controls in any of the variables, except for walking. Confidence intervals of 95% showed that on average, the exercisers improved between 2 and 5 metres more than the controls in the walking test. The improvement in walking performance in the exercise group may result in increased physical activity and an enhanced lifestyle.

Immobility as a major cause of bone remodeling in residents of a long-stay geriatric ward.

Residents of a long-stay geriatric ward at the University Hospital Basel were included in a study to investigate the effects of hypovitaminosis D and immobility. All 91 women (mean age 82.5 years) and 92 men (mean age 78.7 years) were enrolled in the study. Measurements included bone resorption, as measured by urinary deoxypyridinoline (dpd), serum 25-hydroxyvitamin D (25OHD), serum intact parathyroid hormone (iPTH), and their correlations with a four grade mobility score. Mobility score reflected the degree of weight bearing, ranging from walking independently to primarily bed bound. In 86% of all residents, serum 25OHD levels were below the normal limit of 12 ng/ml. Secondary hyperparathyroidism (HPT) was detected in 24% of all patients, using 55 pg/ml as the upper limit for serum iPTH. No significant correlation was found between urinary dpd and serum 25OHD or serum iPTH. Mobility index and both urinary dpd (f: P = 0.001, r = 0.37; m: P < 0.0001, r = 0.47) and serum calcium (female: P = 0.007, r = 0.28; male: P = 0.02, r = 0.24) were positively related. In institutionalized elderly people with a high prevalence of vitamin D deficiency serum intact PTH levels did not correlate with bone resorption as measured by urinary deoxypyridinolin. However, more immobile subjects had significantly higher excretion rates for urinary dpd and higher serum calcium levels. Our results suggest that in elderly people immobility may contribute to bone loss that might preempt the development of secondary HPT through elevation of serum calcium.

Muscle strength in the elderly: Its relation to vitamin d metabolites

Objective: To identify a relation between loss of muscle strength and vitamin D deficiency in ambulatory elderly persons not receiving vitamin D supplementation. Design: Cross-sectional study. Setting: All measurements were taken at the Department of Geriatrics, University Hospital, Basel, Switzerland. Subjects: Three hundred nineteen patients (103 women, 216 men) selected by random sampling from participants in an ongoing interdisciplinary study on aging (mean age for women, 74.2yrs; for men, 76.7yrs). Outcome Measures: Leg extension power (LEP) and body mass index (BMI); serum values of 25-hydroxyvitamin D [calcidiol, 25(OH)d], 1,25-hydroxyvitamin D [calcitriol, 1,25(OH) 2d], and intact parathyroid hormone (iPHT). Results: Twelve percent of women and 18% of men had 25(OH)D values below the normal range (<12ng/mL). Muscle strength was lower in older subjects (female: r = −.35; p = .0005/male: r = −.48; p < .0001) and was lower in women than in men ( p <.0001). In men both 25(OH)D and 1,25(OH)2D was significantly correlated with LEP ( r = 0.24; p = .0004/ r = .14; p = .045). In women, only 1,25(OH)2D was significantly correlated with LEP ( r = 0.22; p = .034). In an ANCOVA including all participants and explaining LEP by sex, age, BMI, 1,25(OH)2D, 25(OH)D, and iPTH, all factors showed significant effects except 25(OH)D and iPTH ( r 2 = .41). Conclusion: Muscle strength declined with age in ambulatory elderly people and showed modest, but significant, positive correlation with 1,25(OH)2 vitamin D in both sexes and with 25(OH)D in male subjects. Therefore vitamin D deficiency appears to contribute to the age-related loss of muscle strength, which might be more pronounced in institutionalized elderly people with a high prevalence of vitamin D deficiency.

Strategies to improve the quality of oral health care for frail and dependent older people.

The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon...

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy‐makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long‐term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.

Nutritional status of vitamin A and E in institutionalized elderly people in Granada (Spain).

A study has been carried out on the nutritional status of vitamin A and E in 93 institutionalized elderly people in Granada (Spain) by studying their vitamin intake and the serum values of retinol and alpha-tocopherol. The influence of lipid intake and lipids in plasma has been also discussed. The vitamin A intake is higher than the recommended amount and represent 209% DR in men and 217% DR in women. The vitamin E intake is deficient in 33% of the men and 27% of the women. The serum values of retinol indicate that 11% of the women have a deficiency (< 0.7 microM), and that 39% of the men and 32% of the women have low values (0.7-1.22 microM). As for the serum values of alpha-tocopherol, 6% of the women have deficient values, and 82% of the men and 37% of the women have low values (11.6-23.2 microM).

施設入居高齢者の歯周組織の健康状態と全身的健康状態の関連性について

施設入居高齢者の歯周組織の健康状態と全身的健康状態の関連性について

Catering for Institutionalized Elderly People:

The most significant demographic change in the UK this century has been the relatively rapid ageing of the population. More specifically, the growth of the very old (those over 80) has widespread implications for health and community care in the UK. Despite the Government′s recently revised community care policy, the changes in family structure brought about through divorce, geographical mobility and lower birth rate, as well as the degenerative nature of many mental and physical diseases, has meant that there are more elderly people being cared for in institutions, particularly private care homes. Consequently, private homes are responsible for the nutritional wellbeing of thousands of elderly people. Reviews the findings of a study of private homes in West Yorkshire in 1992‐3 on the problems of catering for elderly people in care and points to some areas where successes in the field of healthy eating and improving health and independence have occurred.

The incidence of hip fractures in independent and institutionalized elderly people

The incidence density of hip fractures in the population of Amsterdam, aged 70 years and over, was studied according to the type of residence. In 1989, 655 patients were admitted to nine hospitals within Amsterdam for a hip fracture. Postal codes were used to classify the residence of the population and the hip fracture cases as independent, home for the elderly or nursing home. Stepwise logistic regression was used for data analysis. The risk of hip fracture increased with age and was 1.7 times higher for women than for men. In the age group 70-74 years the relative risk (RR) was 7.6 for those in homes for the elderly and 5.8 for those in nursing homes, when compared with the independent elderly. This RR was approximately 1 for those in homes for the elderly aged 85 years and over. However, in nursing homes the RR was still 2.8 in the age group 95+. We concluded that, despite protective measures against falls, the institutionalized elderly are at greater risk of hip fracture than the independent elderly of the same age and sex. This higher risk is especially apparent in the 'younger' age groups.

Factors connected with alveolar bone resorption among institutionalized elderly people.

In this socio-dental investigation among 175 institutionalized somatically disabled edentulous elderly people correlations are described between the test subjects' degree of alveolar bone resorption, their gender and age, their duration of edentulousness, and the number of complete dentures worn. All test subjects were interviewed by dental students and clinically examined by dentists. The mandibular alveolar bone resorption was significantly stronger in women than in men and stronger in people who had been edentulous longer. The longer the test subjects had been edentulous and the greater their degree of mandibular alveolar bone resorption was, the more mandibular dentures they had worn. This study among institutionalized elderly people provides for the most part the same results as a previously presented study among much younger people. Obviously, in these respects there are no differences between these groups.

Benefit related assessment of treatment need among institutionalised elderly people.

It has been assumed that improved oral health leads to a better quality of life for elderly people. It is, however, difficult to assess the benefit of oral health care, especially dental treatment in terms of life quality. The normative assessment, based solely on clinical diagnosis, often leads to an overestimation of the true need for treatment, especially among the 'frail elderly', some of whom do not want treatment, either because there is no perceived need or expressed demand. Others are very ill, and some in such a poor mental condition that they can not express any demand for treatment, and would probably not benefit from treatment e.g. new dentures. The realistic treatment need is an attempt to assess the true need for treatment in relation to the benefit provided. It is a combination of the normative need, the self-perceived need, and the expressed demand for treatment, and takes into account the mental and physical state of the individual, as well as ethical considerations.

Eastenders on the South Coast

In spite of the moves over the last 20 years towards community care, there remain substantial numbers of elderly people with both physical and mental illness who require residential, nursing home and hospital care. There is evidence to suggest that health service provision of long term care for the mentally ill has been, and continues to be, reduced. In addition there has been reduction in beds for long term care by geriatric physicians and while the nursing home and residential care sectors have expanded, this expansion has been entirely within the ‘independent’ private and voluntary sector, with considerable contraction of local authority provision. Representations have been made about this to the Old Age Section of the Royal College of Psychiatrists and they have reported on this (Benbow &amp; Jolley, 1992). Concern has not been confined to the profession. Over the last year, there has been considerable media publicity about the long term care of elderly people in institutions. Some of this has been very critical [Panorama, 20.1.92] and has provoked debate on the pages of the national papers.

The roles staff play in the social networks of elderly institutionalized people

This paper concerns different ways in which nursing home residents interpret their relationships with institution staff. The research on which it is based involved an anthropological social network analysis. Analysis revealed different patterns of resident-staff interaction that are described in relation to four types of personal networks. Their meaning is interpreted in terms of the tensions between residents' common needs for attachment and autonomy and their limited means to achieve satisfaction.

Is relocation harmful to institutionalized elderly people?

One hundred and one elderly continuing-care residents were relocated, from a hospital which closed, to new or refurbished accommodation at another hospital. Barthel and CAPE scores were used to assess changes in disability. Small improvements in disability over the relocation period were seen compared with changes seen over a subsequent, 2-month control period. The monthly mortality rate in the 6 months after relocation was not statistically different from that in the corresponding 6 months the previous year. Relocation to more appropriate accommodation may have had overall beneficial effects on disability.