Number Of Older Persons Research Articles

Nursing Home Safety: A Review of the Literature

The number of older persons in the United States is rapidly growing and, based on this growth projection, the number of consumers needing nursing home (NH) care will likely triple in the next 10 years. Although NHs have been bombarded and scrutinized about the care that they provide, the concept of safety (specifically, error prevention) remains at the margin of most quality improvement efforts. The purpose of this review is to explore what has recently been written (2000-2005) about the evolution of the NH as an organization focused on safety and the most critical clinical processes that must be closely monitored for a safe NH environment to occur. After a thorough review of both organizational and clinical NH literature, 30 organizational studies and 39 clinically based studies were reviewed. The review revealed that, organizationally, teamwork, communication, and leadership all were critical in resident and staff outcomes and clinically, assessment was an important missing process at critical points in the residents' care for prevention and timely treatment of potentially dangerous conditions. The value of the registered nurse (RN) in this setting was clear in the many assessment issues noted and the lack of RN guidance for adherence to recognized practice guidelines. To explicate the role of the RN, first, better outcome measures must be developed that are nurse sensitive. A second clear agenda for NH research is the explication of the role of leadership, particularly nursing leadership, to create an environment where open and accurate communication can be accomplished among all of the diverse NH roles. This will help all members of the team to identify care improvement opportunities. Finally, a new frontier for the NH setting is the use of technology and the need to harness the information that has set in the NH system for years. Information mastery for staff and leadership is a necessary aspect of the organization that must be developed to provide sound information for strategic and focused change to occur.

Whither care of older persons in Sweden?—a prospective analysis based upon simulation model calculations, 2000–2030

The increasing number of older persons to be expected in the coming decades raises serious questions concerning the resources that will be demanded for provision of long-term care of the frail elderly. Clearly there is a need for increased resources. However, simplistic calculations based upon the assumption that future needs of care will be proportional to the number of old persons per age group seem to lead to substantially exaggerated results by failing to take into account the positive health development of the older persons. In fact a simple model earlier co-developed by the author showed that the expected increase in the period 2000–2030 was reduced from 60% to around 20%, assuming that prevailing health trends should continue.In an effort to corroborate these results and make possible further analysis of different factors pertaining to the estimation of future needs of publicly financed long-term care of frail older persons, a new model has been developed. The model also contains a retrospective part described in another paper. Data for the model are derived from different sources—longitudinal studies, local surveys of recipients of care, etc. Four different scenarios are explored. The model calculations show that the results are highly sensitive to the assumptions you make concerning the health development of older persons. In the most pessimistic scenario D the projected cost increase in fixed prices during the period amounts to 69%—in the most optimistic scenario 0 the cost increase stays at 25%. This shows the great importance of policy measures directed at improving the health of the elderly—involving among others conditions that stimulate to increased physical and mental activity and also different medical interventions.

What happened to the care of older persons in Sweden?: A retrospective analysis based upon simulation model calculations, 1985–2000

There is in Sweden a lack of national data connecting public care services to needs in various sub-groups. As result of these statistical deficiencies there has been a severe lack of solid facts to guide the public debate in Sweden concerning the developments of the old age care system. Also connected to this are the similar problems of predicting future needs development in order to estimate future burdens on the systems of care. A computer model has been developed that, by combining different national and local data sources, describes the development of the Swedish public system of care for older persons in terms of service provision and costs per needs group according to age, gender, marital status and degree of disability or ill-health. The model works in 5-year steps and has a retrospective part covering the period 1985–2000 and a prospective part for the period 2005–2030. In this article is described the structure of the model, assumptions, data sources and results for the retrospective part of the model.The model calculations show that despite of a large increase in the number of older persons there has not been a very substantial increase of needs. The number of persons with severe ill-health is basically unchanged, even if there appears to have been some shift in the composition of the group towards more heavy disability. The reductions in provided services, that the municipalities have been forced to do depending on the harsher economic conditions in Sweden since the beginning of the 1990s, have almost exclusively been targeted on persons with lesser needs. Those most in need have largely been shielded.

Identifying Competencies for Geriatric Social Work Practice

Objective: Despite the escalating demand for geriatric social work services to meet the comprehensive needs of a growing number of older persons and their families, no commonly accepted, gerontological knowledge-based skills-or competencies-have been identified for social workers to possess to effectively serve older clients. This inquiry examined the responses of consumers and providers of geriatric social work concerning geriatric social work competencies. Method: A needs assessment was conducted with four focus groups (N = 33) comprised of older adults and caregivers (consumers), as well as employers in the field of aging and recent social work graduates currently working with older people (providers). A content analysis of field notes and transcripts from audio recordings was used to identify common domains and significant feedback. Findings: Consumers identified resource finding as the most important social worker competency. Providers most frequently cited the ability to conduct geriatric assessments and case management, and the capacity for self-awareness as important competencies. Many consumers did not understand the role of social workers. Implications: The results support the need for integrating academic and field curricula to address the lack of commonly accepted geriatric social work competencies, and the need to strengthen public education about the professional role of social work in the field of aging.

Cancer in older persons: an international issue in an aging world

Persons age 65 years and older bear the greater burden of cancer in the United States and other industrial nations. A cross-national perspective using data from several population-based resources (eg, the NCI Surveillance, Epidemiology, and End Results Program; US Bureau of Census; World Health Organization; and International Association for Research on Cancer) illustrates current and future demographic transitions in America in comparison with six industrial nations, and profiles cancer mortality in older persons across the selected nations-Denmark, France, Italy, Japan, Sweden, and United Kingdom. Mortality rates, age-standardized to the world population, are presented for major tumors. US aging and cancer profiles are highlighted. Demographic projections portend a substantial increase in numbers of older persons, and thus, imply resultant increases in cancer incidence and mortality in the elderly. By 2030, there will be larger proportions of persons in the age group most vulnerable to cancer. Information is needed on how age-related health problems affect cancer prevention, detection, prognosis, and treatment. A knowledge base as guidance in management of cancer in the elderly is lacking. Planning for effective prevention measures and improvement of treatment for the elderly is imperative to meet current and future quality cancer care needs.

Responding to the challenges of ageing and dementia in intellectual disability in Ireland

The intellectual disability (ID) population in Ireland is ageing and the number of older persons with the dual disability of ID and dementia is increasing. In spite of these demographic trends, as in other countries adequate policy and service provision for this population are lacking. This paper draws upon data available on the population with ID and dementia, reviews both generic and ID specific literature, considers the policy context and argues for a specific model of service provision. A service model is proposed for the development of multidisciplinary specialist teams within ID, delivered through mobile regional ID dementia clinics.

Chapter 10: Preaching to Senior Citizens

SUMMARY This article addresses two questions: How is preaching to a congregation of senior citizens the same as preaching to younger persons; and how is it different? It includes some practical suggestions for sermon preparation and delivery by ministers whose congregations contain a number of older persons with specific needs.

A collaborative model for research on decisional capacity and informed consent in older patients with schizophrenia: bioethics unit of a geriatric psychiatry intervention research center.

The numbers of older persons with psychiatric disorders are expected to rise rapidly in coming decades, yet most studies of the safety and efficacy of treatments for such disorders have focused on younger adults. A substantial expansion in research involving older patients is needed to meet the treatment needs of this fast growing group. A critical issue in intervention research is ensuring a patient's decision-making capacity. Considerable heterogeneity exists in this regard even within diagnostic groups. Cognitive changes as well as increased complexity of medication regimens in elderly patients may make it particularly difficult for some older persons to fully understand, appreciate, and/or reason about the risks and benefits of participating in any particular study. Empirical research into assessing and possibly improving decisional capacity is warranted in older people with severe mental illness. Such research may be accomplished through collaborations among specialists from various related disciplines and, importantly, with active involvement of community partners. We present one model of this type of collaboration, the Bioethics Unit of an Intervention Research Center, comprising a multi-disciplinary team along with a Community Advisory Board. Preliminary studies in our Center suggest that older individuals with psychotic disorders vary considerably in their decisional capacity, and many subjects appear to be fully capable for consenting to research projects. Furthermore, the patients' level of understanding of the consent material can be improved significantly through repetition and clarification of key elements in the consent form. The decisional capacity for a given research protocol is not necessarily an unmodifiable trait, but can be enhanced with improvements in consenting procedures, even in older persons with psychotic disorders.

The system of care and services for frail older persons in Canada and Quebec.

Since the early 70s, Canada has had a public health care system that guarantees all Canadians universal access to hospital and medical services free of charge. The same values and principles have governed the organization of health and social services in Quebec, including long-term care and services. Over time, changes have occurred within the Quebec system in order to adapt services to new realities more effectively; such changes involve a diversification of services oriented towards helping individuals remain in the community, and services provided close to clients' own environments. Mechanisms have also been established to improve clinical assessment of clients' needs, in order to make service orientation and admission to residential facilities more systematic. Nonetheless, reform is required in order to respond to certain trends related to client needs, i.e., greater needs due to the significant increase in the number of older persons, but also needs that differ from those of a younger population, for whom the system was designed. The new Quebec policy on services for frail older persons advocates a different concept of organization of services for this population group and presupposes major changes in the ways in which services are delivered.

Rejuvenating health systems for aging communities.

Nowadays, about the half of Swiss women die after their 84th birthday. This unprecedented proportion of the population reaching an old age, or even a very old age (25% of women die after 89 years, and 5% after 95 years) is a novel aspect of human demographics, and represents the very last stage of the epidemiological transition, a term coined to describe the transformation of the prevailing health burden in the population, shifting from infectious and communicable pathologies to chronic and degenerative diseases. In developed countries, this epidemiological transition has been well documented during the last century; worldwide, a similar transition is taking place, with some countries still at mid or early stages of transition. A striking aspect of the current transition is its speed. In India, the mean duration of life since 1947 has increased from 32 to 62 years. As a result, India, like many other developing countries, is facing a double burden of disease, i.e., an upsurge of degenerative diseases while the burden from the old agenda (i.e., malaria, tuberculosis) still reaches devastating proportions in the population. This double burden is certainly a crucial problem in developing countries, and probably is the most important health challenge for the coming century. A similar accelerated pace of change is observed with the decline of mortality at old age. Worldwide, the current estimate of centenarians is 100000, i.e., ten time more centenarians than the number estimated in 1960. The downward trend in mortality, which is steeper with increasing age, is now the leading factor to Increase the life expectancy in developed countries. In the United Kingdom, life expectancy increased by 2.5 years between 1971 and 1991; this is equivalent to the increase observed between 1851 and 1961. This accelerated increase will influence public health in two different ways. The first will be the absolute increase in the number of older persons, with a corresponding increase in degenerative diseases. A second consequence will be the need for a substantial and rapid adaptation of the health care system. Three selected aspects are addressed below: 1) the increase of resources, 2) the improvement of performance, and 3) the reduction of demand through preventive strategies.

Taking off the white coat: can family members who are physicians be good surrogate decision-makers?

The challenges inherent in physicians treating members of their own families are well known. However, the issues related to physicians acting as surrogate decision-makers on behalf of relatives have not been addressed. The growing number of older persons will increase the need not only for healthcare resources, but also for physicians to act on behalf of incapacitated family members as surrogate decision-makers. In this paper, some of the clinical and ethical tensions evoked by physicians serving as surrogate decision-makers for family members are explored. Some recommendations for managing these tensions are suggested.

Old Age and Religion in the Writings and Life of Jonathan Edwards

In hisFaithful Narrative of a Surprising Work of God, an account of the awakening of 1734–35 in his church at Northampton, Massachusetts, Jonathan Edwards excitedly reported a considerable number of old persons among the several hundred converts. “I suppose,” he wrote, “there were … more than twenty of them above fifty, and about ten of them above sixty, and two of them above seventy years of age.” Edwards's evident self-satisfaction stemmed from the widespread belief that conversion among the elderly was unusual. “It has been a thing heretofore rarely to be heard of,” he noted, “that any were converted past middle age; but now we have the same ground to think that many such have in this time been savingly changed, as that others have been so in more early years.”

Framing the Issues

Abstract The role of social work in the admissions process to long-term care facilities is discussed from an international perspective using three countries: Israel, Australia, and South Africa as illustrations. Although each of these countries is concerned with demographics, limited resources and meeting the cost of services for an increasing number of older persons, their governments, culture and societal expectations differ. Hence the nature of the challenges and the potential solutions differ.

Research About Family Caregivers Becoming More Urgent

It is encouraging to see research being done in the area of family caregiving, such as Sara Meller's recent article. 1 Meller S A comparison of the well-being of family caregivers of elderly patients hospitalized with physical impairments versus the caregivers of patients hospitalized with dementia. J Am Med Dir Assoc. 2001; 2: 60-65 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar As the population ages, the incidence of Alzheimer's disease, Parkinson's, stroke, hip fractures and other chronic medical conditions becomes greater. According to a study conducted by the US General Accounting Office in 1994, it is estimated that the number of older persons needing long-term care may as much as double over the next 25 years. 2 US General Accounting Office Long-term care: Diverse, growing population includes millions of Americans of all ages. US General Accounting Office, Washington, DCNovember 7, 1994 Google Scholar

Symposium on endocrinology and aging: the 1st meeting of the European Interest Group hormones and aging.

Abstract The decline of multiple hormone systems observed with aging could contribute to the age-related morbidity and mortality. However research protocols addressing the reduction in hormonal function with advanced age and trials assessing the value of hormone replacement therapy in the aged are lacking behind the rapidly increasing number of old persons in Europe. To increase the awareness and to raise the interest for the endocrinology of aging, the recently established European Interest Group of Hormones and Aging has gathered gerontologists and endocrinologists for the inaugural International Symposium. Speakers from Austria, Germany, the United States and Switzerland presented research data as well as an overview of current topics in clinical geriatric and endocrine research, such as somatopause, adrenopause, male menopause, the relationships of age-related changes in body-composition with carbohydrate metabolism and the effects of substitution of DHEA on psychological well-being in young and old individuals. In the current report these presentations are summarized and a Consensus Statement is added.

Responding to issues about older persons in Africa

The number of older persons in the general population is increasing in many African countries due to the gains in life expectancy during the twentieth century (Amosun, 1999; Apt, 1997; Baiyewu et al, 1997; Amosun, Mazarire, & Mawere 1995; Amosun & Alawale, 1994). As the number escalates, the question of how to care for older persons becomes critical. The United Nations proclaimed October 1, 1998 through December 31, 1999 as the International Year of Older Persons (IYOP), offering all countries the opportunity to focus on the needs of and services provided to their aging populations. Through a variety of activities designed to gather information about older individuals in five African countries, the author sought to clarify the following questions: 1) What are some of the specific needs of older persons in Africa? 2) How frequently and how well are physiotherapy services being utilized? and 3) How effectively are the needs of older persons being met? Only after answering these questions can recommendations to further respond to the growing needs of older persons in Africa be proposed.

Change in the Prevalence of Diseases Among Older Americans: 1984-1994

The reported prevalence of diseases increased among older Americans in recent years. The largest increases have been in the proportion of the population with heart disease and cancer. There has also been a decrease in the number of older persons with no disease and an increase in the proportion of people with multiple conditions. The severity of disability among women with most diseases has been reduced; among men there has been no reduction in disability. Both the prevalence of diseases and the prevalence of disability are indicators of population health that result from a complicated process of disease and disability onset survival probability and death rates for people with and without these health conditions. While change in disease prevalence and disability has been based on analysis of two surveys representative of the U.S. noninstitutionalized population taken ten years apart and designed to monitor health change it is possible that changes in medical knowledge or service usage could play a role in increased reporting of disease presence. (authors)

Caregiver Involvement in the Use of Assistive Devices by Frail Older Persons

The population of persons over age 65 years is increasing, and with this trend there is an increase in number of older persons with disabilities, or frail elders. The importance of supportive environments for home-based frail elders has been recognized. Supportive environments include the presence of family caregivers and appropriate assistive devices. Assistive devices (AD) offer the potential to decrease frail elder's need for personal assistance, and could reduce some of the burden expressed by caregivers. The inclusion of family caregivers in treatment planning and its implementation is a component of occupational therapy practice. Occupational therapists are also recognized as the lead professional in the provision of most assistive devices. However, there has been little research on the involvement of family caregivers in the use of assistive devices. The purpose of this study was to examine the relationship between caregiver involvement and the use of, and satisfaction with, assistive devices by frail elders. Interviews regarding assistive devices were conducted with 20 frail, cognitively intact elders who had a primary caregiver in their homes. Results indicate that elders regard assistive devices as very useful in saving time, conserving energy, reducing frustration, and providing a feeling of security. Caregivers were involved in the use of assistive devices when the device was first acquired (early caregiver involvement) and made suggestions for using the devices. They also encouraged, instructed, and assisted with the use of devices later, as necessary. There was a relationship between early caregiver involvement and involvement at the time of the interview (later caregiver involvement). Verbal encouragement and caregiver's use of assistive devices to help perform tasks were strongly associated with both device use and satisfaction. The results reinforce the importance of caregiver involvement with assistive devices used by frail older persons.

DEVELOPING COLLABORATIVE GERONTOLOGY PROGRAMS OFFSHORE: A CASE STUDY

With the number of older persons in Hong Kong and the need for improved standards of care and aged care policy increasing, gerontologists will continue to play a significant role in providing gerontological education on an international level. Over the next 2 decades, the older population in Hong Kong is projected to increase significantly. Individuals 65 years and over are anticipated to number about 1,067,300 by 2016. This article describes a unique collaboration between the University of New England, School of Health (Armidale, New South Wales, Australia), and Chinese University of Hong Kong, School of Continuing Studies, in which the Graduate Diploma and Master of Health Science (gerontology) programs are presented through mixed-mode and on-line education using the World Wide Web. The curriculum was developed with consideration of the Hong Kong health care system and cultural context. The curriculum is multidisciplinary in nature, and students represent a wide range of professions. This article discusses the methodology used to develop this collaborative project and to ensure that the course is relevant for students in Hong Kong.

The status of older persons in Africa: Challenges facing physiotherapists

In many African countries, there has been an increase in the number of older persons because of the gains in life expectancy made in the 20th century. The increase has led to concerns about how to provide necessary care for older persons as many on-going changes in the society threaten to erode the traditional support network. The paper identifies some of the many challenges facing physiotherapists in improving the status of older persons in Africa, and gives suggestions on overcoming the challenges.