People Receiving Home Care Research Articles

Loss of occlusal support affects the decline in activities of daily living in elderly people receiving home care

PurposeThis study aimed to clarify whether the absence of occlusal support would lead to a decline in the activities of daily living (ADL) in elderly people receiving home care. MethodsThe subjects of this study were 322 elderly individual aged 65 and older who were receiving home care during a one-year observation period. The subjects were divided into two groups according to the change in the total score of the Barthel Index (BI) during the prospective cohort study period (the dependent variable): the maintained/improved activities of daily living group, in which the score was unchanged or improved, and the worsened activities of daily living group, in which the score decreased. The relationship between occlusal status (the presence or absence of occlusal support) at the baseline measurement and each BI score change was evaluated in the slightly, moderately and totally dependent ADL subgroups. ResultsThe number of subjects in the maintained/improved and the worsened ADL groups was 152 and 170, respectively. The baseline characteristics of cognitive function and occlusal support were significantly different between the maintained/improved and the worsened ADL groups (p<0.05). Among the ADL subgroups, significantly reduced scores in mobility and toilet use were observed only in the slightly dependent group (p<0.05). ConclusionsOur results suggest that the loss of occlusal support may be an important factor in the decline of ADL in elderly people receiving home care, especially slightly dependent people.

A Systematic Review of Physical Activity Programs for Older People Receiving Home Care Services.

The proportion of older people living in our communities is rising and, to live independently, some require assistance from home care services. Physical activity can improve and maintain function, strength, and balance, which are important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialed with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures, and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain "real-world" knowledge of what interventions are effective and can be delivered within this setting.

Food provision for older people receiving home care from the perspectives of home-care workers.

Malnutrition is a significant cause of morbidity and mortality, particularly among older people. Attention has focused on the inadequacies of food provision in institutions, yet the majority suffering from malnutrition live in the community. The aim of this study was to explore barriers and facilitators to food provision for older people receiving home care. It was a qualitative exploratory study using semi-structured interviews with nine home-care workers in June 2013 employed by independent agencies in a large city in northern England. Data were analysed thematically, based on the principles of grounded theory. Findings showed that significant time pressures limited home-care workers in their ability to socially engage with service users at mealtimes, or provide them with anything other than ready meals. Enabling choice was considered more important than providing a healthy diet, but choice was limited by food availability and reliance on families for shopping. Despite their knowledge of service users and their central role in providing food, home-care workers received little nutritional training and were not involved by healthcare professionals in the management of malnutrition. Despite the rhetoric of individual choice and importance of social engagement and nutrition for health and well-being, nutritional care has been significantly compromised by cuts to social care budgets. The potential role for home-care workers in promoting good nutrition in older people is undervalued and undermined by the lack of recognition, training and time dedicated to food-related care. This has led to a situation whereby good quality food and enjoyable mealtimes are denied to many older people on the basis that they are unaffordable luxuries rather than an integral component of fundamental care.

Interrelationship of oral health status, swallowing function, nutritional status, and cognitive ability with activities of daily living in Japanese elderly people receiving home care services due to physical disabilities

Malnutrition and cognitive impairment lead to declines in activities of daily living (ADL). Nutritional status and cognitive ability have been shown to correlate with oral health status and swallowing function. However, the complex relationship among the factors that affect decline in ADL is not understood. We examined direct and indirect relationships among oral health status, swallowing function, nutritional status, cognitive ability, and ADL in Japanese elderly people living at home and receiving home care services because of physical disabilities. Participants were 286 subjects aged 60 years and older (mean age, 84.5±7.9 years) living at home and receiving home care services. Oral health status (the number of teeth and wearing dentures) was assessed, and swallowing function was examined using cervical auscultation. Additionally, ADL, cognitive ability, and nutritional status were assessed using the Barthel Index, the Clinical Dementia Rating Scale, and the Mini Nutritional Assessment-Short Form, respectively. Path analysis was used to test pathways from these factors to ADL. The mean number of teeth present in the participants was 8.6±9.9 (edentates, 40.6%). Dysphagia, malnutrition, and severe cognitive impairment were found in 31.1%, 14.0%, and 21.3% of the participants, respectively. Path analysis indicated that poor oral health status and cognitive impairment had a direct effect on denture wearing, and the consequent dysphagia, in addition to cognitive impairment, was positively associated with malnutrition. Malnutrition as well as dysphagia and cognitive impairment directly limited ADL. A lower number of teeth are positively related to swallowing dysfunction, whereas denture wearing contributes to recovery of swallowing function. Dysphagia, cognitive impairment, and malnutrition directly and indirectly decreased ADL in elderly people living at home and receiving home nursing care. The findings suggest that preventing tooth loss and encouraging denture wearing when teeth are lost may indirectly contribute to maintaining or improving ADL, mediated by recovery of swallowing function and nutritional status.

Overlap of hospital use and social care in older people in England

To link pseudonymous health and social care use data in order to determine what proportion of older people access hospital and social care services. Retrospective analysis of linked, pseudonymous, routine service use data of people aged 75 and over (n = 133,055) drawn from the operational systems of four primary care trusts and their corresponding local authorities in England. Fourteen percent of older people received local authority-funded social care in one year, 59% accessed NHS hospital care and 10% accessed both types of service. Most people using social care also used a hospital service (71%). This was a higher proportion than for people who did not use social care services (57%, P < 0.001). However, the use of hospitals varied by type of social care such that the residents of care homes had fewer admissions to hospital, fewer Accident and Emergency attendances and fewer outpatient visits than people receiving high intensity home care. Using routine data from large populations, we have demonstrated interactions in the use of hospital care and social care for older people. Residents of care homes tend to use hospitals less frequently than people receiving home care. More detailed work is required to explain this phenomenon.

Geriatric nursing assessment and intervention in an emergency department: a pilot study

To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department (ED). Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home from an ED as time pressure requires staff to focus on the presenting problem although many have complex, unresolved, care needs. A prospective descriptive pilot study was conducted. Older people aged 70 and over and at risk of adverse health and functional outcome were included. At discharge, and at 1 and 6 months follow-up, a brief standardised nursing assessment (ISAR 2) developed by McCusker et al. was carried out. The focus was on unresolved problems that required medical or nursing intervention, new or different home care services or comprehensive geriatric assessment. After assessment, the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next of kin. One hundred and fifty people participated, mean age was 81.7. At discharge, they had a mean of 1.9 unresolved problems, after 1 month 0.8, and after 6 months 0.4. Older people receiving home care services increased from 79% at discharge to 89% at 1 month and 90% at 6 months follow-up. ISAR 2 works well in a Danish ED setting and intercepts older peoples' problems. It seems that unresolved problems decrease when a nurse assesses and intervenes at discharge from ED, and at follow-up. However, a randomised controlled test should be carried out to confirm this. Nursing assessment and intervention should be implemented in the ED to reduce older peoples' unrevealed problems.

Poor care of the elderly —is it inevitable?

This article provides an overview of the findings of an inquiry into the human rights of older people receiving home care. This article focuses on the findings related to the care provided by home care workers and how it resonates with recent findings in the NHS by the Care Quality Commission. Human rights principles and the NHS Constitution values are discussed as a reference framework for care workers to use in their everyday working practices.

Evaluating the potential of removing long-term urinary catheters among home care recipients in Taiwan

BackgroundUrinary catheter placement is a common treatment choice for incontinent people. In Taiwan, urinary catheterization is a common care need for people receiving home care services, but the appropriateness of long-term urinary catheterization in this setting deserves extensive evaluation. PurposeThe main purpose of this study is to evaluate the potential of removing long-term placed urinary catheters among home-care recipients. MethodsHome care recipients with long-term urinary catheterization of a tertiary medical centre in Taichung were invited for study. For all participants, urinary catheters were removed for 4 hours before replacing a new catheter. Residual volume was measured to determine the ability of removing urinary catheters. ResultsIn total, 43 home care recipients (mean age: 80.3 ± 10.2 years, 37.2% men) participated in this study, and most of them were physically dependent [Eastern Cooperative Oncology Group (ECOG) Grade 3 for 48.8% and Grade 4 for 51.2%] and 69.8% were long-term catheterized. After removing urinary catheters, no self-voiding was observed and the mean residual-urine volume was 162.5 ± 9.6 cc during 4-hour observation. The mean residual-urine volume of the more dependent participants (ECOG Level 4) was significantly higher than the less dependent recipients (ECOG Level 3) (166.3 ± 12.5 vs. 157.5 ± 8.1 cc, p = 0.004). Comparing recipients with residual urine volume higher and lower than 160 cc, we found that recipients with higher residual-urine volume were more likely to be people with diabetes (72.7% vs. 19.0%, p = 0.001) and higher dependence (ECOG Grade 4) (72.7% vs. 28.6%, p = 0.01). ConclusionIn conclusion, none of the long-term urinary catheterized home care recipients in this study demonstrated the ability of self-voiding, and those who had a residual-urine volume more than 160 cc were more likely to be people with diabetes and physical dependence. Further prospective interventional study is needed to evaluate the possibility of removing long-term urinary catheters among home care recipients in Taiwan.

Effects of anorexia on mortality among older adults receiving home care: an observation study.

We describe the prevalence of secondary anorexia in a population of older people living in community and receiving home care. In addition, we examined the relationship between secondary anorexia and mortality. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 2757 patients were enrolled in the present study. The main outcome measures were the prevalence of anorexia, weight loss and survival. More than 25% (744 subjects) of the study sample suffered from anorexia. During a mean follow-up of 10 months from initial MDS-HC assessment, 468 patients (17%) died. There was uneven distribution of the risk. After adjusting for age, gender and for all other possible risk factors for death (living alone, physical and cognitive disability, behavior problems, urinary incontinence, pressure ulcer, hearing impairment, congestive heart failure, hypertension, depression, diabetes, renal failure, cancer), subjects with anorexia were more likely to die relative to patients without anorexia (RR, 1.83; 95% CI 1.45-2.31). Even though the risk of mortality was higher among subjects suffering from anorexia and weight loss, the anorexia per se was associated with higher risk compared with subjects without anorexia (RR, 1.45; 95% CI 1.01-2.19). Anorexia is associated with a significant higher risk of all-cause mortality. The present findings support the possibility that anorexia has an independent effect on survival even among old people receiving home care.

More users are satisfied with home care support services.

Nearly half of all older people receiving home care services say the support they receive helps them feel in control of their lives, according to a survey by the Information Centre.

Living with persistent pain: experiences of older people receiving home care.

Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.

Validation of the Resident Assessment Instrument triggers in the detection of under-nutrition.

To test the validity of Resident Assessment Instrument triggers for people in Danish nursing homes and subjects receiving home care by exploring their ability to identify older people with insufficient energy and protein intake. Regression analysis of insufficient energy or protein intake on each of the Resident Assessment Instrument triggers alone or in combination. 38 people receiving home care and 41 living in nursing homes. A 4 day estimated dietary record, assessment of energy and protein intake, calculation of body mass index. Food remaining on the plate, weight loss and any trigger present significantly influenced the energy or protein intake of the nursinghome subjects. No triggers reflected the energy or protein intake of the subjects at home. Observation of food intake seems to be the best way to detect which older Danish people living in nursing homes or receiving home care have insufficient energy or protein intake.

Randomised controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home

To investigate the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority. Randomised controlled trial with blind follow up six months after recruitment. Community of south east London. 69 people aged 65 or over who received home care and were depressed according to criteria of the standardised automatic geriatric examination for computer assisted taxonomy (AGECAT). 33 were randomly allocated to an intervention group and 36 to a control group. Members of the intervention group received an individual package of care that was formulated by the community psychogeriatric team in their catchment area and implemented by a researcher working as a member of that team. The control group received normal general practitioner care. Recovery from depression (AGECAT case at recruitment but non-case at follow up). Data were analysed on an intention to treat basis. 19 (58%) of the intervention group recovered compared with only nine (25%) of the control group, a difference of 33% (95% confidence interval 10% to 55%). This powerful treatment effect persisted after controlling for possible confounders in logistic regression analysis, with members of the intervention group more likely than members of the control group to have recovered at follow up (odds ratio 9.0 (2.0 to 41.5)). This did not seem to be a simple effect of antidepressant prescription: use of antidepressants at follow up did not have a significant effect (multiply adjusted odds ratio 0.3 (0.0 to 1.9)). Depression is treatable in elderly people receiving home care. Therapeutic nihilism based on an assumed poor response to treatment in these socially isolated, disabled elderly people in the community is not supported.