Placement In Institutional Care Research Articles

Symbolic Interaction, Power, and War: Narratives of Unaccompanied Young Refugees with War Experiences in Institutional Care in Sweden

This study concerns young people who have experienced war, taken shelter in Sweden, and been placed in institutions. The purpose of the study is to identify and analyze power relations that contribute to the shaping of young people’s identities and repertoires of action via stigmatizations and social comparisons with different reference groups. The study’s empirical material includes qualitatively oriented interviews with six young people from Iraq, Syria, and Afghanistan who have experienced war, followed by placement in institutional care in Sweden. Analytical findings with the following themes are presented: (1) concrete—physical exercise of power, (2) blackmail as an exercise of power, and (3) anonymous—bureaucratized exercise of power. The study demonstrates that narratives about war, escaping war, and postwar life in Sweden, constructing and reconstructing an image of a series of interactive rituals that are both influenced by and influence the power dynamic between the actors. This relationship, in turn, creates and recreates an interplay among the stigmatizing experiences of the youths, their social comparisons, and definitions of inequality.

Constructing togetherness throughout the phases of dementia: aqualitative study exploring how spouses maintain relationships withpartners with dementia who live in institutional care.

To explore and describe how spouses involve themselves in the relationship with their partners with dementia who live in institutional care. Positive reciprocity between partners has been proven to be significant for spouses with partners living with dementia at home. However, little is known about spousal involvement after placement of a partner in an institutional setting. This subject was therefore the focus of this study. Constructivist grounded theory was used to develop meaningful concepts considering the relational processes experienced and described by the spouses. Interviews were conducted with 15 spouses (eight women and seven men ranging in age from 64-90years) of dementia-afflicted persons living in institutional care. Theoretical sampling, constant comparison and memo-writing guided the data collection and analysis. The analysis showed how the spouses adopted different visiting routines to preserve continuity in their relationship throughout the phases of dementia. Three categories described how these visiting routines were used and adapted along with their partners' dementia progressions in the process of constructing togetherness: 'maintaining involvement and intimacy to preserve continuity in their relationship,' 'structuring visits to facilitate interaction and communication' and 'pursuing moments of mutuality to preserve continuity in a deteriorating relationship.' Being involved and experiencing continuity in the relationship seemed important to the spouses after their partners' placement in institutional care. In the process of constructing togetherness, visiting routines were used to facilitate situations in which they could connect with their partners. These routines were continuously adjusted throughout the phases of dementia. There is a need for a systematic approach to provide sufficient support to spouses throughout their partners' dementia progressions to assist their ongoing involvement.

Arab Mothers' Involvement With Their Offspring With Severe Intellectual Disabilities After Placement in Institutional Care

This study examines the cognitive-behavioral and emotional involvement among 81 Israeli Arab mothers after placement of their offspring with severe intellectual disabilities in institutional care, with respect to mothers' and offspring's background data and measures of divisional roles in the Arab family. Core findings indicate that the most important predictors of maternal cognitive and behavioral involvement are the existence of psychiatric disability in addition to intellectual disability, and the offspring's duration of stay in institutional care. These predictors were poorer in explaining maternal emotional involvement. Findings are interpreted with respect to social work research and practice with Israeli Arab families.

Evaluation and management of the non-motor features of Parkinson’s disease

Parkinson's disease (PD) is traditionally viewed as a motor disorder with a characteristic triad of tremor, rigidity and bradykinesia. There is now increasing awareness that PD is a complex systemic disorder with many nonmotor symptoms (NMS) which include autonomic dysfunction, sleep disorders, sensory and neuropsychiatric features. NMS become more common in severity and frequency with advancing disease when neuropsychiatric features such as cognitive impairment and psychosis dominate the clinical picture. NMS are strongly correlated with quality of life for patients and their families as well as institutional care placement. Despite their importance, NMS are poorly recognized by clinicians and often undeclared by patients. Use of a validated screening tool NMSQuest followed by specific symptom assessment instruments strengthens the recognition and holistic management of NMS in PD. Some NMS such as mood disturbance, anxiety, pain and insomnia may be improved by optimization of dopaminergic therapy. Conversely, psychosis, excess daytime somnolence or impulse control disorder (ICD) may be triggered by dopaminergic drugs. Other NMS such as dementia and severe depression may be unresponsive to dopaminergic treatment and may reflect perturbations in cholinergic, serotonergic or noradrenergic neurotransmitter function. These symptoms are more challenging to manage but may be ameliorated to some extent by agents such as acetylcholinesterase inhibitor or antidepressant drugs. This contribution reviews the evidence for the evaluation and management of key NMS in PD (apathy, anxiety, depression, psychosis, dementia, ICD, sleep disturbance, autonomic dysfunction, pain) and highlights the urgent need for both novel therapies and more controlled trials for current therapeutic strategies.

Israeli parents' involvement with their adult children with intellectual disabilities after placement in institutional care: a national study

This Israeli national study examined a research model predicting parental behavioral involvement with their adult children several years after their placement in institutional care. The sample studied consisted of 278 parents of children with intellectual disabilities in Israel between January 1993 and December 2001. Predictors of behavioral involvement were analyzed by a path analysis, followed by several differential regression analyses. Parental behavioral involvement with their adult children after placement is differential, and explained primarily by the children's gender and age at placement. Parental behavioral involvement with their daughters is predicted by cognitive and emotional involvement, whereas their behavioral involvement with their sons is related to background data. The child's age at the time of placement also plays a role in predicting parental involvement. Parental behavioral involvement with their children is related to gender and age at the time of placement in institutional care. Longitudinal research should be carried out to track the involvement process.

Ten-year health service use outcomes in a population-based cohort of 21 000 injured adults: the Manitoba Injury Outcome Study

To quantify long-term health service use (HSU) following non-fatal injury in adults. A retrospective, population-based, matched cohort study identified an inception cohort (1988-91) of injured people who had been hospitalized (ICD-9-CM 800-995) aged 18-64 years (n = 21 032) and a matched non-injured comparison group (n = 21 032) from linked administrative data from Manitoba, Canada. HSU data (on hospitalizations, cumulative length of stay, physician claims and placements in extended care services) were obtained for the 12 months before and 10 years after the injury. Negative binomial and Poisson regressions were used to quantify associations between injury and long-term HSU. Statistically significant differences in the rates of HSU existed between the injured and non-injured cohorts for the pre-injury year and every year of the follow-up period. After controlling for pre-injury HSU, the attributable risk percentage indicated that 38.7% of all post-injury hospitalizations (n = 25 183), 68.9% of all years spent in hospital (n = 1031), 21.9% of physician claims (n = 269 318) and 77.1% of the care home placements (n = 189) in the injured cohort could be attributed to being injured. Many people who survive the initial period following injury, face long periods of inpatient care (and frequent readmissions), high levels of contact with physicians and an increased risk of premature placement in institutional care. Population estimates of the burden of injury could be refined by including long-term non-fatal health consequences and controlling for the effect of pre-injury comorbidity.

A whole system study of intermediate care services for older people

Intermediate care (IC) services have been widely introduced in England and have the strategic objectives of reducing hospital and long-term care use. There is uncertainty about the clinical outcomes of these services and whether their strategic aims will be realised. A metropolitan city in northern England. A quasi-experimental study comparing a group of older people before and after the introduction of an IC service. A quota sampling method was used to match the groups. Patients presenting as emergency admissions to two elderly care departments with falls, confusion, incontinence or immobility. a city-wide service in which a joint care management team (multi-agency, multi-disciplinary) assessed patient need and purchased support and rehabilitation from sector-based IC teams. Nottingham Extended Activities of Daily Living score, Barthel Index, Hospital Anxiety and Depression score, mortality, readmission to hospital, and new institutional care placement at 3, 6 and 12 months post-recruitment. There were 800 and 848 patients, respectively, in the control and intervention groups. Clinical outcomes, hospital and long-term care use were similar between the groups. Uptake of IC was lower than anticipated at 29%. An embedded case-control study comparing the 246 patients who received IC with a matched sample from the control group demonstrated similar clinical outcomes but increased hospital bed days used over 12 months (mean +8 days; 95% CI 3.1-13.0). This city-wide IC service was associated with similar clinical outcomes but did not achieve its strategic objectives of reducing long-term care and hospital use.

Family meetings--a qualitative exploration of improving care planning with older people and their families.

To explore the opinions of participants in family meetings to improve the quality of this important rehabilitation tool. Qualitative exploration of opinions and experience from staff, patients and families. Tertiary teaching geriatric rehabilitation hospital. Staff, families and patients who had recently participated in family meetings. Focus groups, written surveys and individual semi-structured interviews. Three main themes were identified in the staff focus groups-preparation, staff skills and aftermath. Opinions from family members revealed a high level of satisfaction. The patient interviews revealed a worrying lack of informed consent and lack of clarity of the purpose. All three groups identified an unclear agenda as the underlying reason for unsatisfactory meetings. An unfavourable outcome decision (such as placement in institutional care) also influenced patient opinions on the process. The majority of patients found the family meeting to be helpful. Family meetings are much appreciated by patients and their families. A model of the family meeting process is proposed to account for our research findings and as a means to improve meetings. Adequate preparation and consent, and skilled facilitation may improve the effectiveness of family meetings while maintaining the patient's sense of autonomy.

Systematic review of day hospital care for elderly people

Objective: To examine the effectiveness of day hospital attendance in prolonging independent living for elderly people.Design: Systematic review of 12 controlled clinical trials (available by January 1997) comparing day hospital...