Receiving Home Care Research Articles

Aged and Health Care Service Utilization by Older Australians Receiving Home Care Packages.

To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. This study included people who accessed HCP between January 1, 2016 and December 31,2016. The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65years old in 2016 was evaluated. Descriptive statistics were employed. In 2016, 84,681 individuals received HCPs, of which 68.4% (n= 57,942) accessed HCP levels 1‒2, 26.0% (n= 22,057) accessed HCP levels 3‒4, and 5.5% (n= 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n= 27,787) started services that year and 16.7% (n= 14,117) moved to permanent residential aged care, 18.4% (n= 15,592) used respite care and 5.8% (n= 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary.

Epidemiology, symptoms, transmission, prevention, treatment, and future prospects of the Lassa fever outbreak: a potential study.

Epidemiology, symptoms, transmission, prevention, treatment, and future prospects of the Lassa fever outbreak: a potential study.

Telenursing and Telemonitoring During and Beyond the COVID-19 Pandemic

Background The presenter will be discussing home monitoring–based telenursing for people with chronic conditions. This technology has been implemented in home-care individuals with chronic obstructive pulmonary disease, type 2 diabetes, congestive heart failure, lung cancer, and amyotrophic lateral sclerosis, who are treated at home, including during the COVID-19 pandemic. The pandemic, which began in late 2019, has limited our everyday activities and opportunities to connect with people. Older adults with chronic conditions are most especially affected. While telenursing practice is not so familiar in the Japanese context, the Japan Academy of Home Care (2021) first defined telenursing as “information and communication technologies involving telecommunication provided by nurses.” Furthermore, we are providing seminars for the nurses and expanding their capacity on how to provide efficient telenursing support for people receiving home care. Objective This study aims to present effective telenursing practice examples, as well as the challenges surrounding the use of technology in care for older adults with chronic conditions during and beyond the COVID-19 pandemic. Methods A fully longitudinal mixed methods design was used to evaluate the physical and emotional fluctuations of people from qualitative and quantitative strands, and we integrated the results and meta-inferences. Results The patients showed a continuous change over time in terms of their physical and psychological status. Living with symptoms, the patients were constantly reminded of the reality of their disease and the activity limitations the pandemic brought. At times, they were able to find hope for the future by actively controlling and managing their disease, maintaining their health and physical function, and realizing that they could live a normal life. On the other hand, they experienced a loss of activity, a decline in physical function, and anxiety about the future, brought about by the pandemic. Thus, people who receive telenursing are on a dynamic disease trajectory that vacillates between hope and despair, and telenursing can help them. Conclusions Performing telemonitoring and telerehabilitation of older adults throughout the pandemic, as well as adapting to their physical and emotional fluctuations, will improve their quality of life. Conflicts of Interest None declared.

The Prevalence of Developmental Disabilities among Children Who Received Home Cares in the Neonatal Period Despite Being High-Risk

Background and aims: High-risk neonates (HRNs) included neonates who were born with a weight of less than 1500 g at birth and/or gestational age between 24 and 37 weeks and needed longer intensive medical care. This study aimed to evaluate the prevalence of developmental disabilities among 5-year-old children that were HRNs in the neonatal period. Methods: In a historical cohort study, 120 five-year-old children were included and divided into two groups of 60 eligible children in the exposed and control groups. They were born as HRNs in 2016 and admitted to the neonatal intensive care units (NICUs). After stabilization of their general condition, the infants in the exposed group were discharged and received home care (HC) services, but the control group received long-time care in NICU and did not receive HC services. They were evaluated in terms of developmental domains including vision, hearing, fine motor skills, gross motor skills, communication, problem-solving, and personal and social affairs. The developmental screening was done using the Ages and Stages questionnaire (ASQ). Results: A total of 61 (50.83%) children were classified as suspected cases of developmental disabilities. There was no significant difference between the exposed and control children in the total frequency of developmental disability (P=0.1). A significant difference was seen only in the problem-solving domain between the exposed and control groups (P=0.043). Conclusion: There were no significant statistical differences in most dimensions of developmental disabilities (except for the problem-solving domain) between the exposed and control children.

Language and pain predict persistent depression among seriously ill home care clients.

This study examined potential predictors of persistent depressive symptoms in a cohort of seriously ill older adults (aged 65+ years) receiving home care services. This was a retrospective cohort study using secondary data collected from the Resident Assessment Instrument for Home Care for all assessments completed between 2001 and 2020. The cohort included seriously ill individuals with depressive symptoms at baseline and who continued to have depressive symptoms on reassessment within 12 months (n=8,304). Serious illness was defined as having severe health instability, a prognosis of less than 6 months, or a goal of care related to palliative care (PC) on admission to the home care program. The mean age of the sample was 80.8years (standard deviation [SD]=7.7), 61.1% were female, and 82.1% spoke English as their primary language. The average length of time between assessments was 4.9months (SD=3.3). During that time, 64% of clients had persistent symptoms of depression. A multivariate logistic regression model found that language, pain, caregiver burden, and cognitive impairment were the most significant predictors of experiencing persistent depressive symptoms. Persistent depressive symptoms are highly prevalent in this population and, left untreated, could contribute to the person experiencing a "bad death." Some of the risk factors for this outcome are amenable to change, making it important to continually assess and flag these factors so interventions can be implemented to optimize the person's quality of life for as long as possible.

Knee function, quality of life, pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications

BackgroundDistal femoral resection knee arthroplasty is a limb salvage procedure. The impact of distal femoral resection arthroplasty on patient function and health status is unknown. The aim of this study was to report knee function, quality of life, knee pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications.MethodsOf 52 patients (52 knees) undergoing distal femoral resection knee arthroplasty in a single institution between 2012 and 2021, 22 were excluded as 3 patients had ≤90 days follow-up, 6 had died, and 13 declined or were unable to participate for unrelated reasons. Thus, 30 patients were included and interviewed by telephone in March 2021 (mean follow-up 3.5 years after surgery). Patient completed the Oxford Knee Score (0–48, 48 best), EQ-5D-5L, and the Copenhagen Knee ROM, and information on pain and living conditions was obtained.ResultsThe mean age was 67.9 years (SD 13.6), and 21 (70%) were female.Mean total Oxford Knee Score was 29.9 (SD 10.5), mean Copenhagen Knee ROM flexion was 116° (SD 21.6), and mean extension was − 2° (SD10.1). Mobility aids were used by 18 (60%) patients, i.e. a cane (30%), walker (26.7%) or wheelchair (3.3%).Mean EQ-5Dindex score was 0.70 (SD 0.22) and mean EQ-5D VAS score was 55.4 (SD 23.9). Nine (30%) patients used paracetamol or NSAID and 2 (6.7%) used opioids for knee pain. Mean VAS knee pain score was 1.30 (SD 2.2) at rest and 2.8 (SD 3.1) when walking.Most (90%) patients lived in their own home, with only 3 patients in nursing homes. Two-thirds (66.7%) required no home care, 5 (16.6%) received home care 1–2 times over 2 weeks, and 5 (16.6%) every day.ConclusionDistal femoral resection knee arthroplasty appears to be a viable treatment option for non-tumor indications. Acceptable patient outcomes were achieved in terms of functional status and quality of life, especially considering treatment alternatives such as femoral amputation.

How do our older adults die? The perception of family members about suffering in the last year of life

Objectives: To characterize the signs and symptoms of suffering, the circumstances of death, and health service use in the 12 months prior to death in a cohort of community-dwelling older adults according to relatives’ perception, as well as to verify the relationships between baseline frailty and signs/symptoms of suffering in the last year of life. Methods: This retrospective cohort study used data from the Frailty in Older Brazilians (FIBRA) Study. Home interviews were carried out with the relatives of deceased older adults. Descriptive statistical analyses were performed, including adjusted prevalence ratios through Poisson regression. Results: A total of 192 family members participated (64.58% women). The mean age of the deceased was 80.59 years (59.90% women; 27.08% with no formal education). In the year before death, 51.34% had fatigue, 43.68% had pain, 42.63% had anorexia, 41.27% had dyspnea, and 41.21% suffered a fall. Most died either at home (52.10%) or in the hospital (41.66%). The most frequent causes of death were circulatory and respiratory system diseases and neoplasms; 29.63% died suddenly, 51.05% were admitted to an intensive care unit, 52.60% were hospitalized, 58.76% used pain medication, and 27.13% received home care. Relative to non-frailty, baseline frailty was associated with dependence (prevalence ratio = 2.52) and pain medication use (prevalence ratio = 1.52) in the last year of life. Conclusions: Signs and symptoms of suffering in the last year of life were high among community-dwelling older adults, highlighting the need to support them and their families through provide palliative care.

Sleeping Conditions of Older Adults with Delirium Receiving Home Care

Sleeping Conditions of Older Adults with Delirium Receiving Home Care

Evaluation of Malnutrition in Geriatric Patients Receiving Home Care Services

Evaluation of Malnutrition in Geriatric Patients Receiving Home Care Services

Observational Survey Research Regarding People with Disabilities Receiving Home Care Services

Observational Survey Research Regarding People with Disabilities Receiving Home Care Services

Evaluation of Urinary Tract Infection Agents and Antibiotic Susceptibility in Patients Receiving Home Care

Evaluation of Urinary Tract Infection Agents and Antibiotic Susceptibility in Patients Receiving Home Care

Evaluation of malnutrition frequency and related factors of geriatric patients in need of home healthcare

The nutritional status of frail elderly people receiving home health services should be evaluated. This study aimed to determine the nutritional status of patients aged ≥65 years registered in the Home Healthcare Services unit and investigate the factors that may be associated with malnutrition. This cross-sectional descriptive study was conducted during routine visits to patients and their caregivers. A total of 161 patients were asked to fill in surveys asking about sociodemographic characteristics, patient history, and clinical status. Anthropometric measurements were taken from all patients. The Mini Nutritional Assessment Short Form was applied to the patients for screening purposes. Patients who scored ≤11 on the Mini Nutritional Assessment Short Form were then asked to complete the full Mini Nutritional Assessment form. According to the Mini Nutritional Assessment Short Form and Mini Nutritional Assessment tests, almost half of the elderly patients included in the study (49.7%, n=161) were malnourished or at risk of malnutrition. Analyses showed that those who had COVID-19 [odds ratio (OR): 9.423, 95%CI 2.448-36.273) and those diagnosed with dementia/depression (OR: 8.688, 95%CI 3.246-23.255) were more likely to be malnourished, whereas those with diabetes (OR: 0.235, 95%CI 0.084-0.657) were less likely to have malnutrition. Strikingly, those who were fed by caregivers (OR: 15.061, 95%CI 3.617-62.710) were also more likely to be malnourished than those with self-feeding ability. Malnutrition or the risk of malnutrition is common in elderly patients receiving home care services. Many factors can have an impact on malnutrition.

How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021.

Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services. We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission. Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission. The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.

Cost effectiveness of a telerehabilitation intervention vs home based care for adults with severe neurologic disability: A randomized clinical trial.

Several options are available for the care of neurological conditions including care delivered in rehabilitation centres, at home or remotely. While economic studies are available comparing centres and homes, very little economic data relates to mobile teams comparing face-to-face and remote care. To conduct an economic study comparing face-to-face care at home and care delivered remotely (tele-rehabilitation). A randomised clinical study with two groups; a control group receiving home care and an experimental group receiving tele-rehabilitation. The primary outcome measure was the ICER (Incremental Cost Effectiveness Ratio). Patients with severe neurological disabilities. 80 patients were enrolled in the study; 77 were analysed to calculate the ICER, which was positive and located in the SW quadrant. A bootstrap with 1000 replications was positioned at 72.8% in the SW quadrant. Tele-rehabilitation is an acceptable alternative to the management of neurological patients at home. In the mildest cases, remote-rehabilitation may even be dominant. More extensive studies are needed to specify the indications.

Investigation of the Use of Traditional and Complementary Medicine Methods by Individuals Receiving Home Care Services

Investigation of the Use of Traditional and Complementary Medicine Methods by Individuals Receiving Home Care Services

Factors associated with living will among older persons receiving long-term care in Finland.

A living will document is known to be an important tool for preparing for future care together with healthcare professionals. A living will supports an older person's self-determination and autonomy. Only a few studies have approached the underlying factors of a living will document among older long-term care recipients. To explore how common having a living will was among older persons receiving home care or round-the-clock long-term care, as well as to evaluate associations between socio-demographical factors and functional capacity with a living will. The study population consisted of older persons receiving long-term care in Finland in 2016-2017. Data were collected via individual assessments at home or at a care facility. The questions in the assessment covered health, functional capacity, service use, and social support. Primary outcome 'living will' and associated factors were identified for each person aged 65 or older from RAI-assessment data (Resident Assessment Instrument, RAI). Cross-tabulations with χ²-tests and adjusted binary logistic regression models were performed to evaluate the association between the factors and a living will. Of the 10,178 participants, 21% had a living will - a greater proportion were female (22%) than male (18%), and a greater proportion of residents in assisted living (25%) and residential care homes (20%) compared with home care residents (15%) had a living will. Female gender (p < 0.001), having a proxy decision-maker (p = 0.001), increasing age (p = 0.003), impairing functional capacity (activities of daily living hierarchy p < 0.001, Cognitive Performance Scale p < 0.001), instability of health status (Changes in Health, End-Stage Disease and Signs and Symptoms p < 0.001), and closeness of death (p < 0.001) were significantly associated with a living will among older persons. Extensive differences in results were found between home care clients and clients of round-the-clock long-term care. Preparedness for the future with a living will varies according to services and on individual level. To reduce inequalities in end-of-life care, actions for advance care planning with appropriate timing are warranted.

Assessment of the Burden of Care and Burnout Level in Caregivers of Dementia Patients in a Home Care Setting

Aim: This study aims to evaluate the factors affecting the care burden and burnout levels of caregivers with dementia patients receiving home care services. Methods: This descriptive study was conducted in Samsun Training and Research Hospital Home Care Services which paid a visit at home between March 20 and June 20, 2021. The caregivers of the patients who were followed up by the diagnosis of dementia were included in the study after having agreed to participate in the study with their written informed consents. The 'Socio-demographic Data Form', 'Zarit Burden Interview' and 'Maslach Burnout Inventory’ were administered to caregivers during face-to-face interviews. Results: A total of 157 caregivers were included in our study, of which 70.1% (n=110) were women. 68.2% (n=107) were in the 40-64 years age group. The mean Zarit Burden Interview score was calculated as 47.10±16.14 (min=21, max=85). 76.4% of caregivers had moderate to severe escalated care burden. Once the impact of the increase in caregiver burden score on Maslach Burnout Inventory subgroups was examined, the relationship was found to be positively significant with emotional exhaustion and depersonalization, and negatively significant with personal achievement. Conclusion: As the burden of care increases, the level of burnout of individuals increases. Female gender, illiteracy, lack of income, duration of care given which is prolonged for more than one year, and daily care duration exceeding 12 hours were determined as outstanding factors that increase the care burden and level of burnout. Keywords: home care services, caregivers, dementia, caregiver burnout

The Impact of Frailty and Geriatric Syndromes on the Quality of Life of Older Adults Receiving Home-Based Healthcare: A Cross-Sectional Survey.

Purpose: To identify the effect of frailty and geriatric syndromes on the quality of life (QoL), of older adults receiving home care, taking into consideration their socioeconomic and homebound status, including multi-comorbidities. Patients and Methods: This cross-sectional study enrolled elders aged (≥65) years old, registered members of “Help at Home” programs in the Reference Region of Crete, from March to May 2019. Participants were screened using the WHOQOL-BREF for Quality of Life, geriatric syndromes such as frailty using the SHARE-Frailty Index (SHARE-Fi), the Montreal Cognitive Assessment (MoCA), for cognitive function and the Geriatric Depression Scale (GDS), for the assessment of depression. Results: The mean age of the 301 participants was 78.45 (±7.87) years old. The prevalence of frailty was 38.5%, severe depression 13.6%, cognitive dysfunction 87.8% and severe comorbidity 70.6%. Intriguingly, none of the participants (0%) was identified as free of comorbidity (CCI = 0−1). The overall QoL (ranging from 4−20) of the study participants was 13.24 (±4.09). The bivariate analysis showed that overall QoL significantly differed among older adults with frailty (15.91 vs. 11.56, p < 0.001), cognitive dysfunction (15.42 vs. 12.90, p < 0.001), depression (14.90 vs. 9.31, p < 0.001), and disability in Activities of Daily Living (13.67 vs. 10.67, p = 0.002), compared to non-frail, normal cognition and depression, and independent elders, respectively. Multiple linear regression models revealed that frail and depressive elders reported significantly lower QoL (β = −2.65, p < 0.001 and (β = −5.71, p < 0.001), compared to non-frail and older adults with no depressive symptoms, respectively, despite the fact that this association was not significant for older adults with dementia (β = −2.25, p = 0.159), even after adjusting for potential confounding effects (age, gender, comorbidity, homebound status, etc.). Conclusion: frailty and geriatric syndromes including comorbidities are important risk factors for “poor” QoL among older adults receiving home-based healthcare.

Visual impairment and the need for vision care services amongst older Finnish people receiving home care.

This study aimed to describe visual performance and the need for vision care services among Finnish older people receiving home care. We evaluated the applicability of the Resident Assessment Instrument of Home Care (RAI HC) in identifying visual impairment (VI) and the need for vision care services among older people. A descriptive quantitative, cross-sectional design. Visual impairment and the need for vision care services for older people receiving home care (N=70) were determined by an optometrist's screening examination and vision assessment by home care workers using the RAI HC instrument. In this study, the definition of visual impairment was visual acuity (VA) <0.63 (logMAR >0.2). According to the distance VA measurements, 41% of the participants showed VI (<0.63) of the better eye, while the RAI HC assessment revealed VI among 36% of the participants. The Kappa value for interrater reliability in classifying VI was 0.137. The optometrist's vision screening examination recognized a previously unknown and unmet need for vision care services more than twice as often as the RAI HC assessment.

Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada.

In the general population, sensory impairments increase markedly with age in adults over 60years of age. We estimated the prevalence of hearing loss only (HL), vision loss only (VL), and a combined impairment (i.e., dual sensory loss or DSL) in Canadians receiving home care (HC) or long-term care (LTC). Annual cross-sectional analyses were conducted using data collected with one of two interRAI assessments, one used for the HC setting (n = 2,667,199), and one for LTC (n = 1,538,691). Items in the assessments were used to measure three mutually exclusive outcomes: prevalence of VL only, HL only, or DSL. Trends over time for each outcome were examined using the Cochran-Armitage trend test. A negative binomial model was used to quantify the trends over time for each outcome while adjusting for age, sex and province. In HC, there was a significant trend in the rate for all three outcomes (p < 0.001), with a small increase (roughly 1%) each year. In HC, HL was the most prevalent sensory loss, with a rate of roughly 25% to 29%, while in LTC, DSL was the most prevalent impairment, at roughly 25% across multiple years of data. In both settings, roughly 60% of the sample was female. Males in both HC and LTC had a higher prevalence of HL compared to females, but the differences were very small (no more than 2% in any given year). The prevalence of HL differed by province after adjusting for year, age and sex. Compared to Ontario, Yukon Territory had a 26% higher rate of HL in HC (relative rate [RR] = 1.26; 95% confidence interval [CI]:1.11, 1.43), but LTC residents in Newfoundland and Labrador had a significantly lower rate of HL (RR: 0.57; CI: 0.43, 0.76).When combined, approximately 60% of LTC residents, or HC clients, had at least one sensory impairment. Sensory impairments are highly prevalent in both HC and LTC, with small sex-related differences and some variation across Canadian provinces. The interRAI assessments provide clinicians with valuable information to inform care planning and can also be used to estimate the prevalence of these impairments in specific population sub-groups.