Use Of Community Support Services Research Articles

Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England.

ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.

Conceptualizing Family Caregivers' Use of Community Support Services: A Scoping Review.

Only a fraction of the 53 million caregivers in the United States use available formal community services. This scoping review synthesized the literature on the barriers and facilitators of community support service utilization by adult caregivers of a family member or friend with an illness, disability, or other limitation. We searched PubMed, CINAHL, PsycInfo, and Web of Science for quantitative and qualitative articles assessing barriers and facilitators of caregivers' access to and utilization of resources, following Preferred Reporting Items for Systematic Review and Meta-Analysis scoping review guidelines. Thematic analysis, drawing on an initial conceptualization, informed key insights around caregivers' resource navigation process. The review provides support for individual factors affecting service use. Notably, some factors-such as time restrictions and increased caregiving demands-appear to function as barriers to accessing services even as they increase caregivers' need for support. Additionally, contextual barriers including cultural factors and support of friends/family can affect caregivers' access to resources. Finally, experience with health systems and structures and the intersection with other factors can affect service utilization. Suboptimal access to and utilization of community support services can be addressed at both the person and system level to mitigate potential inequities. Ensuring that caregivers are aware of, eligible for, and have the capacity and support to access the appropriate resources at the right time is essential for improving caregiver outcomes, reducing burnout, and supporting continued care.

Intensive care bereavement practices across New Zealand and Australian intensive care units: a qualitative content analysis

End-of-life and bereavement care is an important consideration in intensive care. This study describes the type of bereavement care provided in intensive care units across Australia and New Zealand. Inductive qualitative content analysis was conducted on free-text responses to a web-based survey exploring unit-based bereavement practice distributed to nurse managers in 229 intensive care units in New Zealand and Australia. A total of 153 (67%) surveys were returned with 68 respondents making free-text responses. Respondents were mainly Australian (n=54, 85·3%), from the public sector (n=51, 75%) and holding Nurse Unit Managers/Charge Nurse roles (n=39, 52·9%). From the 124 free-text responses, a total of 187 individual codes were identified focussing on bereavement care practices (n=145, 77·5%), educational provision to support staff (n=15, 8%) and organisational challenges (n=27, 14·4%). Bereavement care practices described use of memory boxes, cultural specificity, annual memorial services and use of community support services. Educational provision identified local in-service programmes, and national bereavement courses for specialist bereavement nurse coordinators. Organisational challenges focussed on lack of funding, especially for provision of bereavement follow-up. This is the first Australasian-wide survey, and one of the few international studies, describing bereavement practices within intensive care, an important aspect of nursing practice. However, with funding for new bereavement services and education for staff lacking, there are continued challenges in developing bereavement care. Given knowledge about the impact of these areas of care on bereaved family members, this requires review. Nurses remain committed to supporting bereaved families during and following death in intensive care. With limited resource to support bereavement care, intensive care nurses undertake a range of bereavement care practices at time of death, and after death through family bereavement follow-up.

Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

Telomere Attrition in Human Lens Epithelial Cells Associated with Oxidative Stress Provide a New Therapeutic Target for the Treatment, Dissolving and Prevention of Cataract with N-Acetylcarnosine Lubricant Eye Drops. Kinetic, Pharmacological and Activity-Dependent Separation of Therapeutic Targeting: Transcorneal Penetration and Delivery of L-Carnosine in the Aqueous Humor and Hormone-Like Hypothalamic Antiaging Effects of the Instilled Ophthalmic Drug Through a Safe

Visual impairment broadly impacts the ability of affected people to maintain their function and to remain independent during their daily occupations as they grow older. Visual impairment affects survival of older patients, quality of life, can affect a person's self-ranking of health, may be associated with social and functional decline, use of community support services, depression, falls, nursing home placement, and increased mortality. It has been hypothesized that senile cataract may serve as a marker for generalised tissue aging, since structural changes occurring in the proteins of the lens during cataract formation are similar to those which occur elsewhere as part of the aging process. The published analysis revealed a strong age-dependent relationship between undergoing cataract surgery and subsequent mortality. Nuclear opacity, particularly severe nuclear opacity, and mixed opacities with nuclear were significant predictors of mortality independent of body mass index, comorbid conditions, smoking, age, race, and sex. The lens opacity status is considered as an independent predictor of 2-year mortality, an association that could not be explained by potential confounders. Telomeres have become important biomarkers for aging as well as for oxidative stress-related disease. The lens epithelium is especially vulnerable to oxidative stress. Oxidative damage to the cuboidal epithelial cells on the anterior surface of the lens mediated by reactive oxygen species and phospholipid hydroperoxides can precede and contribute to human lens cataract formation. The erosion and shortening of telomeres in human lens epithelial cells in the lack of telomerase activity has been recognized as a primary cause of premature lens senescence phenotype that trigger human cataractogenesis. In this study we aimed to be focused on research defining the mechanisms that underlie linkages among telomere attrition in human lens epithelial cells associated with oxidative stress, biology of the lens response to oxidative damages, aging and health, cataract versus neuroendocrine regulation and disease. The cumulative results demonstrate that carnosine, released ophthalmically from the patented 1% Nacetylcarnosine prodrug lubricant eye drops, at physiological concentration might remarkably reduce the rate of telomere shortening in the lens cells subjected to oxidative stress in the lack of efficient antioxidant lens protection. Carnosine promotes the protection of normal cells from acquiring phenotypic characteristics of cellular senescence. The data of visual functions (visual acuity, glare sensitivity) in older adult subjects and older subjects with cataract treated with 1% N-acetylcarnosine lubricant eye drops showed significant improvement as compared, by contrast with the control group which showed generally no improvement in visual functions, with no difference from baseline in visual acuity and glare sensitivity readings. N-acetylcarnosine derived from the lubricant eye drops may be transported into the hypothalamic tuberomammillary nucleus (TMN) histamine neurons and gradually hydrolyzed. The resulting L-histidine may subsequently be converted into histamine, which could be responsible for the effects of carnosine on neurotransmission and hormone-like antiaging and anti-cataract physiological function. The research utilizing the N-acetylcarnosine lubricant eye drops powerful therapeutic platform provides the findings related to the intraocular uptake exposure sources as well as a timing dosage and duration systemic absorption of said preparation from the conjunctional sac reaching the hypothalamus with activities transfer into the hypothalamic-neuroendocrine pathways affecting across the hypothalamus metabolic pathway the telomere biology and cataract disease occurrence, reversal and prevention and the average expected lifespan of an individual. Such findings can be translated into clinical practice and may provide a basis for personalized cataract disease and aging prevention and treatment approaches.

EFFECT OF A TELEPHONE-BASED DEMENTIA CAREGIVER INTERVENTION ON USE OF COMMUNITY SUPPORT SERVICES AND HEALTH CARE RESOURCES

Project Description: Dementia caregivers tend to underutilize community support services (e.g., support groups, respite care) and may overuse healthcare resources (e.g., physician and hospital visits). We developed a telephone-delivered intervention, Family Intervention: Telephone Tracking - Caregiver (FITT-C), which has been shown to reduce caregivers' depressive symptoms and reactions to care recipients' behavioral problems. This study examined the effects of FITT-C on community support and healthcare use. Participants were 250 (M age = 62.72, SD = 12.99; 78% female; 95% Caucasian) distressed informal dementia caregivers who were randomly assigned to receive the FITT-C or Telephone Support (TS). Participants in both interventions received a resource packet containing educational materials about dementia and local services/resources. Both groups received 16 telephone contacts from a trained master's level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem-solving, and other directive therapeutic approaches based on assessment of key areas. TS provided supportive therapeutic strategies (e.g., venting, reflective listening). Outcome measures were caregivers' report of community support service use, total number of visits to the emergency department, and total hospital stays for themselves and care recipients during the interventions. Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C showed significantly greater use of community support services at end of treatment compared to those receiving TS (FITT-C M = 8.95, SD = 12.05 vs. TS M =6.13 SD =8.33, p =.046). FITT-C caregivers also showed fewer total emergency department visits (FITT-C M =.13, SD =.39 vs. TS M =.32 SD =.78, p=.030) and number of hospital stays (FITT-C M =.09, SD =.33 vs. TS M =.26 SD = .64, p=.025) over the 6-month course of the intervention compared to TS caregivers. Care recipients' use of community or medical resources did not differ by group. An entirely telephone delivered intervention shows efficacy for increasing caregivers' engagement in community resources and for reducing caregivers' use of healthcare resources. In conjunction with previous findings showing positive mental health effects of FITT-C, these results highlight FITT-C's potential impact on healthcare utilization.

Visual Impairment and Subsequent Use of Support Services Among Older People: Longitudinal Findings From the Blue Mountains Eye Study

To assess the impact of visual impairment and blindness on the incident use of community support services in the Blue Mountains Eye Study. Population-based cohort. Of 3654 baseline participants (1992-1994), 2334, 1952, and 1149 were re-examined after 5, 10, and 15 years, respectively. Incident visual impairment was defined as subsequent development of visual impairment (visual acuity <20/40) in the better eye of subjects with best-corrected visual acuity ≥20/40 at baseline. Community support service use included regular use of Meals on Wheels, Home Care, or community nurse services. Informal support included assistance from family or friends. Discrete logistic regression models with time-dependent study and outcome variables were used to assess associations between visual impairment and subsequent use of support, adjusted for potential confounders. Among participants with bilateral visual impairment at baseline, incident use of community services over 5-15 years was 41.7% compared to 19.4% in those without visual impairment at baseline (odds ratio, 1.39; 95% confidence interval, 0.54-3.60). Persons with incident bilateral visual impairment were more likely to subsequently need community support (odds ratio, 3.32; confidence interval 1.96-5.59) in 5 years, compared to persons without visual impairment during the entire follow-up period. Baseline older age, walking disability, receiving pension, and having 2+ hospital admissions within 12 months were also significantly associated with incident use of support services. Development of bilateral visual impairment in this cohort was associated with greater likelihood of subsequent use of community or informal support services in 5 years, independent of physical comorbidities.

Use of Community Support Services and Activity Limitations Among Older Adults With Chronic Kidney Disease

There is a lack of population-based data on associations between chronic kidney disease (CKD) and the functional status/independence of older adults. We assessed prospective associations between CKD and (a) use of community support services and/or reliance on nonspouse family/friend support and (b) activities of daily living measures among older adults. A total of 1,952 participants from the Blue Mountains Eye Study aged 50 years or older at baseline were examined between 1992-1994 and 2002-2004. CKD was defined as Modification of Diet in Renal Disease Study estimated glomerular filtration rate of less than 60mL(.)min(-1)·1.73·m(-2). Use of services and nonspouse family/friend support was self-reported at baseline and follow-up. Functional status was determined by the Older Americans Resources and Services activities of daily living scale. After adjusting for age, sex, education level, receipt of pension, living status, poor self-rated health, hypertension, diabetes, number of hospital admissions, walking disability, and visual impairment, participants with CKD had increased odds of using community support services, odds ratio, 1.75 (95% confidence interval: 1.06-2.89). With increasing severity of CKD at baseline, the likelihood of using community support services 10 years later increased significantly, p trend = .02. After multivariable adjustment, participants with CKD had a greater likelihood of incident impaired instrumental activities of daily living after 10 years, odds ratio, 2.02 (95% confidence interval: 1.15-3.57). Increasing severity of CKD at baseline was associated with increased likelihood of incident impaired instrumental activities of daily living, p trend = .02. CKD could be a potential barrier to independent living for older adults, as shown by the increased need for formal home care services.

P4‐363: The medical food Souvenaid preserves functional brain network organisation in patients with mild Alzheimer's disease

clinical evaluation was complex; but for our purpose we have used MMSE, grouping the patients into stages: mild (MMSE score 21-26), mild to moderate (MMSE score 15-20), moderate (MMSE score 10-14) and severe (MMSE score Below 10).For evaluating their socioeconomic and clinical status the Centre’s standard questionnaire was used; care costs were included (for medications, use of professional services, use of community support services by caregivers and lay carers.Caregiver burden was also determined by specific scales, using the human capital method. Descriptive statistics and regression models were used.Assessment of costs was made considering existing costs at 1st of January, 2010 as applicable to a discounting rate of 6%. Results: A total of 64 claims were reviewed. The average total cost of AD per patient per a 12-month period was ,V6072. The proportion of cost attributable to caregivers was the main component of burden 61% in AD.The annual societal cost of care per patient increased with severity of Alzheimer’s disease. The cost per patient was estimated to be 5.378V 8V for mild disease, 6.259V for mild to moderate disease, 6.343V for moderate disease and 6.407V for severe disease. Poorer functional status was associated with higher total and care giving costs. For subjects living in the community, unpaid caregiver time was the greatest components of cost and increased with disease severity. Conclusions: Health care costs for AD are substantial. The societal cost of care of Alzheimer’s disease increases with increasing disease severity. Informal cost is responsible for the largest cost component

Hearing loss impacts on the use of community and informal supports

the aim of this study is to estimate the cross-sectional and longitudinal impact of hearing loss on use of community support services and reliance on non-spouse family/friends among older people. Blue Mountains Hearing Study participants (n = 2,956) were assessed for hearing impairment by audiologists in sound-treated booths. Participants were classified as hearing impaired if PTA(0.5-4)( )(kHz) >25 dB HL. Use of services and non-spouse family/friend support was assessed cross-sectionally. Incident use was assessed among survivors at the 5-year follow-up (n = 1,457). a significant cross-sectional association between hearing loss (>25 dB HL) and use of community support services was observed after adjusting for age, sex, living status, self-rated poor health, self-reported hospital admissions, disability in walking and best-corrected visual impairment [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.15-3.90]. Participants with hearing loss who never used a hearing aid were twice as likely to use formal supports as participants without hearing loss (multivariate-adjusted OR 2.25, 95% CI 1.19-4.24). Hearing loss increased the incident need for non-spouse family/friend support or community services (multivariate-adjusted OR 1.49, 95% CI 1.02-2.18). after adjusting for confounding factors, hearing impairment negatively impacted on the independence of older persons by increasing reliance on community or family support.

Sensory Impairment, Use of Community Support Services, and Quality of Life in Aged Care Clients

To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients. The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits. After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0-7.8). Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

Self-identifying as a caregiver: Exploring the positioning process

There is a huge body of research focused on family caregivers. Underpinning this body of knowledge is the assumption that there exists some distinct entity known as a ‘caregiver’. Drawing on data generated through in-depth qualitative interviews with forty seven family caregivers, this paper will examine the usefulness of this self-identification to family members. Questions asked of the data included: how does one come to self-identify as a caregiver, what does it mean to be a caregiver, and how does affiliation with this self-identity influence the experience of caring for an older or frail family member. The analysis suggests that a recognition of oneself as a caregiver is produced primarily through interactions with others; without external influence, family members will often see the work they are doing as simply an extension of their relational role. Affiliating oneself as a family caregiver appears to have positive benefits which include promoting effective use of community support services and creating a sense of belonging and connection to a broader community. This can be empowering. However, an unintended consequence of assuming the position of caregiver may be the inadvertent discounting and marginalization of the person requiring care. Positioning theory is introduced as a useful conceptual frame for understanding the process and implications associated with self-identifying as a caregiver.

Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study

Objective: To assess variables associated with different perceived global health ranks in an older population. Materials and Methods: The Blue Mountains Eye Study was a population based survey of residents aged ≥49 years in an area west of Sydney, Australia. Questions relating to demographic and socioeconomic indicators, limitations of daily living activities, medical history, hearing problems, exercise, smoking and alcohol consumption were asked in a standardised questionnaire at interview. Comprehensive eye examinations were performed. Self-rated health was assessed from a standard question and categorised as excellent, good, fair or poor. Associations were assessed using logistic regression models. Results: After exclusions, 714/3589 (19.9%) participants rated their health as excellent, 1969 (54.9%) as good, 766 (21.3%) as fair and 140 (3.9%) as poor. A wide array of study variables assessed showed significant associations with self-rated health. Compared with a self-ranking of good or excellent health, variables significantly associated in a multivariate model with a rank of poor health included: regular use of community support services, more than one hospital admission in the last 12 months, perceived inability to go out alone, difficulty walking, or history of angina, asthma or cancer. Variables significantly associated with a rank of fair health were broader and included socioeconomic status, sensory impairment, tinnitus, many chronic diseases and negative health behaviours, including smoking and heavy alcohol consumption. Conclusions: Our findings suggest that different sets of variables may influence people to rank their global health at different perceived levels.

Quality indicators for dementia in vulnerable community-dwelling and hospitalized elders.

Dementia is a leading cause of disability among older adult patients. Appropriate attention to early identification, the assessment of medications and health conditions that may be contributing to ...

Use of community support services by middle-aged and older patients with psychotic disorders.

The study sought to determine the degree to which use of community services is related to predisposing, enabling, and need factors among older patients with psychotic disorders who live in the community and to assess whether high use of community services is associated with improving or declining psychopathology. The sample consisted of 89 middle-aged and elderly community-dwelling patients with schizophrenia or other psychotic disorders. Assessments at baseline and two follow-ups at six-month intervals included measures of psychopathology, well-being, and social adjustment, in addition to the frequency of use of 17 formal community services in three categories-psychological, social, and daily living services. Ninety-two percent of patients reported use of community support services. The mean number of annual service contacts per patient was 36.6 for psychological services, 81 for social services, and 39.7 for daily living services. High users of psychological services were younger and experienced more severe positive psychotic symptoms and depressive symptoms. High users of social services were of higher socioeconomic status, more likely to be female, and had a longer history of psychosis, more cognitive deficits, and more severe negative psychotic and depressive symptoms. Patients who used daily living services were older, had poorer functional health status and more cognitive deficits, and had more severe negative psychotic and depressive symptoms. A trend was noted for high users of social services to experience relief from depressive symptoms over time. Use of community services is common among older outpatients with psychotic disorders, but its frequency varies as a function of patient characteristics.

Factors associated with use of community support services in an older Australian population

ObjectiveTo assess prevalence and risk factors associated with use of community support services in a representative older Australian population. MethodsThe Blue Mountains Eye Study surveyed 3,654 people age <49 years, 82.4% of eligible residents from an area west of Sydney during 1992-94. Questions about use of community support services were asked during face-to-face interview. Information on marital and living status, socio-economic status measures, past medical history and self-ranked health status were also collected. Results186 (5.4%) persons including 124 women (6.3%) and 62 men (4.2%) reported regular use of community support services, including Meals-on-Wheels (n=52), Home Care (n=147) or visits from a community nurse (n=63). All three services were used by 17 persons and two services by 42 persons. There was a marked age-related increase in use of services from 1.8% in persons aged <60 years to 25.3% in persons aged 80+ years. Factors significantly associated with use of community services in a multivariate model were: age (OR 1.7 per age decade), living alone (OR 2.5), walking disability (OR 4.1), visual impairment (OR 3.0), stroke history (OR 2.2), arthritis history (OR 1.8), low perceived health status (OR 1.7), cancer history (OR 1.7) and a history of any falls in the past 12 months (OR 1.6). ConclusionsOur study has found a wide range of health-related factors that impact on the use of community support services, particularly conditions causing difficulty in walking. ImplicationsThese data may assist health planners in identifying target populations for the provision of community support services.

Hearing impairment and hearing aid use in women over 65 years of age

(i) To describe the prevalence of self-reported hearing impairment and level of hearing aid use in women aged 65 years and over living in the community; (ii) to provide comparison findings from the National Health Survey and the Survey of Disability and Ageing undertaken by the Australian Bureau of Statistics. Cross-sectional study of a large community population. Conducted as part of the Randwick Falls and Fractures Study, in Randwick a surburban area in eastern Sydney. Four hundred and ninety-six women aged between 65 and 99 years (mean age, 74.6 years) took part in the study. The sample was representative of the population from which it was drawn. We found a higher level of hearing difficulty than the levels reported in the Australian Bureau of Statistics surveys for women of comparative ages, which may reflect differences in the questions posed. The proportions with a hearing aid in the Randwick study and the Survey of Disability and Ageing were very similar (7.1% and 7.3% respectively). Of the one-third of the Randwick sample who reported a hearing difficulty, only half had been referred for audiometry and a quarter had been prescribed an aid. Only slightly more than a third of those who received an aid were regularly wearing it. Among the women with hearing difficulties, not using an aid was not associated with age, cognitive status or subjective health. There was a trend suggesting that those who did not use an aid had increased use of community support services. Women who had not received assistance with their hearing impairment had more difficulty shopping and relied more on family members. Almost two-thirds of people prescribed a hearing aid were not wearing it regularly, denying themselves proven benefits in communication, social involvement and life satisfaction. The prescribing of these unused aids represents a huge waste of health resources. A program to increase hearing aid use by hearing impaired people may reduce the waste of health resources and the need for community support services. Such a program may greatly increase the life satisfaction for this very large group of disabled older people.

Physical therapy and speech therapy in Parkinson syndrome--a status assessment

74 inpatients and outpatients (mean age 71.9 years) with idiopathic Parkinson's disease, a vascular pseudo-parkinsonian syndrome or a Parkinson-associated dementia were analysed by present-state clinical rating with regard to use and needs of physical and speech therapy. 55% of the patients had physical therapy whatsoever, 32% of them on a daily schedule. 58% of patients without everyday physical therapy indicated to do less physical therapy than one year ago or that they have quite any exercise. This item showed significant correlations with: age of disease onset over 70 years, Hoehn-Yahr stage of 3 and over, activities of daily living according to Schwab-England of less than 60%, diagnosis of vascular pseudoparkinsonian syndrome or Parkinson-associated dementia, more frequent use of community support services for the ambulatory elderly. Only 8% of the patients had ever had speech therapy. Using both ratings of complaints and clinical findings, about 30% of patients had moderate to severe impairment of speech, 80% of these had also considerable memory disturbances. The study suggests that the need for physical therapy might be derived more from patient's assessment of reduced daytime motor activities than from a scaled item rating of an external observer. Use and continuity of physical and speech therapy in Parkinsonism seems to be limited largely by cognitive disturbances and social variables. Speech therapy appears to be useful only for a subgroup of Parkinsonian patients.

Factors differentiating elderly residential movers and nonmovers

This paper identifies factors which differentiate elderly residential movers and non-movers. Longitudinal data were used in the analysis. Logistic regression results showed that length of residency, home ownership, use of community support services, and number of adult children each had an effect on relocation. Respondents who reported longer lengths of residency and those who owned a home were less likely to relocate. Those elders who utilized more community support services were also less likely to move. Conversely, elders with greater numbers of adult children were more likely to relocate. There was not a significant effect of health status on relocation.

Use of community support services by elderly patients discharged from general medical and geriatric medical wards

This descriptive study examines the use of community support services by elderly persons discharged from general and geriatric medical wards of a large acute care British teaching hospital. A convenience sample of 40 patients were interviewed at 6-week intervals over a 3-month period about their need for and use of community support services. The type of ward from which patients were discharged did not influence the use of nursing, homemaker, physician, or warden/community visitor services, hospital day care, or meals-on-wheels. Patients who used the largest number of community services, and were the most frequent users of all available services, were those who, because of their fragility, died or were readmitted to hospital within 6 weeks of discharge. All families interviewed identified a need for more information about their elderly members' illnesses and prescribed medical regimes.