Home About us Contact
|
Home About us Contact | ||
|
|
||
Residential Homes (residential + home)
Selected AbstractsOlder patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] The Effect of an Attachment-Based Behaviour Therapy for Children with Visual and Severe Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 2 2008P. S. Sterkenburg Background, A combination of an attachment-based therapy and behaviour modification was investigated for children with persistent challenging behaviour. Method, Six clients with visual and severe intellectual disabilities, severe challenging behaviour and with a background of pathogenic care were treated. Challenging behaviour was recorded continuously in the residential home and during therapy sessions. Alternating treatments were given by two therapists. In phase 1, the experimental therapist attempted to build an attachment relationship in sessions alternating with sessions in which a control therapist provided positive attention only. In phase 2, both therapists applied the same behaviour modification protocol. Results, Across clients, challenging behaviour in the residential home decreased during the attachment therapy phase. The behaviour modification sessions conducted by the experimental therapist resulted in significantly more adaptive target behaviour than the sessions with the control therapist. Conclusion, For these clients with a background of attachment problems, attachment-based behaviour modification treatment may have important advantages over standard behaviour modification. [source] A comparison of physical activity levels in two contrasting elderly populations in ThailandAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2001C.J.K. Henry There is little information available on physical activity patterns in the elderly in developing countries. This is particularly important at a time when developing countries are in transition and show signs of moving toward Western style patterns of physical activity and social structure. This study is unique in that it compares the physical activity levels in two contrasting communities: a residential home and a rural community of elderly subjects in Thailand. Ninety elderly people living in a residential home and 78 elderly people living with their families in a rural community were recruited. The men in the rural community were slightly lighter and leaner than the men in the residential community, but the differences were not significant. However, the women were significantly (P < 0.001) heavier and fatter in the residential home than in the rural community. This is consistent with the higher levels of physical activity in the rural community. There was considerable variation in physical activity in this population. The physical activity level (PAL) values ranged from 1.21 to 1.73 in the residential home and from 1.21 to 3.08 in the rural community. This is apparently the first study of physical activity patterns in elderly subjects in a developing country. It highlights the variation in activity within the rural community and between both communities. The opportunities for the elderly living in the residential home to have active lifestyles are limited. It is likely that this will result in increased morbidity in the final years of life. Am. J. Hum. Biol. 13:310,315, 2001. © 2001 Wiley-Liss, Inc. [source] Survey of dietetic provision for patients with diabetesDIABETIC MEDICINE, Issue 8 2000M. Nelson SUMMARY Aims To survey dietitians involved in diabetes care regarding the provisions for patients with diabetes. Methods A national survey of 512 dietitians known to be engaged in provision of diabetes care was conducted in 1997 and 391 (76%) responded. Results Nationally the median provision of dietetic care for diabetes reported was 10.7 h per 100 000 general population per week, but the provision was uneven ranging from 2.0 to 27.6 h per 100 000. Eighty-five per cent of dietitians worked in areas where the provision was less than 22 h per 100 000 general population per week (the current recommended minimum standard). Dietetic provision was greater in secondary care (median 9.1 h per 100 000 general population per week) than in general practice, residential homes and other locations (median 4.4 h per 100 000 general population per week). Provision was greater in those areas in which a designated dietitian had responsibility for co-ordinating the dietetic service for diabetes than in areas where the co-ordinator was not a dietitian or where there was no co-ordinator. Over 90% of dietitians reported following British Diabetic Association (BDA) recommendations regarding advice on carbohydrate, sugar, fat and fibre consumption, but only one-third routinely advised on salt restriction. Of the 17% of dietitians who continue to use carbohydrate exchanges, all combine this method with other approaches. Of the recommendations made by the Clinical Standards Group, only 69% of dietitians reported seeing more than half of newly diagnosd adult patients within four weeks, and less than 50% reported offering half or more of their patients an annual review. Amongst the literature in current use, 98% of dietitians use BDA literature for teaching patients and 90% use BDA publications in their own education. Seventy-six per cent of dietitians believed that there was a role for commercial slimming organizations in weight management of people with diabetes Conclusions Given the proven value of dietetic input in diabetes management, there would be advantages to correcting the regional inequalities in dietetic provision for diabetes care in the UK. [source] Effect of housing factors and surficial uranium on the spatial prediction of residential radon in IowaENVIRONMETRICS, Issue 5 2007Brian J. Smith Abstract Growing epidemiologic evidence suggests that residential radon is an important risk factor for lung cancer. Consequently, public health professionals have expressed interest in characterizing the spatial distribution of radon concentrations in order to identify geographic regions of high exposure. Ambient radon concentrations are a function of geologic features including soil radium content. Indoor radon concentrations can vary based on building characteristics that affect the entry of radon into the building and movement between rooms therein. We present a geostatistical hierarchical Bayesian model for radon that allows for spatial prediction based on geologic data and housing characteristics. Our model is applied to radon data from an epidemiologic study in Iowa that consist of 136 outdoor measurements and 2590 indoor measurements from 614 residential homes. Housing characteristics collected in the Iowa Study are included as predictors in the model. Geologic data in the form of county-average surficial uranium concentrations from the USGS National Uranium Resource Evaluation project are also considered. A ,change of support' approach is implemented to combine the radon measurements, collected at points in space, and the uranium concentrations, averaged over counties, so that point-source concentrations for the latter are available for the analysis. Estimates of the effect of select housing factors on radon are provided along with spatial maps of predicted radon concentrations in Iowa. Copyright © 2006 John Wiley & Sons, Ltd. [source] Measuring the productive efficiency and clinical quality of institutional long-term care for the elderlyHEALTH ECONOMICS, Issue 3 2005Juha Laine Abstract The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care. Copyright © 2004 John Wiley & Sons, Ltd. [source] Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-upINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2006Hanna-Mari Alanen Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source] Risk indicators of depression in residential homesINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2004A. M. H. Eisses Abstract Objectives To assess risk indicators of depressive symptoms in social and personal domains of residents of residential homes. Methods In a cross-sectional study risk indicators for depressive symptoms (Geriatric Depression Scale) were examined in bivariate and multivariate analyses, four hundred and seventy-nine elderly subjects from 11 residential homes took part in the study. Results Functional impairment, loneliness, higher education levels, a family history of depression and neuroticism are associated with depressive symptom. Conclusion The risk indicators of depression found in residential homes are similar to those in the community. Copyright © 2004 John Wiley & Sons, Ltd. [source] Voting practices of the residents of nursing and residential homesINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2002Waheed NabiArticle first published online: 28 MAY 200 No abstract is available for this article. [source] An assessment of pharmaceutical inspection reports from nursing and residential homes for the elderly in Northern IrelandINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2004Anna K. Schweizer Phd student Objectives To highlight issues currently being inspected in nursing, residential and dual-registered homes (care homes) for the elderly in Northern Ireland as part of a pharmaceutical inspection. Methods A cross-sectional survey and analysis of reports from pharmaceutical inspections in Northern Ireland care homes between January 1999 and December 2000 was undertaken, using reports provided by the four Registration and Inspection Units (R & I Units 1,4) within the region. Reports were reviewed and all recommendations made by inspectors were classified into 11 main categories. Binary logistic regression was used to examine possible relationships between the type of home (nursing, residential or dual-registered) or the R & I unit and the recommendations made by the inspectors, with corresponding odds ratios and 95% confidence intervals. Key findings Reports from 415 homes (one report per home) formed the final sample for analysis. Each R & I unit used different documentation to conduct a pharmaceutical inspection. Homes received the majority of recommendations from inspectors in the categories ,Records' (66.7% of all homes), ,Policies and protocols' (39.3%) and ,Medication' (31.8%). More recommendations in a number of categories emanated from R & I unit 4 compared with R & I unit 1 (referent). Dual-registered homes (those registered as a nursing and residential facility) were more likely to receive a recommendation in the categories ,Storage of medicine', ,Order and receipt of medication' and ,Equipment' than nursing or residential homes. Conclusion Inspections of care homes should be standardised in terms of documentation used and facilities should be given guidance on issues that are likely to result in recommendations from inspectors. In the longer-term, pharmaceutical inspections should move from a focus on structure/process measures to those that emphasise quality in prescribing. [source] Effect of Service Structure and Organization on Staff Care Practices in Small Community Homes for People with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 5 2008Jim Mansell Background, An important question in community living is what factors influence the extent to which staff provide ,active support'. Methods, Engagement, care practices and a range of staff and organizational characteristics were studied in 72 residential homes serving 359 adults with intellectual disabilities. Managers in 36 settings were trained in person-centred active support (PCAS). A group comparison design and multivariate analysis was used to investigate the relationship between variables. Results, The PCAS group showed more active support, assistance, other contact from staff and engagement in meaningful activity but no difference in choice-making or assessment of participation in activities of daily living. The PCAS group had more staff with a professional qualification, were more likely to think that challenging behaviour was caused by lack of stimulation, had attitudes more in line with a policy of community care, rated most care tasks as less difficult, and were more organized to deliver active support. The comparison group were more likely to think that challenging behaviour was learned negative behaviour, showed more teamwork and were more satisfied. Multivariate analysis identified a range of staff and organizational variables associated with engagement and active support. Conclusions, The results suggest that some variables which have not hitherto been studied in relation with active support are associated with it. Professional qualification, knowledge and experience appear to be important as do some staff attitudes, clear management guidance, more frequent supervision and team meetings, training and support for staff to help residents engage in meaningful activity. [source] Offering choices to people with intellectual disabilities: an interactional studyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 12 2008C. Antaki Abstract Background At the level of policy recommendation, it is agreed that people with intellectual impairments ought to be given opportunities to make choices in their lives; indeed, in the UK, the Mental Capacity Act of 2005 enshrines such a right in law. However, at the level of practice, there is a dearth of evidence as to how choices are actually offered in everyday situations, which must hinder recommendations to change. Method This qualitative interactional study, based on video recordings in British residential homes, combines ethnography with the fine-grained methods of Conversation Analysis. Results We identify six conversational practices that staff use to offer choices to residents with intellectual disabilities. Conclusions We describe the unwanted consequences of some of these practices, and how the institutional imperative to solicit clear and decisive choice may sometimes succeed only in producing the opposite. [source] Views of People with Intellectual Disabilities of Their Present and Future Living ArrangementsJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3-4 2004Roy McConkey Abstract, To determine personal perceptions and preferences of present and potential living arrangements, 180 adults with intellectual disabilities were recruited to participate in 20 focus groups held across Northern Ireland. About half were living with family carers and the balance in a range of other types of accommodations. Verbal probing and video clips were used to elicit views on four different living options (residential homes, small group homes, supported living, and living with a nonrelated family). Four personal preference themes emerged that were common to all participants irrespective of where they lived: having their own bedroom, participating in household activities; having access to community activities, and maintaining contact with family and friends. Adults living on their own or in supported housing valued their independence and having access to support staff, whereas adults living in residential homes spoke of the importance of relationships with co-residents and staff. Overall, most of the adults were content with their present situation, although small group homes and supported living arrangements were the most popular alternatives to living with their families. The discussion group process was useful in eliciting comments and offering participants a chance to reflect on their personal perceptions of housing options. Overall, the findings point to the need for greater consideration of personal preferences in home option choice-making by housing and services providers. [source] Eye injuries in rural Victoria, AustraliaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 7 2009Simon Raymond MPH Abstract Background:, Eye injury causes significant morbidity and is a leading cause of blindness worldwide. This study investigates the incidence, spectrum and patterns of eye injury presenting to a rural hospital in Victoria, Australia. Methods:, A retrospective review of the medical records of all patients presenting with eye injury to the emergency department of Mildura Base Hospital, Victoria, Australia in year 2004 was conducted. As the emergency department of Mildura Base Hospital also acts as the outpatient department for this hospital, the series included all patients treated for eye injury at Mildura Base Hospital in year 2004, including admissions. Results:, There were 435 patients present to Mildura Base Hospital emergency department for eye injury in 2004, which represented approximately 1% of the population of Mildura. The majority of eye injuries were superficial. Fifty-six (13%) patients required specialist attention. Most patients were male (83%) and were middle-aged. The most common locations where eye injuries took place were residential homes (47%) and workplaces (32%). The most common causes of eye injuries were trade tools and machinery (47%), followed by chemicals (12%) and branches/sticks/twigs (11%). Of particular concern for Mildura is that approximately one-quarter of the patients treated at Mildura Base Hospital for eye injury in 2004 had been treated at Mildura Base Hospital for a separate episode of eye injury in the past. Conclusion:, Eye injuries represent a significant socioeconomic burden. This research contributes to the knowledge required for the design and implementation of effective preventative strategy. [source] | ||||||||||