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Frail Elderly (frail + elderly)
Terms modified by Frail Elderly Selected AbstractsEvaluation of gender differences in caregiver burden in home care: Nagoya Longitudinal Study of the Frail Elderly (NLS-FE)PSYCHOGERIATRICS, Issue 3 2006Yoshihisa HIRAKAWA Abstract Background:, Japan is presently experiencing a growth in the number of male caregivers and this situation has given rise to some concerns over gender differences. Previous studies have suggested that there are gender differences in caregiver burden in home care, however, it is still unclear whether or not gender differences exist. We therefore conducted this study to attain a better understanding of the Japanese male caregiver burden in home care, using data from the Nagoya Longitudinal Study of Frail Elderly (NLS-FE). Methods:, NLS-FE is a large prospective study of community-dwelling elderly persons eligible for public long-term care insurance who live in Nagoya city and use the services of the Nagoya City Health Care Service Foundation for Older People, which comprises 17 visiting nursing stations and corresponding care-managing centers, from November to December 2003. Data used in this study included the Japanese version of the Zarit Caregiver Burden Interview, caregivers' and dependents' characteristics, and the caregiving situation. The differences in dependent and caregiver characteristics between male and female caregiver groups were assessed using the ,2 -test for categorical variables or the unpaired t -test for continuous variables. Multiple logistic regression was used to examine the association between dependent and caregiver characteristics and caregiver burden. Results:, A total of 399 male caregivers and 1193 female caregivers were included in our analysis. Before and after controlling baseline variables, we did not detect a difference between male and female caregivers with respect to caregiver burden. Conclusion:, Our study suggests that differences in caregiver burden may not necessarily exist between male and female caregivers in Japan. [source] How is geriatrics different from general internal medicine?GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2004Thomas E Finucane Geriatrics and general internal medicine overlap greatly: most sick patients seen by a generalist are elderly and geriatricians care for nearly the full spectrum of diseases seen in internal medicine. Differences between the two disciplines can be seen in the areas of patient care, research and administration. As a group, geriatric patients are different from young adults because they are more likely to have multiple chronic illnesses, to depend on others, to be frail and to die in the near future. Each of these characteristics requires special knowledge on the part of the physician. The research agenda in geriatrics extends from attempts to find the molecular basis of sarcopenia and frailty to clinical research on the support of caregivers, who are themselves critically important to patients. In the US, nursing homes are required to have medical directors; this position is largely administrative and requires a distinct set of knowledge and attitudes. Clinical care, research and administrative efforts must all respond to the enormous number of patients who will develop cognitive impairment over the next three decades. Because the number of elderly patients so far exceeds the ability of geriatricians to provide care, education and ,geriatricizing' other specialties will also be an important mission for geriatricians. Proper reimbursement presents a serious challenge to physicians who care for the frail elderly. If geriatricians take care of the frailest, sickest and most vulnerable patients, but reimbursement mechanisms cannot recognize this fact, then all geriatricians will soon go bankrupt. [source] Two new potent and convenient predictors of mortality in older nursing home residents in JapanGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2004Orie Tajima Background: Malnourishment is closely connected with poor health outcomes in frail elderly. However, the relative importance of specific nutritional predictors of mortality remains unclear in the Japanese population. We investigated the potent nutritional factors associated with mortality from nutritional assessments of three parameters in Japanese frail elderly. Methods: Ninety residents in a nursing home in Japan, aged 65 and over (18 men, 72 women; mean age 82.2 ± 8.0 years) were enrolled in a 38-month follow-up study. The eligibility condition for analysis was having lived at the nursing home for more than 30 days, so three participants were excluded. Three nutritional parameters, which included: anthropometric measurements (body mass index, mid-arm circumference, triceps skinfold thickness and calf circumference); serum markers (albumin, total protein, prealbumin, retinol binding protein and total cholesterol); and food intake, were assessed. After categorizing each putative factor according to tertile distribution, risk of mortality was analyzed using Cox proportional hazard models. Results: At the end of the 38-month follow-up period, 29 participants had died. After adjustment for gender, age, clinical status, and functional status, three indicators (i.e. mid-arm circumference, triceps skinfold thickness and lipid intake) showed a significant relationship with mortality. When all of the putative factors were included in a stepwise procedure, mid-arm circumference and lipid intake were significantly associated with adjusted mortality. Conclusion: Among institutionalized Japanese frail elderly, lower levels of mid-arm circumference and lipid intake could potently predict an increased risk of mortality. These two indicators may be useful for many kinds of assessments and intervention for the improvement of health conditions in Japanese frail elderly. [source] Whole-system approaches to health and social care partnerships for the frail elderly: an exploration of North American models and lessonsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2006Dennis L. Kodner PhD Abstract Irrespective of cross-national differences in long-term care, countries confront broadly similar challenges, including fragmented services, disjointed care, less-than-optimal quality, system inefficiencies and difficult-to-control costs. Integrated or whole-system strategies are becoming increasingly important to address these shortcomings through the seamless provision of health and social care. North America is an especially fertile proving ground for structurally oriented whole-system models. This article summarises the structure, features and outcomes of the Program of All-Inclusive Care for Elderly People (PACE) programme in the United States, and the Système de soins Intégrés pour Personnes Âgées (SIPA) and the Programme of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in Canada. The review finds a somewhat positive pattern of results in terms of service access, utilisation, costs, care provision, quality, health status and client/carer satisfaction. It concludes with the identification of common characteristics which are thought to be associated with the successful impact of these partnership initiatives, as well as a call for further research to understand the relationships, if any, between whole-system models, services and outcomes in integrated care for elderly people. [source] Prevalence of frailty on clinical wards: Description and implicationsINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2010Richt M Andela PhD RN Andela RM, Dijkstra A, Slaets JPJ, Sanderman R. International Journal of Nursing Practice 2010; 16: 14,19 Prevalence of frailty on clinical wards: Description and implications This paper describes the prevalence and frailty level of patients aged , 75 years upon admission to various clinical wards. The data collection took place on five clinical wards of different clinical specialisms: Geriatric Centre, traumatology, pulmonology/rheumatology, internal medicine and surgical medicine. The Groningen Frailty Indicator was used to assess the frailty of newly admitted patients. The presence of number and kind of the various frailty indicators was different for the clinical wards, because of clinical diagnose, age and gender. On the Geriatric Centre, almost all patients were indicated as frail. On the other wards, 50,80% of the patients were indicated as frail with most frailty indicators on the scale ,psychosocial'. The study show a high prevalence of frail elderly on some wards and gives an indication of the various needs for other disciplines within the framework of the care for frail elderly people. [source] Nutrition and inflammation: the missing link between periodontal disease and systemic health in the frail elderly?JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2006Rita Jepsen [source] Comparison of maximum bite force and dentate status between healthy and frail elderly personsJOURNAL OF ORAL REHABILITATION, Issue 6 2001H. Miura The purpose of the present study was to (1) determine the standard value of maximum bite force and to (2) compare the maximum bite force of the elderly between healthy and frail subjects. Subjects included 349 healthy elderly individuals (149 males, 200 females) and 24 frail elderly individuals (seven males, 17 females) ranging from 65 to 74 years of age. Maximum bite force was evaluated using a Dental Prescale systemÔ. The maximum bite force of the healthy subjects was significantly higher than that of the frail subjects in both males (P=0·020) and females (P=0·015). However, no significant difference was observed in the number of present teeth between the healthy and frail subjects. Median of maximum bite force in healthy males was 408,0 N, and that of the healthy females was 243,5 N. These results suggest that the frail elderly have latent bite force problems. [source] A philosophical analysis of the concept empowerment; the fundament of an education-programme to the frail elderlyNURSING PHILOSOPHY, Issue 4 2005Anne Merete Hage RN Cand.san. Abstract, The word ,empowerment' has become a popular term, widely used as an important claim, also within the health services. In this paper the concept's philosophical roots are traced from Freire and his ,Pedagogy of the Oppressed' to the philosophical thoughts of Hegel, Habermas, and Sartre. An understanding of the concept, as a way to facilitate coping and well-being in patients through reflection and dialogue, emerges. Within an empowerment strategy the important claim on the nurse and the patient will be to reveal the patient's own resources and limitations in times with sickness and reduced functionality to promote the patient's choice to act and cope. From this point of view an education-programme for the frail elderly is outlined. If the nurse wants to empower the elderly patient she has to be willing to be educated through the dialogue with the patient, and to look for the patient's own meaning of being frail and elderly. The coping and self-care solutions for the patient may then even be different from the preferences of the nurse, and this does not mean that the empowerment strategy is a failure or that the patient then has to continue without the assistance from the nurse. Within an empowerment strategy, in the Freirerian sense, the important thing is that both the patient and the nurse together critically reflect on the meanings of the sickness so that the patient can be able to make his own conscious choices. [source] The Growing Pains of Integrated Health Care for the Elderly: Lessons from the Expansion of PACETHE MILBANK QUARTERLY, Issue 2 2004DIANE L. GROSS The early success of the demonstration Program of All-Inclusive Care for the Elderly (PACE) led to its designation as a permanent Medicare program in 1997. But the growth in the number of programs and enrollment has lagged and does not meet expectations. This article offers insights into the mechanisms influencing the expansion of PACE, from information obtained in interviews and surveys of administrators, medical directors, and financial officers in 27 PACE programs. Sixteen barriers to expansion were found, including competition, PACE model characteristics, poor understanding of the program among referral sources, and a lack of financing for expansion. This experience offers important lessons for providing integrated health care to the frail elderly. [source] Research: The challenges of clinical trials in the exclusion zone: The case of the frail elderlyAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2008Iman Ridda Frail older people have been systematically excluded from randomised controlled trials (RCT). We aim to recruit older, frail hospitalised patients in an RCT and evaluate the frailty index (FI) as a measure to describe the types of people included in the study. We recruited 315 hospitalised patients aged 65 years; age ranged from 60 to 102 years. Baseline assessment scores ranged as follow: Mini-Mental Status Examination from 7 to 30, Barthel index from 5 to 100 and FI from 2 to 24. Total deaths were 20 (6%). We demonstrated that it is feasible to recruit frail older people into RCTs. The FI does not show any ,floor' or ,ceiling' effects. We can measure frailty in an RCT cohort, and we believe that clinical trials should include more frail older people and that the use of an FI can facilitate such trials and generate reliable data to guide future medical practice in a rapidly ageing society. [source] | ||||||||||||||||||||||