Wellbeing, functional performance and personal control about care provision of non-institutionalized and institutionalized elderly

The present study is part of a broader investigation on the effects of living in a home for the elderly on functional performance and opportunities for successful aging. Community dwelling elderly and elderly living in an institution were compared concerning some indicators of successful aging: life satisfaction, positive and negative affect and physical and social wellbeing. The relationships between the different aspects of wellbeing and functional performance in every domain of functioning (instrumental and basic activities of daily living and leisure and social activities) and personal control about care provision were studied in both settings. A structured interview was administered to 74 non-institutionalized and 79 institutionalized elderly, aged 71 to 97 years, living in Flanders. Both groups showed only differences in physical and social wellbeing. Being active in the domain of leisure and social activities and self-care was positively related to wellbeing in both groups. Household tasks seemed to be a burden for community-dwellers, while they positively contributed to wellbeing in the nursing home. Personal Control was not related to wellbeing in the community. In the nursing home, ability constraints, as reason for help, were negatively correlated with wellbeing, as was "own choice" for self-care. Choosing for help and overcompensation in the household was positively related to wellbeing in the nursing home.     

Falling rate of provision of residential care for the elderly.

The rapid increase in the number of very aged people has not been accompanied by appropriate expansion of local authority residential facilities. The rate of provision in 1976 was already acknowledged to be inadequate, but data are now presented to show that since then there has been an effective fall in the rate of provision of some 9000 places equivalent to, say, 180 old people''s homes of 50 places each. The prospects for the future are even gloomier: public spending cuts and local authority priorities suggest a continuing fall in the rate of provision that can be expected to have a profound effect on the National Health Service, on the burden on families, and on the condition in which old people are obliged to remain "in the community" (where support services have likewise failed to keep pace with demographic change).     

Association between serum calcium and periodontal disease progression in non-institutionalized elderly

Objective: To assess the effect of baseline serum calcium on the progression of periodontal disease in non‐institutionalized elderly. Background: Although a few studies have found some evidence of the role played by dietary calcium in periodontal disease process, there is a paucity of information pertinent to longitudinal assessment of serum calcium‐periodontal relationships. Material and methods: Clinical attachment levels of 266 Japanese subjects aged 70 years were recorded at baseline and annually for six consecutive years. Progression of periodontal disease (PPD) was defined as the number of teeth that showed additional attachment loss of ≥3 mm during the 6 years. The number of PPD was calculated for each subject and categorised into four levels, namely, PPD₀, PPD₁, PPD₂ and PPD₃ where the number of teeth with additional attachment loss ranged from 0, 1–10, 11–20 and >20 respectively. The levels of serum calcium, albumin, random blood sugar, immunoglobulin (IgG, IgA and IgM), gender, smoking habits, education, gingival bleeding and the number of teeth present were obtained at baseline. Results: Serum calcium, IgA, smoking, gingival bleeding and teeth present were associated with PPD at p ≤ 0.10 and were included in a multinomial logistic regression analysis. Serum calcium was the only variable that was significantly associated with PPD with relative risks of 100 at PPD₁ and PPD₂, respectively, and 1000 at PPD₃. Conclusion: Serum calcium may be considered a risk factor for periodontal disease progression in non‐institutionalized elderly.     

Depending on care: recognition of vulnerability and the social contribution of care provision

People who are paid to provide basic care for others are frequently undervalued, exploited and expected to reach often unrealistic standards of care. I argue that appropriate social recognition, support and fair pay for people who provide care for those who are disabled, frail and aged, or suffering ill health that impedes their capacity to negotiate daily activities without support, depends on a reconsideration of the paradigm of the citizen or and moral agent. I argue that by drawing on the ideas of human vulnerability and dependency as central to our personhood, a more realistic conception of selves, citizens and persons can be developed that better recognises the inevitability of human dependency and the social value of care work. I also indicate the significance of this vulnerability-focussed view for ethical evaluation of the emotional aspects of care relationships.     

A comparison of biochemical indices of bone turnover in elderly institutionalized and free-living subjects

Plasma concentrations of calcium-phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25(OH)D) and albumin, and fasting urinary sodium/creatinine (Na/Cr), calcium/creatinine (Ca/Cr) and hydroxyproline/creatinine (HPr/Cr) were measured in a survey of 208 Chinese elderly subjects living in chronic care institutions, and compared with values from free-living elderly subjects. Plasma parathyroid hormone estimations were also performed on a subpopulation of women living in an institution.Subjects in institutions had higher urinary HPr/Cr ratios in both men and women, as well as higher urinary Ca/Cr ratios in women, suggesting increased bone resorption. These values show significant variation depending on the degree of mobility. Factors which could contribute to the increased bone loss among institutionalized subjects are: reduced physical activity, reduced exposure to sunlight and hence reduced plasma 25(OH)D concentrations, low calcium intake, protein caloric malnutrition and possibly higher sodium intake. Correction of these factors may reduce the risk of fractures among the elderly living in chronic care institutions.     

Oral health and treatment needs in a non-institutionalized elderly population: Experience of a dental school associated geriatric clinic

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.     

Mental competence and elderly care

Competence or decision-making capacity are concepts, which are far from clear-cut. The normative consequences of an incapacity-judgment in elderly care require a balanced approach, which takes into consideration the risk of misuse in the context of the justification of interventions that are applied without consent of the patient. In this article a number of central issues in the debate on decision-making capacity are discussed. The different criteria, which are proposed to assess capacity, are discussed as well as the development of instruments in order to objectify capacity. It is concluded that the common approach towards decision-making capacity, which is strongly cognitive-oriented, is inadequate. A number of relevant aspects remain underexposed within this approach. A broader approach is explored, which takes into account the role of emotions, identity, and dialogue and deliberation. The different approaches are illustrated by way of a case example.     

Artificial reef design affects benthic secondary productivity and provision of functional habitat

1. Novel hard substratum, introduced through offshore developments, can provide habitat for marine species and thereby function as an artificial reef. To predict the ecological consequences of deploying offshore infrastructure, and sustainably manage the installation of new structures, interactions between artificial reefs and marine ecosystem functions and services must be understood. This requires quantitative data on the relationships between secondary productivity and artificial reef design, across all trophic levels. Benthic secondary productivity is, however, one of the least studied processes on artificial reefs.
2. In this study, we show that productivity rates of a common suspension feeder, Flustra foliacea (Linnaeus 1758), were 2.4 times higher on artificial reefs constructed from “complex” blocks than on reefs constructed from “simple” blocks, which had a smaller surface area.
3. Productivity rates were highest on external areas of reefs. Productivity rates decreased by 1.56%, per cm distance into the reef on complex reefs and 2.93% per cm into the reef on simple block reefs. The differences in productivity rates between reefs constructed from simple and complex blocks are assumed to reflect different current regimes and food supply between the external and internal reef areas, according to reef type.
4. Synthesis and applications. Our results show that artificial reef design can affect secondary productivity at low trophic levels. We demonstrate that the incorporation of voids into reef blocks can lead to a greater proportion of the structure serving as functional habitat for benthic species. By including such modifications into the design of artificial reefs, it may be possible to increase the overall productivity capacity of artificial structures.

     

Exercise of mechanisms for dynamic stability control increases stability performance in the elderly

Old adults show a decreased recovery performance compared to young ones after unexpected perturbations increasing the risk of falls. Therefore, the purpose of the present study was to examine the effect of a specific training of mechanisms responsible for dynamic stability on the recovery performance of old adults after simulated forward falls and the contribution of muscle strength exercise. 38 old adults (two experimental groups each n=13 and a control group, n=12) participated in the study. Group 1 exercised the mechanisms responsible for dynamic stability like increase in base of support and counter-rotating segments around the centre of mass by practicing specific tasks including these mechanisms. Group 2 exercised these mechanisms of dynamic stability and muscle strength. The exercise volume was equal in both interventions (14 weeks, two times per week and ～1.5 h per session). Stability performance has been examined by simulated forward falls before and after the intervention. The two experimental groups improved in a similar extent (～35%) their ability to regain balance during forward falls after the intervention. The reason was a faster increase in base of support. Further, the performance enhancement was related to an increase in the rate of hip moment generation. Exercising the mechanisms responsible for dynamic stability control in old adults affects their ability to regain balance after forward falls. A faster utilization of these mechanisms due to improved neuromuscular coordination resulted in the significant performance enhancement.     

The interrelationship among achievement patterns of activities of daily living for institutionalized dependent elderly

The purpose of the present study was to examine the interrelationship of achievement patterns between 74 activities by selecting nine ADL domains, including 27 items used in existing ADL index for the institutionalized disabled elderly (Disabled-ADL). For these 74 ADL items, 706 institutionalized dependent elderly were assessed using a dichotomous scale of "possible" or "impossible" by staff working at the subjects' institutions. The difficulty of each item was examined by calculating the proportion of "possible" responses. The interrelationships among activities were determined by calculating phi coefficients. Furthermore, the degree of agreement assessed between ADL items was calculated by dividing the total response by the number of "possible-possible" and "impossible-impossible" responses, in order to examine the similarity of the achievement pattern of ADL. The phi coefficient values were high among ADL items with comparable difficulty where the item proportions were within about 10%. Even if belonging to a different ADL domain, the relationship was high among ADL items with similar difficulty and kinds of activity. All of the 27 activities used in Disabled-ADL indicated high agreement of over 80% with one or more activities among the other 47 activities used in this study. Especially, three lower extremity activities of "putting on trousers while standing", "going up and down stairs" and "squatting down from a standing posture" agreed more than 90% with many other lower extremity activities. The possibility is suggested in determining lower extremity functional levels by assessing these three activities. The selection of ADL items considering these influences is necessary to comprehensively assess ADL ability of disabled elderly.