Functional ability of the elderly in institutional and non-institutional care in Croatia

Gerontology-public health indicators of functional ability of the elderly in institutional and non-institutional health care in Croatia were determined by use of expert methodology developed at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health in Zagreb, with the aim to upgrade the Program of Health Care Measures and Procedures in Health Care of the Elderly. Comparison of functional ability between the users of selected Old People's Homes (institutional care; N = 5030) and Gerontology Centers (non-institutional care; N = 2112) yielded highest between-group difference in the proportion of "fully movable" and "fully independent" categories in favor of the latter, thus steering the program of health care for the elderly accordingly. In addition, study results showed greater difference in the proportion of categories describing mental status of institutional and non-institutional care users as compared with the categories describing their physical status, suggesting that mental status plays a more important role than physical status in the geriatric user's stay in non-institutional care versus institutional care. This issue requires additional studies. The results obtained by this indicator analysis pointed to the preventive and geroprophylactic measures to ensure efficient health care for the elderly and to develop the program of mental health promotion and preservation. According to 2007 estimate, there were 759,318 (16.9%) persons aged > or = 65 in Croatia. Data collected at gerontology database kept at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health (September 2008) showed 2% of the elderly (N = 14807) to be accommodated at Old People's Homes, which is below the European average of 4%.     

Influenza vaccination in the elderly: 2. The economics of sending reminder letters

Reminder letters and follow-up telephone calls were used to increase influenza vaccination acceptance by 273 well elderly registered at an urban community health centre. The net effect of the reminder letters was to increase overall coverage to 43%, from 17% in the previous year. Follow-up telephone calls to patients who had not responded to the letters increased coverage to only 55%. Calculation of costs per additional vaccination given revealed that the use of reminder letters alone was much more cost-effective than follow-up telephone calls in increasing coverage. However, with the current fee-for-service reimbursement by medical care insurance in Ontario, neither means of improving vaccination coverage would result in net practice earnings. The implications for an effective and efficient annual influenza program in Canada are discussed.     

Staff attitudes to oral health care. A comparative study of registered nurses,nursing assistants and home care aides

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.     

Instrument for determination and planning of care

Geronte is a French instrument to assess and visualize the need of care of elderly people. In 1995 Geronte was translated into Dutch. In order to be able to determine differences in the need of care, it was investigated whether the Dutch Geronte is able to discriminate between the users of different care-providing institutions. Five groups of fifteen elderly people in five different situations were examined: residents with predominantly psycho-geriatric impairment, residents with predominantly somatic impairment and residents of a home for the elderly, elderly people living at home with home help and elderly people living at home without any assistance. The Dutch Geronte proved to be able to reveal differences between the users of the different types of care, with the exception of residents of the home for the elderly and elderly people living at home with home help. The Dutch Geronte proved to be useful in the assessment and visualization of the need of care of elderly people.     

Dental Care for the Elderly

The geriatric population in many parts of the United States is underserved by dentistry. Socioeconomic problems, difficult access to dental facilities, and confusion about the need for dental care often prevent the elderly from seeking dental service. Because dental diseases are not life threatening or outwardly disabling, administrators of institutions for the elderly and health legislators place a low priority on dental care for the elderly. These factors working in concert with the insidious, progressive, and cummulative nature of denture diseases contribute to the poor dental health experienced by some segments of the geriatric population. Dentistry has the manpower and the technology to improve the oral health of the elderly, but society must be made aware of the importance of dental health in the total health of elderly persons in order that dentistry be given a chance to achieve that goal.     

Oral health care in long‐term care facilities for elderly people in southern Brazil: a conceptual framework

doi:10.1111/j.1741‐2358.2009.00280.x
Oral health care in long‐term care facilities for elderly people in southern Brazil: a conceptual framework Objective: To present a theoretical model for understanding oral health care for the elderly in the context of long‐term care institutions (LTCI). Methods: Open‐ended individual interviews were conducted with the elderly residing in LTCI, their carers, nursing technicians and nurses, directors of care, dental surgeons and managers of public health services. A grounded theory methodological approach was adopted for data collection and analysis. Results: The emerging core category revealed a basic social process: ‘Promoting oral health care for the elderly based on the context of LTCI’. This process was composed of two contradicting yet correlated aspects: the oral health care does not minimise the poor oral epidemiological condition, and at the same time, there was a continued improvement in the oral care expressed by better care practices. These aspects were related to the: attribution of meaning to oral health, social determination of oral health, the ageing process, interactions established in the oral health care practices, oral health care management in LTCI, inclusion of oral health care into the political–organisational dimension and possibility of conjecturing better oral health care practices. Conclusion: The core concept of ‘Promotion of oral health care for elderly people based on the context of LTCI’ is capable of explaining the variations in the structure and process of LTCI, as well as in helping to understand the meaning of the oral health care practices for the institutionalised elderly.     

2014-2015 年乌鲁木齐市院前急救老年患者疾病谱分析

目的：了解乌鲁木齐市院前急救老年患者疾病谱变化,提高老年人救治效率。方法：回顾性收集2014 年1 月1 日-2015 年 12 月31 日乌鲁木齐市120院前急救调度指挥中心数据库中40823 例老年（≥ 60 岁）患者病例信息,并进行疾病谱分析。结果： 40823 例老年患者中男性22284 例,女性18539 例,平均年龄（75.25 8.49）岁;其中汉族35018 例,维吾尔族3608 例,回族1698 例,其他民族499 例。院前急救老年患者疾病谱以心脑血管疾病、呼吸系统疾病、损伤、消化系统疾病、神经系统疾病为主,且心脑 血管疾病接诊率最高。院前急救老年患者接诊高峰月份为每年3-5 月,9-10 月,12-1 月;呼叫高峰时段为每日8:00-12:00,其次为 每日12:00-16:00;高发区域集中在新市区与沙依巴克区。结论：随着院前急救老年患者接诊数量的增多,应加强院前医护人员的 相关培训。根据院前急救老年患者的高发地区、月份及时段,合理配置院前急救资源。     

Preventive Health Care for the Elderly

Demographic, economic and humanitarian considerations dictate that effective preventive health care be provided to the elderly. A disease-specific approach to geriatric preventive health care will not suffice; measures to enhance or maintain physical, mental and social function must also be emphasized. Unfortunately, the effectiveness of many preventive care procedures has not been adequately investigated in the elderly. Research is urgently needed to determine the efficacy of and appropriate target population for various geriatric preventive health care measures.     

干旱区绿洲城市生态文明建设公众参与意识研究——以“一带一路”沿线城市乌鲁木齐为例

生态文明是人类文明发展的新阶段,其强调人与自然的协调发展。基于公众科学理论框架,采用模型模拟方法、实地问卷调查、多元回归方法,分析了乌鲁木齐居民参与城市生态文明建设的自我感知、满意程度、参与意愿,并构建了结构方程模型(SEM),探讨了居民参与城市生态文明意愿的可行路径,分析了居民参与城市生态文明建设的意愿与其相关因素间的关系,揭示了居民参与城市生态文明建设主要限制因素。结果表明:(1)居民自我感知与城市生态文明建设参与意愿呈显著正相关,满意程度与参与意愿呈显著负相关;(2)45.36%的受访者表示非常愿意参与城市生态文明建设;(3)居民主体意识和支持度占比分别为72.92%、72.04%,生态认知、生态关注及参与信心占比分别为43.08%、64.33%和55.14%;(4)受访者对城市生态文明建设状况满意度的平均偏效应为2.32,各项满意度均值情况为:城市绿化状况(2.51)政府环境信息公开程度(2.41)城市空气状况(2.35)城市垃圾处理与分类状况(1.99)。研究成果以期为建立和推进城市生态文明建设提供科学参考。     

Medication error in mental health: implications for primary care

Medication errors are associated with significant morbidity and people with mental health problems may be particularly susceptible to medication errors due to various factors. Primary care has a key role in improving medication safety in this vulnerable population. The complexity of services, involving primary and secondary care and social services, and potential training issues may increase error rates, with physical medicines representing a particular risk. Service users may be cognitively impaired and fail to identify an error placing additional responsibilities on clinicians. The potential role of carers in error prevention and medication safety requires further elaboration. A potential lack of trust between service users and clinicians may impair honest communication about medication issues leading to errors. There is a need for detailed research within this field.     

Prospective Study of the Quality of Colonoscopies Performed by Primary Care Physicians: The Alberta Primary Care Endoscopy (APC-Endo) Study

Background

The quality of colonoscopies performed by primary care physicians (PCPs) is unknown.

Objective

To determine whether PCP colonoscopists achieve colonoscopy quality benchmarks, and patient satisfaction with having their colonoscopy performed by a primary care physician.

Design

Prospective multi-center, multi-physician observational study. Colonoscopic quality data collection occurred via completion of case report forms and pathological confirmation of lesions. Patient satisfaction was captured by a telephone survey.

Setting

Thirteen rural and suburban hospitals in Alberta, Canada.

Measurements

Proportion of successful cecal intubations, average number of adenomas detected per colonoscopy, proportion of patients with at least one adenoma, and serious adverse event rates; patient satisfaction with their wait time and procedure, as well as willingness to have a repeat colonoscopy performed by their primary care endoscopist.

Results

In the two-month study period, 10 study physicians performed 577 colonoscopies. The overall adjusted proportion of successful cecal intubations was 96.5% (95% CI 94.6–97.8), and all physicians achieved the adjusted cecal intubation target of ≥90%. The average number of ademonas detected per colonoscopy was 0.62 (95% CI 0.5–0.74). 46.4% (95% CI 38.5–54.3) of males and 30.2% (95% CI 22.3–38.2) of females ≥50 years of age having their first colonoscopy, had at least one adenoma. Four serious adverse events occurred (three post polypectomy bleeds and one perforation) and 99.3% of patients were willing to have a repeat colonoscopy performed by their primary care colonoscopist.

Limitations

Two-month study length and non-universal participation by Alberta primary care endoscopists.

Conclusions

Primary care physician colonoscopists can achieve quality benchmarks in colonoscopy. Training additional primary care physicians in endoscopy may improve patient access and decrease endoscopic wait times, especially in rural settings.     

Patient satisfaction and quality in home health care of elderly islanders

Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Losinj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease (14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.     

Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care

The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the ‘secondary prevention’ (12%) and ‘care of chronic conditions’ (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.     

The televisit system in patients care after discharge in clinical use--first experiences]

The televisite is a form of application of telemedicine, that allows a communication between the patient and the family doctor or specialist in the clinic after discharging of hospital. Pioneers for the use of telematic projects have been up to now wide states like the USA, Canada, Norway or Australia to provide, guarantee and maintain by the means of telemedical solutions medical care in geographic regions hardly reachable and of little medical attention. In central Europe and Germany telemedicine is gaining in significance on the one hand because of increasing importance of the cost factor and resulting pressure on the public health system and on the other hand because of the rising demand of the patients for optimised medical care. It specially represents a new form of treatment in patients care after dischargement of hospital. In the year of 2002 a prospective randomised two-armed study was initiated including patients after operative intervention by arthroplasty in posttraumatic contracture of the elbow. The system of the Televisite is used for 6 weeks after dischargement and patients had been controlled ambulant after 6 months including a physical examination. The functional outcome will be scored, the duration of stay in hospital measured, the arising costs for treatment calculated and the satisfaction of the patients in handling the Televisite surveyed. Over this first results showed a shortened stay in hospital together with lowered costs in medical treatment on the one hand and on the other no difference in functional outcome could be found in comparison to the control group by additionally high grade of satisfaction with the new system.     

心内科住院患者人性化护理问题的分析与对策研究

目的:探讨心内科实施人性化护理的问题及产生问题的原因,寻找有效的解决措施。这对提高护理质量,有效保证住院患者的安全,促进住院患者身心健康有重要意义,同时,也为临床护理提供依据。方法:对我院2011年1月-2011年3月心内科住院患者进行护理满意度和护理需求问卷调查。结果:调查数据显示,实施人性化护理患者的满意度为89.86%,较2010年有较大的提高。导致患者不满意的原因依次为护患沟通不足、护理人员专业素质差、护理人员缺乏经验和个别护理人员职业道德低下。根据患者需求调查数据显示,患者在病房环境、个人隐私尊重与保护、服务态度、医疗技术操作水平及职业道德5个方面还有较大需求。结论:人性化护理对改善医患关系,提高护理安全,促进患者的身心健康有积极的作用。依据调查的患者需求量,人性化护理还需要有针对性的改进和提高。     

Rural-Urban Differences in the Long-Term Care of the Disabled Elderly in China

Background

In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors.

Methods

This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates.

Results

Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively), but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products.

Conclusions

The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.     

Research on a Community-based Platform for Promoting Health and Physical Fitness in the Elderly Community

This study aims to assess the acceptability of a fitness testing platform (iFit) for installation in an assisted living community with the aim of promoting fitness and slowing the onset of frailty. The iFit platform develops a means of testing Bureau of Health Promotion mandated health assessment items for the elderly (including flexibility tests, grip strength tests, balance tests, and reaction time tests) and integrates wireless remote sensors in a game-like environment to capture and store subject response data, thus providing individuals in elderly care contexts with a greater awareness of their own physical condition. In this study, we specifically evaluated the users’ intention of using the iFit using a technology acceptance model (TAM). A total of 101 elderly subjects (27 males and 74 females) were recruited. A survey was conducted to measure technology acceptance, to verify that the platform could be used as intended to promote fitness among the elderly. Results indicate that perceived usefulness, perceived ease of use and usage attitude positively impact behavioral intention to use the platform. The iFit platform can offer user-friendly solutions for a community-based fitness care and monitoring of elderly subjects. In summary, iFit was determined by three key drivers and discussed as follows: risk factors among the frail elderly, mechanism for slowing the advance frailty, and technology acceptance and support for promoting physical fitness.     

心内科住院患者人性化护理问题的分析与对策研究

目的：探讨心内科实施人性化护理的问题及产生问题的原因,寻找有效的解决措施。这对提高护理质量,有效保证住院患者的安全,促进住院患者身心健康有重要意义,同时,也为临床护理提供依据。方法：对我院2011年1月-2011年3月心内科住院患者进行护理满意度和护理需求问卷调查。结果：调查数据显示,实施人性化护理患者的满意度为89．86％,较2010年有较大的提高。导致患者不满意的原因依次为护患沟通不足、护理人员专业素质差、护理人员缺乏经验和个别护理人员职业道德低下。根据患者需求调查数据显示,患者在病房环境、个人隐私尊重与保护、服务态度、医疗技术操作水平及职业道德5个方面还有较大需求。结论：人性化护理对改善医患关系,提高护理安全,促进患者的身心健康有积极的作用。依据调查的患者需求量,人性化护理还需要有针对性的改进和提高。     

Comparing Older Adults' Perceived Need for Dental Care with a Normative Hierarchy of Needs1

The elderly are reported to have poor perception of their need for dental care. In a secondary analysis of data from a community interview and clinical examination survey of older adults, we set out to determine the nature and extent of the inconsistency of perceived and normative needs. The data were gathered originally to estimate the oral health status and need for treatment among adults aged 50 and older in East York, Ontario. In the interview, participants responded to four questions dealing with their satisfaction with, and need for, dental care. Dentists conducted clinical examinations following WHO methods which included oral health status and treatment needs. Data were analyzed using SPSSPC +. We placed the clinical needs in order from urgent to no need, following ADA guidelines. The perceptions of subjects were then compared to this normative hierarchy using Kruskal-Wallis analysis of variance. We found that participants' perceptions were closely associated with the normative hierarchy in all comparisons. Our results suggest that the concordance between perceived and normative needs is greater than previously reported.     

2001-2010年我院采用内分泌疗法治疗老年乳腺癌的临床效果分析

目的：分析内分泌治疗在老年患者乳腺癌中的疗效。方法：回顾性分析2001 年1 月至2010 年12 月我院外科手术切除的≥60 岁的116 例乳腺癌患者的临床资料,按照内分泌治疗分成三组,不进行内分泌治疗的对照组、三苯氧胺（TAM）组和芳香化酶抑制剂（AI）组,比较不良反应、存活时间及存活率。结果：对照组的副作用发生率为75.86%,副作用主要为关节痛、其他关节症状和子宫内膜增厚;TAM 组的副作用发生率为63.33%,副作用主要为其他关节症状和子宫内膜增厚;AI 组的副作用发生率为55.56%,副作用主要为其他关节症状和子宫内膜增厚。三组患者的不良反应如潮红、妇科症状、子宫切除和静脉栓塞等发生率低,总不良反应发生率无显著性差异（P=0.802）。对照组的中位生存时间为7.35 年,TAM组的中位生存时间为10.46 年,AI组的中位生存时间为9.94 年,三组患者的生存时间具有显著性差异（P=0.001）,TAM组和AI组的生存时间显著高于对照组。对照组、ATM组、AI 组的5 年生存率为74%、90%、71%,10 年生存率为24%、71%、68%,三组患者的生存率具有显著性差异（P=0.007）,TAM组和AI组的生存率均显著高于对照组。结论：性激素受体阳性老年乳腺癌患者总体预后较好。TAM、AI用于性激素受体阳性的老年乳腺癌患者的治疗,具有较好的疗效与安全性。