Developing an instrument to support oral care in the elderly

Background: The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co‐operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency. Purpose: In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial‐agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument. Methods: a) Plaque removal study: The plaque‐ removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index, b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations. Results: a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly. Conclusion: It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly.     

Asthma in the elderly: an epidemiological survey.

A random sample of one in eight people aged 70 and over living at home in a south Wales town was surveyed to establish the prevalence of asthma. Subjects attended a screening clinic, where spirometry before and after an inhalation of salbutamol, skin prick testing, blood count, and sputum examination were carried out and a questionnaire answered. Those in whom asthma seemed at all likely were subsequently examined in detail in a chest clinic. Out of 485 subjects eligible, 418 (86.2%) were screened. Twelve (2.9%) had current asthma, of whom three had not previously been diagnosed as asthmatic and four were being treated but were unaware of the diagnosis. A further 15 (3.6%) had mild asthma or a history of the disease, giving a total prevalence of any history of asthma of 6.5%. Only one of the subjects who did not attend the screening clinic was known to have asthma, suggesting that the overall prevalence did not differ greatly from this figure. It was found that the disease might start or remit at any age. Thus in the elderly current asthma is more prevalent in men than women (5.1% compared to 1.8%) and in terms of spirometry is more severe. Two underlying disease processes may perhaps exist that fulfil criteria for asthma in the elderly, one causing sputum eosinophilia and the other a form of chronic bronchitis with reversible airways obstruction.     

Private rest homes in the care of the elderly.

Sixteen private rest homes were visited to assess their facilities and the types of disability of the residents. Apart from one home, which was a hotel for the elderly, all the homes provided care for physically and mentally frail elderly people over the long term. Although care was good the trends in the use of the homes are worrying, and stricter regulations are required to ensure appropriate levels of care. Greater support is also required from district nursing services.     

The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics

Background

The many randomized trials of the collaborative care model for improving depression in primary care have not described the implementation and maintenance of this model. This paper reports how and the degree to which collaborative care process changes were implemented and maintained for the 75 primary care clinics participating in the DIAMOND Initiative (Depression Improvement Across Minnesota–Offering a New Direction).

Methods

Each clinic was trained to implement seven components of the model and participated in ongoing evaluation and facilitation activities. For this study, assessment of clinical process implementation was accomplished via completion of surveys by the physician leader and clinic manager of each clinic site at three points in time. The physician leader of each clinic completed a survey measure of the presence of various practice systems prior to and one and two years after implementation. Clinic managers also completed a survey of organizational readiness and the strategies used for implementation.

Results

Survey response rates were 96% to 100%. The systems survey confirmed a very high degree of implementation (with large variation) of DIAMOND depression practice systems (mean of 24.4?±?14.6%) present at baseline, 57.0?±?21.0% at one year (P?=?<0.0001), and 55.9?±?21.3% at two years. There was a similarly large increase (and variation) in the use of various quality improvement strategies for depression (mean of 29.6?±?28.1% at baseline, 75.1?±?22.3% at one year (P?=?<0.0001), and 74.6?±?23.0% at two years.

Conclusions

This study demonstrates that under the right circumstances, primary care clinics that are prepared to implement evidence-based care can do so if financial barriers are reduced, effective training and facilitation are provided, and the new design introduces the specific mental models, new care processes, and workers and expertise that are needed. Implementation was associated with a marked increase in the number of improvement strategies used, but actual care and outcomes data are needed to associate these changes with patient outcomes and patient-reported care.

     

PROTEIOS: an open source proteomics initiative

SUMMARY: PROTEIOS is an initiative for the development of a comprehensive open source system for storage, organization, analysis and annotation of proteomics experiments. The PROTEIOS platform is based on commonly acknowledged principles for proteomics data publishing. AVAILABILITY: http://www.proteios.org     

Bereavement in the elderly: the role of primary care

Bereavement in the elderly is a concern to primary care physicians (PCPs) as it can lead to psychological illness such as depression. Most people are able to come to terms with their grief without any intervention, but some people are not. This case highlights the importance of early recognition of bereavement-related depressive illness in elderly people. PCPs need to optimise support and available resources prior to, and throughout, the bereavement period in order to reduce the family members'' burden and suffering.