An epidemiological survey of the health needs of disabled people in a rural community

Availability and need of home adaptations for personal mobility among individuals with spinal cord injury

OBJECTIVE

To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI).

DESIGN

Cross-sectional study.

SETTING

Swiss Spinal Cord Injury Community Survey 2012.

PARTICIPANTS

Individuals aged 16 or older with chronic SCI living in Switzerland.

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.

RESULTS

Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.

CONCLUSION

Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.

Formal and informal care in relation to activities of daily living and self-perceived health among older care-dependent individuals in Norway

Background.  Research about formal care of older home-dwelling people in the Nordic countries is comprehensive, while research on informal care has been less inclusive. Aim.  To describe self-reported activities of daily living and perceived health, and to relate them to amount and types of formal and informal care received by a group of care-dependent, home-dwelling older individuals in Norway. Design and methods.  A sample consisting of 242 persons aged 75+ years receiving home nursing services. Data were collected by means of structured interviews with questions about activities of daily living (ADL), amount and types of formal and informal care and demographic variables. Descriptive statistics, chi-square test, Mann-Whitney U-test and multiple stepwise regression were used in the analyses. Results.  ADL dependency was the only predictor for explaining quantity of home nursing received. Those who received a generous amount of formal care also received a lot of care and support from informal networks. The type of care from the two sources differed. The home nurses performed PADL tasks. While the informal caregivers offered help with IADL tasks. Conclusion.  This study of receiving help in this group of older people in Norway shows that formal and informal care resources complement one another.

[Factors associated with hospitalization in a cohort of elderly patients included in a home care program]

BACKGROUND AND OBJECTIVE

The objective is to identify the features associated with next year hospital admissions among elderly dependent patients living at home (EDLH) and visited by primary care teams at their home setting.

PATIENTS AND METHOD

Longitudinal cohort study of a sample of EDLH patients admitted to a home care programme delivered by 72 primary care teams. A global health assessment was performed at recruitment in all patients (health and social status, informal and formal carer characteristics and burden of care). We further collected data on visits by primary care personnel and the use of social, emergency and hospital services by EDLH patients throughout one year after recruitment.

RESULTS

A sample of 1,093 EDLH patients was included. 258 (23,6%) patients were admitted to hospital during follow-up and 170 (15.6%) were lost to follow-up. Hospitalised patients received the same volume of primary care and social care services at home than those that were not hospitalised. Independent predictors of high risk of hospital admission were calling and using the after-hours emergency community services (odds ratio [OR]= 2.50, 95% confidence interval [95% CI] 1.56-4.01) and comorbidity as measured by the Charlson Index (OR= 1.16, 95% CI 1.06-1.27) at recruitment. Similarly, female sex (OR= 0.59, 95% CI 0.40-0.85) and high subjective physical health status scores as measured by the SF12 questionnaire (OR 0.97, 95% CI 0.95-0.99) predicted a low-risk of hospital admission.

CONCLUSIONS

Hospital admission among EDLH patients is related to comorbidity, gender, subjective health status and the use of uncoordinated emergency services as measured at recruitment, rather than to the use of services during the one-year follow-up.

Mind the gap: rethinking community neurological rehabilitation services

Recognition that there was a lack of knowledge about what services existed for adults aged 18– 65 years with an acquired neurological condition in North Cumbria, and how they were accessed and co-ordinated, led to a project to identify community rehabilitation provision and explore potential service models. Interviews were undertaken with service providers, and focus groups, interviews and a questionnaire were undertaken with services users and carers.

The five areas of concern to emerge from a thematic analysis of the data related to service provision; respite care and day time occupation, transport and geography, co-ordination of services, and information. There were differences in perspectives and priorities. Having one point of contact for access to all services emerged as the preferred model, although this would not address the gaps in service provision.

Despite the recognition that the National Service Framework for Long-term Conditions (Department of Health (DH), 2005b) has promoted service development for the target group, there is still a need to work towards greater coherence in service provision across a plurality of providers.

Health care service provision for country people with developmental disability: an Australian perspective

Priorities in the delivery of health care to Australian country people with developmental disability were explored through focus groups and interviews of key stakeholder groups from four rural/regional towns. Data were analysed for themes, which converged on lack of access to primary health care providers who lacked knowledge about and had poor attitudes towards developmental disability, discriminatory practices, the burden on support people, and communication difficulties between GPs and people with developmental disability. Potential strategies to address the apparent dissatisfaction with primary health care and GP concerns about working with this group were also evident in the data. In particular, open communication between stakeholders as a mechanism for collaborative problem solving and a strategy to avoid burn out for both support people and GPs is recommended. Facilitation of such communication can best occur through undergraduate training and participation of disability workers in activities of organisations that support GPs.

Occupational therapists in rural healthcare: a "jack of all trades"

Rural areas are often perceived to have limitations in healthcare resources. The literature indicates that shortages of occupational therapy resources exist within rural health areas. This study reports on a survey that was distributed to rehabilitation departments in Nebraska, excluding only the metropolitan areas of Omaha and Lincoln. Forty-four of the ninety-three surveys sent were completed and returned (47.3%). The survey examined the occupational therapy resources available and those diagnoses treated in the designated geographical area. Although the survey results do not support the literature regarding limitations of occupational therapy resources, results do demonstrate a variety of challenges faced by therapists practicing in isolated areas.