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Jeon YH, Simpson JM, Comans T, Shin M, Fethney J, McKenzie H, Crawford T, Lang C, Inacio M. Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence. Age Ageing 2023; 52:afad195. [PMID: 37890521 PMCID: PMC10611449 DOI: 10.1093/ageing/afad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP). METHODS Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65-100 years), and an age- and sex-matched HCP cohort (N = 20,980). RESULTS Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for ≤18 months; HR 0.89 [95%CI, 0.84-0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for ≤18 months; HR 0.91 [95%CI, 0.85-0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5 years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion. CONCLUSIONS Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services.
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Affiliation(s)
- Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Judy M Simpson
- School of Public Health, University of Sydney, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Mirim Shin
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Tonia Crawford
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Lang
- Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Maria Inacio
- Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Marengoni A, Tazzeo C, Calderón-Larrañaga A, Roso-Llorach A, Onder G, Zucchelli A, Rizzuto D, Vetrano DL. Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care. J Am Med Dir Assoc 2021; 22:2184-2189.e1. [PMID: 33556330 DOI: 10.1016/j.jamda.2020.12.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden. MEASURES In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization. RESULTS Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization. CONCLUSIONS AND IMPLICATIONS Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Centrum, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Song M, Song H. Disagreement between a public insurer’s recommendation and beneficiary’s choice of long-term care services in Korea. Health Policy 2020; 124:881-887. [DOI: 10.1016/j.healthpol.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Schnitzer S, Blüher S, Teti A, Schaeffner E, Ebert N, Martus P, Suhr R, Kuhlmey A. Risk Profiles for Care Dependency: Cross-Sectional Findings of a Population-Based Cohort Study in Germany. J Aging Health 2019; 32:352-360. [PMID: 30658538 PMCID: PMC7322978 DOI: 10.1177/0898264318822364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Rising life expectancy in Western societies is accompanied by a rising incidence of care dependency (CD) among older people. Objective: The aim of the study was to examine which health-related and social determinants were associated with CD. Method: We used cross-sectional data from the first follow-up (N = 1,699) of a prospective, population-based cohort study of older participants (≥70 years). CD was assessed if participants required substantial assistance in at least two activities of daily living for 90+ minutes daily. Multivariate logistic regressions were applied. Results: Participants’ mean age was 82 years; 18.9% were care-dependent. CD was significantly associated with older age, urinary incontinence, stroke, falls, cancer, diabetes, education level, having no partner, limited mobility, and limited physical activity. Discussion: Our research highlights the importance of promoting mobility, even in care-dependent people. Further research should investigate the role of partnership in terms of the prevention and delay of CD.
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Affiliation(s)
| | | | | | | | | | - Peter Martus
- Universitätsklinikum Tübingen, Baden-Württemberg, Germany
| | - Ralf Suhr
- Zentrum für Qualität in der Pflege / Centre for Quality in Care (ZQP), Berlin
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Hanratty B, Stow D, Collingridge Moore D, Valtorta NK, Matthews F. Loneliness as a risk factor for care home admission in the English Longitudinal Study of Ageing. Age Ageing 2018; 47:896-900. [PMID: 30007359 DOI: 10.1093/ageing/afy095] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Background loneliness has an adverse effect on health and well-being, and is common at older ages. Evidence that it is a risk factor for care home admission is sparse. Objective to investigate the association between loneliness and care home admission. Setting English Longitudinal Study of Ageing (ELSA). Participants two-hundred fifty-four individuals across seven waves (2002-15) of ELSA who moved into care homes were age, sex matched to four randomly selected individuals who remained in the community. Methods logistic regression models examined associations between loneliness, socio-demographic factors, functional status and health on moving into care homes. Results loneliness (measured by the University of California, Los Angeles (UCLA) Loneliness Scale and a single-item question from the Center for Epidemiological Studies Depression Scale (CES-D)) was associated with moving into a care home (CES-D OR 2.13, 95% CI 1.43-3.17, P = 0.0002, UCLA OR 1.81, 95% CI 1.01-3.27, P = 0.05). The association persisted after adjusting for established predictors (age, sex, social isolation, depression, memory problems including diagnosis of Alzheimer's disease, disability, long-term physical health and wealth). The impact of loneliness (measured by CES-D) on admission accounted for a population attributable fraction of 19.9% (95% CI 7.8-30.4%). Conclusions loneliness conveys an independent risk of care home admission that, unlike other risk factors, may be amenable to modification. Tackling loneliness amongst older adults may be a way of enhancing wellbeing and delaying or reducing the demand for institutional care.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Daniel Stow
- Institute of Health and Society, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Danni Collingridge Moore
- International Observatory on End of Life Care, Lancaster University, Furness Building Lancaster, UK
| | - Nicole K Valtorta
- Institute of Health and Society, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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Temple JB, Jukic M, Dow B. Informal care relationships and residential aged care recommendations: evidence from administrative data. BMC Geriatr 2017; 17:289. [PMID: 29258437 DOI: 10.1186/s12877-017-0656-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Australian government recognises the importance of informal care to enable ageing in place. Yet, few multivariable studies have examined aspects of informal care that alter the probability of entry to residential care in Australia. Existing Australian and international studies show differing effects of informal care on entry to residential care. Methods We utilise unique administrative data on aged care assessments collected from 2010 to 2013, consisting of 280,000 persons aged 65 and over. Logistic regression models were fitted to measure the propensity to be recommended care in a residential care setting, disaggregated by characteristics of informal care provision. Results Providing some explanation for the divergent findings in the literature, we show that close familial carer relationships (partner or child) and coresidence are associated with recommendations to live in the community. Weaker non-coresidential friend or neighbour carer relationships are associated with recommendations to live in residential care for women, as are non-coresidential other relatives (not a child, partner or in-law) for both males and females. Non-coresident carers who are in-laws (for females) or parents have no impact on assessor recommendations. Despite these significant differences, health conditions and assistance needs play a strong role in assessor recommendations about entry to residential care. Conclusion Co-resident care clearly plays an important protective role in residential care admission. Government policy should consider the need for differential supports for co-resident carers as part of future aged care reform.
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Schüssler S, Dassen T, Lohrmann C. Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study. Aging Clin Exp Res 2016; 28:973-82. [PMID: 25527067 DOI: 10.1007/s40520-014-0298-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.
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Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Wagner M, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Longitudinal Predictors of Institutionalization in Old Age. PLoS One 2016. [PMID: 26658776 DOI: 10.1371/journal.pone.014420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach. METHODS In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits. RESULTS The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization. CONCLUSION Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Lange
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Posselt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Susanne Steinmann
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Wagner M, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Longitudinal Predictors of Institutionalization in Old Age. PLoS One 2015; 10:e0144203. [PMID: 26658776 PMCID: PMC4685990 DOI: 10.1371/journal.pone.0144203] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach. Methods In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits. Results The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization. Conclusion Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Lange
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Posselt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Susanne Steinmann
- WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kaplan MS, Huguet N, Feeny D, McFarland BH, Caetano R, Bernier J, Giesbrecht N, Oliver L, Ramage-Morin P, Ross NA. The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study. Addict Behav 2014; 39:219-24. [PMID: 24169370 DOI: 10.1016/j.addbeh.2013.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/15/2013] [Accepted: 09/09/2013] [Indexed: 11/17/2022]
Abstract
Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.
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Nielsen ABS, Siersma V, Waldemar G, Waldorff FB. The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up. Age Ageing 2014; 43:50-7. [PMID: 23985335 DOI: 10.1093/ageing/aft131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear. METHODS seven-hundred fifty-seven non-nursing home residents ≥65 years from general practices in Central Copenhagen were followed for 4 years (2002-2006). Patients gave information on SRH, cognition (SMC and MMSE), quality of life (EQ-5D) and socio-demographics. Information on comorbidities and permanent NH placement came from registries. The association between SRH (dichotomised into good versus poor) and SMC, and permanent NH placement was assessed using Cox proportional hazard regression adjusted for potential confounders. RESULTS NH placement totaled 6.5% at 4-year follow-up. Poor SRH increased NH placement [hazard ratio (HR) = 2.07, 95% CI: 1.11-3.87] adjusted for age, SMC, MMSE, sex and comorbidities. SRH was not associated with NH placement if accounting for additional health information; however, SMC was (HR = 2.47, 95% CI: 1.26-4.86). Increased placement was seen for patients with good SRH and SMC (HR = 6.64, 95% CI: 2.31-19.12), but not among patients with poor SRH and SMC (HR = 1.37, 95% CI: 0.59-3.20) when compared with the reference group (good SRH and without SMC). CONCLUSIONS both poor SRH and SMC were associated with permanent NH placement risk among elderly primary care patients. However, when SMC was present a reverse association was found for SRH: good SRH increased NH placement. Since SRH is integrated in widely used psychometric instruments, further research is needed to establish the mechanism and implications of this finding.
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Affiliation(s)
- Anni B S Nielsen
- The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Vaz Fragoso CA, Gill TM. Respiratory impairment and the aging lung: a novel paradigm for assessing pulmonary function. J Gerontol A Biol Sci Med Sci 2012; 67:264-75. [PMID: 22138206 PMCID: PMC3297762 DOI: 10.1093/gerona/glr198] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/02/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Older persons have an increased risk of developing respiratory impairment because the aging lung is likely to have experienced exposures to environmental toxins as well as reductions in physiological capacity. METHODS Systematic review of risk factors and measures of pulmonary function that are most often considered when defining respiratory impairment in aging populations. RESULTS Across the adult life span, there are frequent exposures to environmental toxins, including tobacco smoke, respiratory infections, air pollution, and occupational dusts. Concurrently, there are reductions in physiological capacity that may adversely affect ventilatory control, respiratory muscle strength, respiratory mechanics, and gas exchange. Recent work has provided a strong rationale for defining respiratory impairment as an age-adjusted reduction in spirometric measures of pulmonary function that are independently associated with adverse health outcomes. Specifically, establishing respiratory impairment based on spirometric Z-scores has been shown to be strongly associated with respiratory symptoms, frailty, and mortality. Alternatively, respiratory impairment may be defined by the peak expiratory flow, as measured by a peak flow meter. The peak expiratory flow, when expressed as a Z-score, has been shown to be strongly associated with disability and mortality. However, because it has a reduced diagnostic accuracy, peak expiratory flow should only define respiratory impairment when spirometry is not readily available or an older person cannot adequately perform spirometry. CONCLUSIONS Aging is associated with an increased risk of developing respiratory impairment, which is best defined by spirometric Z-scores. Alternatively, in selected cases, respiratory impairment may be defined by peak expiratory flow, also expressed as a Z-score.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Department of Internal Medicine, Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut 06516, USA.
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Österlind J, Hansebo G, Andersson J, Ternestedt B, Hellström I. A discourse of silence: professional carers reasoning about death and dying in nursing homes. Ageing and Society 2011; 31:529-44. [DOI: 10.1017/s0144686x10000905] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTNursing homes are a setting in which death and dying is common. How death and dying is articulated and the actions that take place in a nursing home constitute a discourse that guides the staff in their work. The aim of this study was to explore the discourse of death and dying in nursing homes from the perspective and understanding of the staff. The study draws on Foucault's discourse analysis. Data are from five focus-group discussions held with 28 staff of four different nursing homes in Sweden. The findings show that the discourse had three characteristics: (a) dying was silent and silenced, (b) emotions were pushed into the background, and (c) attentiveness to death arose after the moment of the elderly person's death. The structure of the discourse was characterised by a movement between two positions, avoiding and confronting death, the main focus being on avoidance. The articulation and practices of silence highlight a need to regard dying as a process that requires attention. One way to ensure appropriate attention could be to instil the philosophy of palliative care in nursing homes, including training and support for the staff in their work. The study demonstrates that nursing-home staff need more knowledge and support to enable them to feel that they do a good job.
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Luppa M, Luck T, Matschinger H, König HH, Riedel-Heller SG. Predictors of nursing home admission of individuals without a dementia diagnosis before admission - results from the Leipzig Longitudinal Study of the Aged (LEILA 75+). BMC Health Serv Res 2010; 10:186. [PMID: 20584341 PMCID: PMC2909999 DOI: 10.1186/1472-6963-10-186] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 06/29/2010] [Indexed: 11/22/2022] Open
Abstract
Background In previous decades a substantial number of community-based studies mostly including dementia cases examined predictors of nursing home admission (NHA) among elderly people. However, no one study has analysed predictors of NHA for individuals without developing dementia before NHA. Methods Data were derived from the Leipzig Longitudinal Study of the Aged, a population-based study of individuals aged 75 years and older. 1,024 dementia-free older adults were interviewed six times on average every 1.4 years. Socio-demographic, clinical, and psychometric variables were obtained. Kaplan-Meier estimates were used to determine mean time to NHA. Cox proportional hazards regression was used to examine predictors of long-term NHA. Results Of the overall sample, 7.8 percent of the non-demented elderly (n = 59) were admitted to nursing home (NH) during the study period. The mean time to NHA in the dementia-free sample was 7.6 years. Characteristics associated with a shorter time to NHA were increased age, living alone, functional and cognitive impairment, major depression, stroke, myocardial infarction, a low number of specialist visits and paid home helper use. Conclusions Severe physical or psychiatric diseases and living alone have a significant effect on NHA for dementia-free individuals. The findings offer potentialities of secondary prevention to avoid or delay NHA for these elderly individuals. Further investigation of predictors of institutionalization is warranted to advance understanding of the process leading to NHA for this important group.
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Affiliation(s)
- Melanie Luppa
- Department of Psychiatry and Psychotherapy, Public Health Research Unit, University of Leipzig, (Semmelweisstrasse 10), Leipzig, (04103), Germany.
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Kendig H, Browning C, Pedlow R, Wells Y, Thomas S. Health, social and lifestyle factors in entry to residential aged care: an Australian longitudinal analysis. Age Ageing 2010; 39:342-9. [PMID: 20233734 DOI: 10.1093/ageing/afq016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND strategies to enable older people to remain in their own homes require information on potential intervention areas and target groups for health promotion and healthcare services. OBJECTIVE this study aimed to identify socioeconomic, health and lifestyle factors in entry to residential aged care facilities. DESIGN a prospective cohort study was conducted from 1994 to 2005. SETTING the information source was the Melbourne Longitudinal Studies on Healthy Ageing Program. SUBJECTS one thousand Australians aged 65 years and over living in the community were used as baseline sample. METHODS socio-medical data were gathered in face-to-face baseline interviews, and outcomes were identified in biennial follow-ups with respondents, informants and death registries over 12 years. Cox regression models identified baseline predictors of subsequent entry to residential aged care for men and women from among socio-demographic, health status and lifestyle factors. RESULTS the most significant factors were older age, Instrumental Activities of Daily Living (IADL) dependence, cognitive impairment, underweight body mass index (BMI) and low social activity. For men only, the number of medical conditions and healthy nutrition score also emerged as significant. For women only, never having been married, IADL dependence and low BMI also were significant. For men, the risk of entry to residential aged care facilities was associated mainly with disease burden, whereas for women, social vulnerability and functional capacities were more important. Healthy lifestyles were important indirectly insofar as they influenced subjects' health status. CONCLUSION to facilitate older people to stay in the community, it is important to treat or ameliorate medical conditions, promote healthy lifestyles and consider gender-specific risks.
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Affiliation(s)
- Hal Kendig
- Ageing, Work, and Health Research Unit, The University of Sydney, Sydney, New South Wales, Australia.
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Abstract
OBJECTIVE in the past decades, many studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of predictors of NHP in the general population of developed countries. DESIGN relevant articles were identified by searching the databases MEDLINE, Web of Science, Cochrane Library and PSYNDEXplus. Studies based on population-based samples with prospective study design and identification of predictors by multivariate analyses were included. Quality of studies and evidence of predictors were determined. RESULTS thirty-six studies were identified; one-third of the studies were of high quality. Predictors with strong evidence were increased age, low self-rated health status, functional and cognitive impairment, dementia, prior NHP and a high number of prescriptions. Predictors with inconsistent results were male gender, low education status, low income, stroke, hypertension, incontinence, depression and prior hospital use. CONCLUSIONS findings suggested that predictors of NHP are mainly based on underlying cognitive and/or functional impairment, and associated lack of support and assistance in daily living. However, the methodical quality of studies needs improvement. More theoretical embedding of risk models of NHP would help to establish more clarity in complex relationships in using nursing homes.
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Affiliation(s)
- Melanie Luppa
- Department of Psychiatry and Psychotherapy, University of Leipzig, Germany.
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Mora Fernández J, Silveira Guijarro LJ, Calcerrada Díaz-Santos N, Maganto Villamiel MA, Merino Cáceres C, Ribera Casado JM. [Analysis of placement in public nursing homes after hospital admission in the fragile elderly]. Rev Esp Geriatr Gerontol 2009; 44:186-93. [PMID: 19592141 DOI: 10.1016/j.regg.2009.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 02/23/2009] [Accepted: 03/03/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To analyze placement in public nursing homes in elderly inpatients referred by the social work unit. MATERIAL AND METHODS We performed a cohort study in an acute geriatric unit of a tertiary hospital. The sociodemographic, clinical, functional and socioeconomic data registered on admission (inclusion period: 4 years) were analyzed. The patients were followed-up for 6 months after discharge. The percentage gaining places in public nursing homes, the waiting time (monthly incidence rate) and the reasons for not gaining a place were evaluated. The variables associated with gaining a place were introduced into a multivariate logistic regression model. RESULTS A total of 415 elders were referred to public nursing homes. The mean age was 85.1 years (SD=6.7), and 61.9% were women. During the follow-up period, 72 elders were granted a place (17.3%; monthly incidence rate 3.14%). In the multivariate analysis, the factors independently associated with gaining a place at a public nursing home were living alone (OR 2.788; p=0.005), having a lower income (OR 0.807; p=0.018), having a social work report from the hospital (OR 2.132; p=0.037), having previously requested a place at a public nursing home (OR 3.298; p=0.002) and discharge destination other than the home (OR 5.792; p<0.001). The main causes associated with not gaining a place were death while on the waiting list (41.4%) and not completing the paperwork (32.9%). CONCLUSIONS Hospitalization in the frail elderly frequently leads to requests for public nursing home admission, although few places are granted in the short term to patients in the acute unit. Certain socioeconomic factors and referral by social workers were positively associated with gaining a place. However, the waiting time leads to a substantial proportion of deaths and incomplete paperwork, largely due to the complexity of the process.
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Österlind J, Hansebo G, Lindqvist R, Ternestedt B. Moving on a roundabout at the end of life—What counts? Health Policy 2009; 91:183-8. [DOI: 10.1016/j.healthpol.2008.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Revised: 12/01/2008] [Accepted: 12/07/2008] [Indexed: 11/21/2022]
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Abstract
UNLABELLED The Katz Index of Independence in Activities of Daily Living can help nurses detect subtle changes in health and prevent functional decline. OVERVIEW Created 45 years ago, the Katz Index of Independence in Activities of Daily Living has shown itself to be an important tool in measuring an older adult's capacity to care for her- or himself. When a nurse using the tool notes a diminishment in the patient's ability to perform any of six activities-bathing, dressing, toileting, eating, transferring, or remaining continent-further assessment may uncover a reversible cause, such as a chronic or acute condition requiring treatment. A video demonstrating the use of the Katz index is available for free online at http://links.lww.com/A241.
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Ollonqvist K, Aaltonen T, Karppi SL, Hinkka K, Pöntinen S. Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial. Health Soc Care Community 2008; 16:115-125. [PMID: 18290977 DOI: 10.1111/j.1365-2524.2007.00733.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The AGE study is a national randomised, long-term, multicentre research project aimed at comparing a new network-based rehabilitation programme with the use of standard health and social services. The use of home help services is associated with increasing age, living alone and having difficulties with activities of daily living. During a rehabilitation intervention the elderly participants' need for care can be assessed. The focus of this paper is to investigate the possible effects of the network-based rehabilitation programme on the use of informal and formal support among home-dwelling elderly at a high risk of long-term institutionalisation. The randomised controlled trial with a 12-month follow-up was implemented in 7 rehabilitation centres and 41 municipalities in Finland. The participants were recruited between January and October 2002. A total of 708 home-dwelling persons aged 65 years or older with progressively decreasing functional capacity and at the risk of being institutionalised within 2 years participated. Persons with acute or progressive diseases or poor cognitive capacity (Mini Mental State Examination<18 points), and those who had participated in any inpatient rehabilitation during the preceding 5 years, were excluded. Participants were randomly allocated to the intervention group (n=343) or to the control group (n=365). The intervention consisted of a network-based rehabilitation programme specifically designed for frail elderly people. Main outcome measures included the help received from relatives and municipal or private services. The use of municipal services increased more in the intervention group (P<0.05) than in the control group. Support from relatives decreased in the control group. The rehabilitees' ability to manage with daily activities decreased and they received additional help; hence, in this respect the rehabilitation model seems successful. A longer follow-up within the still ongoing AGE study is needed to verify whether the programme actually can delay long-term care.
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McCallum J, Simons LA, Simons J, Friedlander Y. Delaying dementia and nursing home placement: the Dubbo study of elderly Australians over a 14-year follow-up. Ann N Y Acad Sci 2008; 1114:121-9. [PMID: 17986578 DOI: 10.1196/annals.1396.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In order to capture the "longevity dividend," modifiable risk factors for a diagnosis of dementia and nursing home placement were examined in a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. One thousand two-hundred thirty-three men and 1572 women 60 years and older living in the community were examined in 1988 and followed to 2002 for diagnosis of dementia and nursing home placement. There were 244 (8.7%) nursing home placements and 44% of these placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. The Cox proportional hazards model for nursing home placement, showed placement increased significantly with age, urinary incontinence, impaired peak expiratory flow, physical disability, and depression. The hazard of placement was significantly reduced by alcohol intake and female gender. Socioeconomic factors were not significant. Similar risk factors for dementia and nursing home placement indicate that the continuation of moderate alcohol intake, the maintenance of physical activity, especially daily gardening, and improvement of respiratory function, and the treatment of depression are recommended targets for interventions to delay or prevent major negative late-life experiences.
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Affiliation(s)
- John McCallum
- Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia.
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Giles LC, Glonek GFV, Luszcz MA, Andrews GR. Do social networks affect the use of residential aged care among older Australians? BMC Geriatr 2007; 7:24. [PMID: 17916238 PMCID: PMC2174923 DOI: 10.1186/1471-2318-7-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 10/04/2007] [Indexed: 11/23/2022] Open
Abstract
Background Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants) and total social networks upon use of low-level residential care and nursing homes. Methods Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks. Results Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75). Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90). Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use. Discussion Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.
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Affiliation(s)
- Lynne C Giles
- Department of Rehabilitation and Aged Care, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
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Chen CK, Sabir M, Zimmerman S, Suitor J, Pillemer K. The Importance of Family Relationships With Nursing Facility Staff for Family Caregiver Burden and Depression. J Gerontol B Psychol Sci Soc Sci 2007; 62:P253-60. [PMID: 17906166 DOI: 10.1093/geronb/62.5.p253] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience.
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Affiliation(s)
- Cory K Chen
- Carolina Program in Healthcare and Aging Research, University of North Carolina--Chapel Hill, Chapel Hill, NC 27514, USA.
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Simons LA, Simons J, McCallum J, Friedlander Y. Lifestyle factors and risk of dementia: Dubbo Study of the elderly. Med J Aust 2006; 184:68-70. [PMID: 16411871 DOI: 10.5694/j.1326-5377.2006.tb00120.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 11/24/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify risk factors for dementia in an elderly Australian cohort. DESIGN AND SETTING A longitudinal cohort study conducted in Dubbo, NSW. PARTICIPANTS 2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years. MAIN OUTCOME MEASURE Admission to hospital or nursing home with any kind of dementia. RESULTS There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. CONCLUSION While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.
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Affiliation(s)
- Leon A Simons
- Lipid Research Department, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia.
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Simons LA, Simons J. Impact of smoking, diabetes and hypertension on survival in the elderly: the Dubbo Study. Med J Aust 2005. [DOI: 10.5694/j.1326-5377.2005.tb06799.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Judith Simons
- Lipid Department, St Vincent's Hospital, Darlinghurst, NSW 2010
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