Factors that contribute to remaining in the community among older adults

OBJECTIVES

Using national data on Medicare beneficiaries and their caregivers (CGs), we investigated CG and care recipient (CR) factors associated with the likelihood of remaining in the community.

METHODS

We obtained data on 722 CG and CR dyads who lived in the community in 2011 from the National Study of Caregiving and the National Health Aging and Trend Study. We then used pooled data from 2011 to 2015 to track the CRs' likelihood of remaining in the community. Generalized Estimating Equation (GEE) analyses were used to assess the association between CG and CR factors and likelihood of community residence over five years.

RESULTS

The GEE analyses showed that the strongest CR factors predicting continued community residence include lower CR age, higher CR ADL capabilities, not having dementia, and having a heightened sense of community. CG factors predicting continued community residence included reporting no physical difficulties from caregiving, and higher positive aspects of caregiving.

CONCLUSION

In addition to widely found predictors of remaining in the community (e.g., CR age and dementia), psychosocial variables (CG positive aspects of caregiving, CR sense of community engagement) were also significant independent predictors. Interventions that emphasize not only traditional risk factors for placement, but also psychosocial factors such as promoting CG positive aspects of caregiving and strengthening CRs' linkages with their neighbors or community members deserves greater attention.

Observed dietary intake in adults with intellectual disability living in the community

Background

Knowledge is lacking about dietary habits among people with intellectual disability (ID) living in community residences under new living conditions.

Objective

To describe the dietary habits of individuals with ID living in community residences, focusing on intake of food, energy and nutrients as well as meal patterns.

Design

Assisted food records and physical activity records over a 3-day observation period for 32 subjects.

Results

Great variation was observed in daily energy intake (4.9–14 MJ) dispersed across several meals, with on average 26% of the energy coming from in-between-meal consumption. Main energy sources were milk products, bread, meat products, buns and cakes. The daily intake of fruit and vegetables (320±221 g) as well as dietary fiber (21±9.6 g) was generally low. For four vitamins and two minerals, 19–34% of subjects showed an intake below average requirement (AR). The physical activity level (PAL) was low for all individuals (1.4±0.1).

Conclusion

A regular meal pattern with a relatively high proportion of energy from in-between-meal eating occasions and a low intake of especially fruits were typical of this group of people with ID. However, the total intake of energy and other food items varied a great deal between individuals. Thus, every adult with ID has to be treated as an individual with specific needs. A need for more knowledge about food in general and particularly how fruit and vegetables could be included in cooking as well as encouraged to be eaten as in-between-meals seems imperative in the new living conditions for adults with ID.

Placement challenges: implications for long-term care of dementia sufferers

Caregivers and long-term care staff seek appropriate placements for dementia sufferers, but there is little empirical research to guide such decision-making. However, recent national trends in mental health care have emphasized the placement of persons with serious mental illness in privatized, community-based residences. This body of empirical research has indicated that persons with psychosis, substance use disorder, assaultive behavior, and medication noncompliance have shorter tenure in these residential settings. These findings are also important for other, more traditional health care settings, as the patients discharged from community residences may require assistance on occasion from such other settings. This study continues the inquiry into the characteristics of patients with serious mental illness, who have shorter tenure in community residences. Dangerous behaviors, treatment-resistant psychosis, medical illnesses, and social-interpersonal skill deficiencies were common causes for discharge in this study. Since there remains a paucity of published empirical studies on the issue for patients with Alzheimer's disease and other dementias, we present the implications of, and guidelines for, addressing these issues in dementia sufferers in long-term care settings.