Search results for ‘Subject term:"activities of daily living"’ Sort:
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To what degree does provider performance affect a quality indicator? The case of nursing homes and ADL change
- Authors:
- PHILLIPS Charles D., CHEN Min, SHERMAN Michael
- Journal article citation:
- Gerontologist, 48(3), June 2008, pp.330-337.
- Publisher:
- Oxford University Press
This research investigates what factors affect the degree to which nursing home performance explains variance in residents' change in status of activities of daily living (ADL) after admission. The database included all residents admitted in 2002 to a 10% random sample of nursing homes in the United States. Longitudinal analyses of outcomes at 3 months after admission test the ability of individual characteristics and nursing home identifiers to explain variance in ADL change for different groups of residents. The best and worst providers (top 20% vs bottom 20%, then 10%, then 5%) were compared. Analyses was restricted to more homogeneous groups of residents. It was found that more of the variance in ADL change was attributable to provider performance. Cognitive function and race also affected the degree to which home performance had an impact on outcomes. The results imply that some quality indicators may be most useful in distinguishing between nursing homes that provide the best or the worst care. Furthermore, the degree to which a quality indicator is driven by a nursing home's performance may vary considerably, depending on the characteristics of the consumer. These findings raise questions about the usefulness of performance measures that focus on heterogeneous groups of consumers or entire provider populations.
Caregiver confidence: does it predict changes in disability among elderly home care recipients?
- Authors:
- LI Lydia W., MCLAUGHLIN Sara J.
- Journal article citation:
- Gerontologist, 52(1), February 2012, pp.79-88.
- Publisher:
- Oxford University Press
Caregivers who are confident in their care recipients’ functional capacity may be less likely to offer assistance and more likely to encourage the recipient to perform tasks independently. The aim of this study was to determine whether caregiver confidence in their care recipients’ functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients over time. The sample included 5,138 elderly recipients of home and community-based long-term care in Michigan. ADL performance was assessed multiple times over a 2-year period. Caregiver confidence was measured at baseline with a single item. Multilevel modelling was used to estimate the effect of caregiver confidence on changes in ADL performance over time, controlling for baseline self-efficacy and ADL performance. The findings showed that elders whose caregivers were confident in their capacity for greater functional independence experienced greater improvement in ADL performance than those whose caregivers were not confident. Elders in dyads in which both members expressed confidence experienced more improvement in ADL performance than those in dyads in which either 1 or both members lacked confidence.
Physical performance characteristics of assisted living residents and risk for adverse health outcomes
- Authors:
- GIULIANI Carol A., et al
- Journal article citation:
- Gerontologist, 48(2), April 2008, pp.203-212.
- Publisher:
- Oxford University Press
This article aims to (a) describe the functional characteristics of residential care/assisted living (RC/AL) residents, (b) examine the relationships between resident- and facility-level characteristics and physical performance, and (c) determine the predictive value of physical performance for adverse outcomes. Data came from 1,791 residents in 189 RC/AL facilities participating in the Collaborative Studies of Long-Term Care in the US. At baseline, residents were tested on four performance measures (grip strength, chair rise, balance, and walking speed), and other resident- and facility-level information was collected. Adverse outcomes were measured over 1 year. Multivariable analyses showed that more cognitive and functional impairment, depressive symptoms and comorbid conditions, and for-profit ownership were associated with poorer physical performance. Controlling for individual characteristics, it was found that better performance on the four physical performance measures was associated with a reduced risk of nursing home placement, fracture, and decline in function over 1 year. Simple performance measures identify modifiable functional deficits and suggest targeted interventions to prolong independent mobility and aging in place in RC/AL facilities.
Economic cost of dementia patients according to the limitation of the activities of daily living in Korea
- Authors:
- KANG Im Ok, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(7), July 2007, pp.675-681.
- Publisher:
- Wiley
Dementia is expected to become a significant social burden in the future. However, there are few reports that have estimated the total economic cost of dementia, particularly according to the limitation in the activities of daily living (ADL) in Korea. This study is to analyze the health care expenditures and cost per dementia patient, and estimated the total economic cost of dementia. Caregivers of 609 dementia patients, who were randomly selected from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed using structured questionnaire in the period of September 2005. The total cost including the direct and indirect costs during a year was calculated. The patients were stratified into three limitation groups according to their ADL score. The cost according to the three limitation groups was analyzed. The national cost of dementia patients was then estimated. The total cost per dementia patient in Korea was $7,462. The direct and indirect costs were $6,626 and $836 per patient, respectively. The cost increased with increasing degree of limitation in the patient's ADL. Over a 1-year period, the total cost per patient in the low limitation group was lower ($3,698) than that of the moderate ($6,064) and high ($11,428) limitation group. This study demonstrates that the direct and indirect costs of dementia are considerately small for patients with lower limitation in their ADL. The total economic cost of dementia per year was estimated to be in the range of 1.3 to 3.3 billion dollars on assumptions in Korea.
Bathing people with dementia: the bathroom and beyond
- Author:
- JENKINS Deirdre A.L.
- Publisher:
- University of Stirling. Dementia Services Development Centre
- Publication year:
- 1998
- Pagination:
- 40p.
- Place of publication:
- Stirling
This publication, written for front line staff in long term care settings, provides a insight about the issues which arise in helping people with dementia bathe. Easy to read, with humour, it can help caregivers to make bathing a positive experience for patients with dementia.
The association between quality of life and nursing home facility for the elderly population: a systematic review and meta-analysis
- Authors:
- LI Yang-Tzu, et al
- Journal article citation:
- International Journal of Gerontology, 15(1), 2021, pp.16-24.
- Publisher:
- Airiti Library
- Place of publication:
- Taiwan
Background: To investigate the association between quality of life and nursing home facility for the elderly population. Methods: The researchers searched the PubMed, Medline, and Cochrane Library for relevant perspective studies without language limitations from inception to 17^(th) June 2020 for relevant publications with a priori defined inclusion and exclusion criteria. Two authors independently selected studies, assessed risk of bias, and extracted data. The disagreement was resolved by discussion with a third author. Results: There are 18 articles involved in the final meta-analysis. The disparities were found of accessing the quality of life (World Health Organization Quality-of-Life, Quality of Life in Last-Stage Dementia, Nottingham Health Profile-Turkish Version, EUROPE Health Interview Survey-QoL , Visual analogue Scales, Flanagan Quality of Life Scale) and the level of independence (Barthel Index, Kahoku Aging Longitudinal Study Scale, Visual Analogue Scales, Activities of Daily Living Scales, Instrumental Activities of Daily Living Scales). Conclusion: The available limited, very low-quality evidence does not support a significant association between quality of life and nursing home facility for the elderly population. Further rigorous and long-term follow-up studies should be conducted with more objective measures. (Edited publisher abstract)
Activity involvement and quality of life of people at different stages of dementia in long term care facilities
- Authors:
- SMIT Dieneke, et al
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.100-109.
- Publisher:
- Taylor and Francis
Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. Results: Despite resident's cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement. (Publisher abstract)
Changing the philosophy of care in long-term care: testing of the restorative care intervention
- Authors:
- RESNICK Barbara, et al
- Journal article citation:
- Gerontologist, 49(2), April 2009, pp.175-184.
- Publisher:
- Oxford University Press
This American study aimed to test the effectiveness of a 12-month restorative care (Res-Care) intervention on the beliefs related to Res-Care, knowledge of Res-Care, observed performance of Res-Care with residents, and job satisfaction among nursing assistants (NAs) in nursing home (NH) settings. A randomized controlled trial was used including 12 sites and using a repeated measure design with follow-up testing done at 4 and 12 months. An intention-to-treat principle was followed in all analyses, and generalized estimating equations were used to perform repeated measures. A total of 556 NAs consented to participate and completed baseline assessments (265 in treatment and 258 in control sites), 427 completed 4-month follow-up (218 in treatment and 195 in control sites), and 357 completed 12-month follow-up (168 in treatment and 158 in control sites). There was a statistically significant increase in the treatment group participants’ outcome expectations related to Res-Care activities and performance of Res-Care at 4 months, and an increase in knowledge of Res-Care and job satisfaction at 12 months. There was no difference between the groups with regard to self-efficacy expectations. Implication: This study provides an important step in understanding the implementation of a Res-Care philosophy in NH settings and the benefit this can have for NAs.
Rehabilitation for older people in long-term care (review)
- Authors:
- FORSTER A., et al
- Publisher:
- John Wiley and Sons
- Publication year:
- 2009
- Pagination:
- 110p., bibliog.
- Place of publication:
- Chichester
Physical rehabilitation (interventions based on the exercising the body) may have a role in improving the physical condition of older people in long-term care and this review examines the evidence available. Forty-nine trials are included in this review, 30 of which were conducted in the USA. In total, 3611 participants with an average age of 82 years were involved, more than two-thirds of whom were female. Most interventions in some way addressed disability in routine daily life, for example walking, eating and dressing. The trial outcomes addressed by this review are disability in daily life, strength, flexibility, balance, general physical condition, mood, cognitive status, participant drop out, session attendance, death, illness, and unwanted effects associated with the intervention, such as injuries. Due to the wide variety of outcome measures used, the studies could not be summarised statistically, therefore a narrative review is provided. While variations between the trials means specific recommendations cannot be made, they were overwhelmingly successful, demonstrating that many different types of physical rehabilitation have benefits to physical health with few reports of unwanted events relating to the intervention.
Enriching opportunities for people living with dementia: the development of a blueprint for a sustainable activity-based model
- Authors:
- BROOKER Dawn J., WOOLEY Rosemary J.
- Journal article citation:
- Aging and Mental Health, 11(4), July 2007, pp.371-383.
- Publisher:
- Taylor and Francis
The aim of this paper is to describe the process of building a multi-level intervention called the Enriched Opportunities Programme, the objective of which is to provide a sustainable activity-based model for people with dementia living in long-term care. It is hypothesised that five key elements need to work together to bring about a sustainable activity-based model of care. These elements are specialist expertise-the staff role of Locksmith was developed as part of this programme; individualised assessment and case work; an activity and occupation programme; staff training; and management and leadership. These elements working together are known as the Enriched Opportunities Programme. This paper reports on the processes undertaken to develop Enriched Opportunities from its inception to the present, and focuses on lessons learnt from the literature, an expert working group and action research in four UK study sites. A blueprint for evaluation in other long-term care facilities is described.