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Improving older adults' functional ability through service use in a home care program in Hong Kong
- Authors:
- CHEUNG Chau-kui, NGAN Raymond Man-Hung
- Journal article citation:
- Research on Social Work Practice, 15(3), May 2005, pp.154-164.
- Publisher:
- Sage
Despite past findings about the contribution of home care services to older users’ functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care programme. The study gathered 116 observations during 2 years concerning 49 home care service users in Hong Kong. The study shows that an older user maintained better functional ability with a longer time of using a home care program in Hong Kong using the service. The time effect, in turn, was primarily due to the increased use of seven services provided by the programme. Among the service components, the home-nursing services generated a unique contribution to the user's functional ability, with its prior score controlled. Multidisciplinary services under case management underpin an effective home care programme.
Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: the Azuchi study
- Author:
- DODGE Hiroko H.
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.222-230.
- Publisher:
- Oxford University Press
In a 3-year follow-up of community-dwelling elderly persons in Azuchi, Japan, this study assessed cognition by using the Hasegawa Dementia Scale. The study examined (a) the cross-sectional association between cognitive impairment and functional disability in each ADL–IADL item; (b) cognitive impairment as a risk factor for incident disability in each ADL–IADL item, through logistic regression models; and (c) probabilities of incident loss of ADL–IADL abilities or death in 3 years, using multinomial logistic regression models. The population attributable risk of cognitive impairment on incident loss of task-specific ADL–IADL abilities was also calculated. Cross-sectionally, the severity of cognitive impairment was associated with disability in each ADL–IADL task, with larger effects shown for ADL items. Longitudinally, minimally or mildly cognitively impaired individuals had a significantly higher risk of losing functional abilities compared with those with intact cognition. The study concludes that cognitively impaired subjects are heterogeneous; the severity of cognitive impairment has a different impact on incident loss of task-specific ADL–IADL abilities, and comorbidities could affect disabilities differently.
Dementia care: a practical photographic guide
- Authors:
- GREALY James, MCMULLEN Helen, GREALY Julia
- Publisher:
- Blackwell
- Publication year:
- 2005
- Pagination:
- 188p.
- Place of publication:
- Oxford
Illustrated guide to caring for people with dementia in care homes. It presents practical prevention and management techniques for resistance to care in common activities of daily living, explores cognitive loss, physical loss and sensory loss in dementia, and examines means of improving communication with those with dementia to enhance their understanding of their environment and improve their compliance in care.
Depressive symptoms, chronic medical conditions and functional status: a comparison of urban and rural elders in Taiwan
- Authors:
- CHIU Herng-Chia, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(7), July 2005, pp.635-644.
- Publisher:
- Wiley
This study hypothesized that strong relations between chronic medical conditions, functional status, and the manifestation of depression would be evident; the interrelationships of the interested measures would differ in urban and rural populations. The study sample was recruited in a community survey in 2001 that included urban and rural elderly dwelling in southern Taiwan. The Chinese-version Geriatric Depression Scale (GDS) was used for data collection on depressive symptoms. Univariate and multivariate logistic regression analyses were performed to identify the predictors for depressive symptoms in urban and rural samples. There were 20.1% of urban elders and 12.8% of rural samples classified with depressive symptoms. While controlling for socio-demographics, the prevalence of chronic disease and ADL summary scores were consistently associated with depressive symptoms for urban and rural samples. Cardiovascular disease and hip fracture were significantly predictive of depression for the urban sample, whereas the influence of stroke history was found to be predictive of depression in the rural sample. By individual PADL/IADL items, toileting problems and shopping difficulties were significant predictors of depression for both elderly samples. The present findings confirm urban-rural differences in the reporting of associations between depressive symptoms, chronic medical conditions, and functional disability. For developing prevention programs on geriatric depression, it is critical to call more attention to chronic medical conditions, functional status, and social support of urban and rural elderly.
Needs assessment in dementia
- Authors:
- MEANEY A. M., CROKE M., KIRBY M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(4), April 2005, pp.322-329.
- Publisher:
- Wiley
Resource allocation and service development traditionally focuses on diagnostic categories and consequent perceived need. Identification of the actual level of need in the elderly with dementia, and the degree to which it is unmet is necessary to plan services both individually and as a group. The aim of this study was to characterise the needs of a sample of community dwelling elderly patients with dementia who were referred to an old age psychiatry service in Ireland between July 2002 and July 2003. Eighty-two consecutively referred community dwelling patients with ICD-10 diagnosis of dementia were assessed on The Care Needs Assessment Pack for Dementia (CareNap-D). Data on needs across seven domains (health and mobility, self-care and toileting, social interaction, thinking and memory, behaviour and mental state, housecare, community living) is presented. Subjects had a mean of 33 (range: 13-56) identified needs. Approximately 1/3 of these were unmet with a mean of 13 (range: 0-37) and a mean of 20 (range: 4-39) were met. High levels of unmet need was identified in the domains of behaviour and mental state (84% of those with agitation) and of social interaction (79% of those with partaking in activities need). The specific item of repetitive questioning occurred in 68 individuals and was unmet in 88% of these cases. Increasing age, lower MMSE score, and living alone were associated with greater total levels of unmet need. This data underlines the degree of unmet need in the community dwelling elderly with dementia and the importance of developing a spectrum of services on the basis of the actual needs identified.
Everyday competence and depressive symptoms: social support and sense of control as mediators or moderators?
- Author:
- CHOU K.-L.
- Journal article citation:
- Aging and Mental Health, 9(2), March 2005, pp.177-183.
- Publisher:
- Taylor and Francis
Depression is common among the elderly members of Hong Kong Chinese society. The objectives of the present study are to assess the relationship between everyday competence and depressive symptoms and to test whether sense of control and social support mediate and moderate the impact of deterioration in everyday competence on depressive symptoms. The respondents were 393 people aged 60 years and older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong and they were interviewed using a structured questionnaire. In multiple regression analyses, we found that everyday competence was significantly and negatively related to depressive symptoms (ß?=?-0.26, p?<?0.01) after we had adjusted age, gender, marital status, years of education, self-rated health status, and number of chronic illnesses. Moreover, both sense of control and social support were mediators in the linkage between everyday competence and depression. However, neither sense of control nor social support moderated the effect of everyday competence on depression. Findings suggest that both sense of control and social support play important roles in the relationship between everyday competence and depression.
Effect of a consumer-directed voucher and a disease-management-health-promotion nurse intervention on home care use
- Authors:
- MENG Hongdao, et al
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.167-176.
- Publisher:
- Oxford University Press
This American article describes the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management–health-promotion nurse intervention, on the probability of use of two types of home care: skilled home health care and personal assistance services. The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial in 19 counties in New York, West Virginia, and Ohio with four groups: disease-management–health-promotion nurse, consumer-directed voucher, combination (nurse plus voucher), and control. Results found that whereas the nurse intervention alone had no effect on the probability of using either type of home care, the voucher alone increased the probability of personal assistance services use by 13 percent but not that of skilled home health care use. The combination of the two interventions increased the probability of personal assistance services use by 18 percent. The authors conclude the implementation of disease-management–health-promotion nurse interventions should not lead to a greater probability of skilled home health care or personal assistance services use, whereas the provision of consumer-directed vouchers should result in an increased probability of personal assistance services use, as intended.
Let's stir up the outdated activity culture in care homes
- Author:
- PERRIN Tessa
- Journal article citation:
- Journal of Dementia Care, 13(4), July 2005, pp.26-27.
- Publisher:
- Hawker
Activity provision in care settings for older people has been under debate for at least 30 years. This article argues that by engaging a person in enjoyable activity this can transform their well being for the better. However, in order for this to occur, managers and staff need to see for themselves the benefits and consequently re-evaluate their current attitudes and beliefs.
A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff
- Authors:
- TRAIN G. H., et al
- Journal article citation:
- Aging and Mental Health, 9(2), March 2005, pp.119-128.
- Publisher:
- Taylor and Francis
Most older people living in 24-hour care settings have dementia. The authors employed qualitative interviews to explore positive and negative aspects of the experience of family carers, staff and people with dementia living in 10 homes in London and West Essex, selected to cover the full range of 24-hour long-term care settings. The interview used open semi-structured questions. We interviewed 21 residents, 17 relatives and 30 staff and five main themes were identified: Privacy and choice; relationships (abuse and vulnerability); activities; physical environment; and expectations of a care environment by carers, should they one day live in long-term care themselves. Despite being no longer responsible for the day-to-day care of the residents there was a continuing level of psychological distress among some relatives. We found that residents with a range of severity of dementia were able to participate. The most striking theme from their interviews was the need for choice. All groups talked about improving lines of communication amongst residents, relatives and staff and about the importance of activities. We recommend that homes should set up formal structures for engaging with user and carer views at all levels. This would mean relatives on the board, and regular meetings for residents, relatives, advocates and staff. This should lead to cultural changes where residents are perceived as individuals and care is provided in a more flexible way. There should be a programme of activities in each 24-hour care setting, which all care staff are given time to implement. These activities need to be tailored to the individual resident rather than the whole group.