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Impairment and abuse of elderly by staff in long-term care in Michigan: evidence from structural equation modelling
- Authors:
- CONNER Tom, et al
- Journal article citation:
- Journal of Interpersonal Violence, 26(1), January 2011, pp.21-33.
- Publisher:
- Sage
A number of risk factors are known to be associated with elder abuse in long-term care. This study aimed to provide a model to place these risk factors in a causal structure that relates the factors to each other and to whether abuse occurs. Nine hypotheses focusing on cognitive impairment, physical impairment, behaviour problems, and age were generated regarding the susceptibility to abuse among the elderly in long-term care. In 2006, a random digit dial survey in Michigan was completed by 1,002 respondents who were knowledgeable relatives of, or adults responsible for, a person in long-term care. The survey measured the level of impairment of the person in long-term care, covering various health-related problems and the ability to do activities of daily living. The survey also asked about the incidence of staff abuse over the previous 12 months, including physical, caretaking, verbal, emotional, neglect, sexual and material abuse. The results were used in the construction of a structural equation model which corresponds to the 9 hypotheses and specifies the relationships between factors and from factors to susceptibility to abuse. In this model, susceptibility to abuse, physical impairment, and cognitive impairment are latent variables, and behaviour problems and age are directly measured. The article concludes by discussing the pattern of relationships between these risk factors for abuse.
Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people
- Author:
- FRIEDMAN Susan M.
- Journal article citation:
- Gerontologist, 45(2), April 2005, pp.157-166.
- Publisher:
- Oxford University Press
This study determined overall risk and predictors of long-term nursing home admission within the Program of All-Inclusive Care for the Elderly (PACE) in the USA. PACE records for 4,646 participants aged 55 years or older who were enrolled in 12 Medicare- and Medicaid-capitated PACE programs during the period from June 1, 1990, to June 30, 1998, were obtained. Participants were enrolled for at least 30 days and had baseline evaluations within 30 days of enrollment. Cox proportional hazard models predicting an outcome of nursing home admission of 30 days or longer were estimated. The cumulative risk of admission to nursing homes for 30 days or longer was 14.9 percent within 3 years. Individuals enrolled from a nursing home were at very high risk for future admission, when compared with those living alone. Among individuals enrolled in PACE from the community, age, instrumental activity of daily living dependence, and bowel incontinence were predictive of subsequent nursing home admission. Concludes that despite the fact that 100 percent of the PACE participants were nursing home certifiable, the risk of being admitted to a nursing home long term following enrollment from the community is low. The presence of some reversible risk factors may have implications for early intervention to reduce risk further, although the effect of these interventions is likely to be modest. Individuals who received long-term care in a nursing home prior to enrollment in PACE remain at high risk of readmission, despite the availability of comprehensive services.
Risk factors related to the admission of people with dementia into a long-term care institution in Spain: an explorative study
- Authors:
- RISCO Ester, et al
- Journal article citation:
- Ageing and Society, 38(1), 2018, pp.192-211.
- Publisher:
- Cambridge University Press
Risk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia. (Publisher abstract)
Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis
- Authors:
- HARRISON Jennifer Kirsty, et al
- Journal article citation:
- Age and Ageing, 46(4), 2017, pp.547-558.
- Publisher:
- Oxford University Press
Background: Moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods: The authors conducted a systematic review (PROSPERO: CRD42015023497) searching the databases MEDLINE; EMBASE and CINAHL Plus in September 2015. The review included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results: From 9,176 records, 23 studies (n = 354,985 participants) were included. Studies were heterogeneous, with the proportions discharged to a care home 3–77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age, female sex, dementia and functional dependency. Conclusions: Discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk. (Edited publisher abstract)
Understanding contextual factors in falls in long-term care facilities
- Authors:
- SIXSMITH Andrew, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 14(3), 2013, pp.160-166.
- Publisher:
- Emerald
Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual factors contributing to fall events. Design/methodology/approach – This paper presents the results of a qualitative observational analysis of video-captured data collected through a network of high-quality video systems in two LTC facilities. The research comprised workshops involving experienced researchers who reviewed six video sequences of fall events. The outcome of the workshops was a written narrative summarising the discussion and researchers’ interpretation of fall sequences. Findings – The analysis indicates that there are a broad range of environmental, behavioral and situational factors that contribute to falls in LTC. This suggests that a limited conceptualisation of a fall as an outcome of the person's impairment and environmental hazards fails to convey the complexity of potential contributory factors typical of most fall incidents. Research limitations/implications – Broadening our understanding of falls provides the potential to make recommendations for falls prevention practice across multiple levels, including the individual, social and organisational context. Originality/value – The paper evaluates the potential of video-based data in fall analysis and points to the development of a case study approach to analysing fall incidents to capture the complex nature of contributory factors beyond research that focuses solely on intrinsic and extrinsic risk factors. (Publisher abstract)
Suicidal ideation and its correlates among elderly in residential care homes
- Authors:
- MALFENT Daniela, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(8), August 2010, pp.843-849.
- Publisher:
- Wiley
Studies have shown that the highest suicide rates are found among the elderly, with suicidal ideation prevalent in long-term care facilities. Despite these facts most residents show no signs of suicidal ideation. However, there is a lack of information on which factors protect against suicidal thoughts among the elderly. This study aimed to assess the prevalence and correlates of suicidal ideation with risk and protective factors among older residential care home residents in Vienna. Participants included 129 residents, aged 60 and older, from 15 Viennese residential care homes, who completed a self-report questionnaire containing socio-demographic factors, physical health, mental health, and protective factors like self-efficacy, and internal locus of control as well as satisfaction with life. They were also asked about active and passive suicidal thoughts. Results indicated active suicidal ideation during the last month in 7% of the elderly, 11% reported active suicidal ideation during the past year. Depressive symptoms and current psychotherapeutic treatment were important predictors. In conclusion, the authors suggest that research and prevention strategies could not only target risk, but also include protective factors.
Individualized Cognition-Action intervention to prevent behavioral disturbances and functional decline in institutionalized older adults: a randomized pilot trial
- Authors:
- DECHAMPS Arnaud, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(8), August 2010, pp.850-860.
- Publisher:
- Wiley
This study evaluated the effectiveness of an individualised Cognition-Action (CA) intervention to reduce behavioural disturbances in severely deconditioned institutionalised old adults. A 12 weeks randomised control trial included 24 participants receiving the individualised Cognition-Action programme, compared to 24 receiving routine medical care. The CA intervention was a non-preconceived ideas approach to the patient's abilities and discourse. Patients received 5 to 15 minute sessions, accumulating 50 minutes of interaction per week. CA intervention used five standardised exercises as tools to enhance communication and social interactions. Measurements included the Neuropsychiatric inventory (NPI) total, the BERG balance scale, and the Geriatric Depression Scale (GDS). Results showed that the CA group had a clinically significant NPI total score reduction compared to the control group. CA group showed a risk reduction of NPI total score worsening. BERG total score was clinically improved in the CA group compared to the control. CA patients reduced their GDS score and improved their Quality of life and Strength. The authors concluded that the combination of tailored guidance and simple standardised exercises was an effective behavioural management approach for behavioural disturbances reduction and functional autonomy improvement in institutionalised older people.
Violent crime victimization increases the risk of nursing home placement in older adults
- Authors:
- LACHS Mark, et al
- Journal article citation:
- Gerontologist, 46(5), October 2006, pp.583-589.
- Publisher:
- Oxford University Press
The authors estimate the independent contribution of crime victimization to nursing home placement in a cohort of older adults who were community dwelling at baseline. The data come from an observational cohort study of 2,321 community-residing older adults who were members of the New Haven Established Populations for Epidemiological Studies in the Elderly cohort in 1985 in the United States. Participants had annual evaluations using standardized instruments. The major outcome, custodial nursing home placement, were defined as a stay of at least 30 days; mean length of nursing home stay was 413 days. Crime victimization was determined by matching police records in the same catchment area as the cohort for the period 1985–1995. Nursing home placement was determined through linkage to the Connecticut Long Term Care Registry. Growth curve modelling was used to estimate the risk of placement in victimized and nonvictimized participants, and multivariable models were used to adjust for other factors known to predict nursing home placement. There were 482 members of the cohort (21%) who experienced victimization over the 10-year follow-up; 747 (32%) experienced nursing home placement. Most victimization episodes were non-violent and noninjurious. However, violent victimization conferred an independent increased risk of nursing home placement that exceeded the increased risk associated with other variables traditionally thought to be predictive of placement (such as functional and cognitive impairment, and social network size). The authors conclude violent crime victimization increases the risk of nursing home placement. They call for future research to be directed at determining the mechanism of this increased risk and developing interventions directed at victimized older adults that might avert nursing home placement in this uniquely vulnerable population.
Helping older adults and their families develop and implement care plans
- Authors:
- PINQUART Martin, SORENSEN Silvia, PEAK Terry
- Journal article citation:
- Journal of Gerontological Social Work, 43(4), 2005, pp.3-23.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
As people age, they are at increased risk of needing assistance with household tasks and personal care. After summarizing research on older adults' preparation for future health care needs, the authors introduce a process model for promoting preparation processes. The focus is on how social workers may best help individuals cope with these risks, that is, how to overcome barriers that inhibit preparation, find an option that fits the older adult's needs, and help the older adult implement care plans. Finally, the authors provide a case example for the application of the suggested model. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
Financial abuse of older people
- Authors:
- WALSH K., BENNETT G.
- Journal article citation:
- Journal of Adult Protection, 2(1), February 2000, pp.21-29.
- Publisher:
- Emerald
Provides an introduction to issues relevant to financial abuse of vulnerable adults, including indicators and remedies. Also highlights areas needing further attention both within the professional systems such as banking.