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Quality of private personal care for elderly people with a disability living at home : correlates and potential outcomes
No full textTo investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the 'poor or fair care' group (n = 16), the 'intermediate care' group (n = 39) and the 'optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean ± standard deviation (SD) were, respectively, 45 ± 23.2, 63.7 ± 19.7 and 68.8 ± 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean ± SD were, respectively, 34.9 ± 25.3, 26 ± 17.7 and 17.6 ± 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care
Quality of private personal care for elderly people in Italy living at home with disabilities : risk of nursing home placement at a 1-year follow-up
No full textThe aim of this prospective study was to evaluate the correlation between the self-perceived quality of private personal care for elderly people living at home and the 1-year risk of hospital admission, nursing home placement and death. We enrolled 100 community-dwelling elderly outpatients (mean age 85 years), who had been receiving private personal care for any kind of disability for at least 1 month. Quality of care was described by both the elderly person without overt cognitive impairment and their informal caregivers, and this was categorised for analysis as 'poor or fair' or 'optimal or intermediate'. Rates of hospital admission, long-term care placement and death were assessed at a 1-year follow-up, between May 2006 and January 2008. One year after enrolment, 67 elderly people were still living at home, 10 had been institutionalised and 23 had died. Forty-six had experienced at least one hospital admission. The elderly people belonging to the 'poor or fair care' group (n = 16) showed a higher risk of nursing home placement when compared to the people belonging to the 'optimal or intermediate care' group (n = 84) (relative risk = 5.25, 95% confidence interval 1.72-16.06), without there being any significant difference between the two groups in terms of baseline assessment and basic functional status at follow-up. The quality of personal care was not a predictor of either hospital admission or death. Therefore, a poor or fair quality of personal care turned out to be a 1-year predictor of placement in a long-term care facility for community-dwelling older adults with a disability
One-year predictors of turnover among personal-care workers for older adults living at home in Italy
No full textPrivately-employed personal-care workers for community-dwelling older adults are widespread in Italy. There have been estimated to be over 700,000 personal-care workers in Italy, with 93% being foreigners. The turnover of these workers is known to be high. This study aimed to identify the predictors of the turnover of personal-care workers. This prospective cohort study in Milan, Italy enrolled 121 older adults living at home along with their personal-care workers and 107 informal carers. The older participants underwent a comprehensive geriatric assessment. At 1 year follow-up, 12 of the older participants had been placed in a nursing home and 26 had died. Of the 83 still living at home, 22 (26.5%) had changed their personal-care staff. Analysis found that the only characteristic of personal-care staff significantly associated with turnover at 1 year follow-up was living far away from their families. Two characteristics of the elders, namely being widowed and having cognitive impairment, were found to be predictors of a low turnover of personal-care workers. These older adults were more likely to keep their personal-care workers at the one-year follow-up independently of the perceived quality of car
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Day care centre attendance and quality of life in depressed older adults living in the community
No full textLate-life depression is associated with disabled functioning and a poor quality of life (QOL). The aim of this cross-sectional study was to find out whether the attendance of a day care centre (DC) was associated with QOL in community-dwelling older adults suffering from a depressive disorder without dementia. The study enrolled 149 depressed older adults aged 70 or older, who consecutively underwent a comprehensive geriatric assessment from April to July 2008 at the Geriatric Medicine Unit of the Fondazione Ospedale Maggiore Policlinico in Milan, Italy. QOL was evaluated by means of the European Quality of Life Visual Analogue Scale (EuroQol VAS). DC attendance was quantified as number of days of attendance per week in the past month. Participants attending a DC at least once a week (n = 17) had a higher mean EuroQol VAS score than non-attendants (n = 132) (mean ± SD 58.8 ± 19 vs. 45.3 ± 22.5; P = 0.019). In multiple linear regression analysis a higher weekly attendance of DCs was related to a better quality of life according to the EuroQol VAS score (unstandardized coefficient 3.048, 95% CI 0.063–6.033, P = 0.045) after correction for age, sex, balance and gait abilities, comorbidity, pharmacotherapy, living alone, and severity of depression. Therefore, in older outpatients suffering from a depressive disorder without dementia the attendance of a DC was an independent correlate of the QOL. A randomized controlled longitudinal study will be necessary to determine whether attending a DC is really effective on the QOL in the management of late-life depressio
An easy intervention to improve short-term adherence to medications in community-dwelling older outpatients. A pilot non-randomised controlled trial
Full text linkBACKGROUND: Complex interventions to improve compliance to pharmacological treatment in older people have given mixed results and are not easily applicable in clinical practice. The aim of this study was to test the short-term efficacy on self-reported medication adherence of an easy intervention in which the patient or caregiver was asked to transcribe the pharmacological treatment while it was dictated to him/her by the doctor.
METHODS: Pilot non-randomised controlled trial involving 108 community-dwelling outpatients aged 65+ (54 in the intervention arm, 54 controls) referred to a geriatric service from May to July 2009 and prescribed by the geriatrician a change in therapy. The intervention was applied at the end of the visit to the person managing the medications, be it the elder or his/her caregiver. Outcome of the study was the occurrence of any adherence error, assessed at a one-month follow-up by means of a semi-structured interview.
RESULTS: The socio-demographic, functional and clinical characteristics of the two compared groups were similar at baseline. At a one-month follow-up 43 subjects (40%) had made at least one adherence error, whether unintentional or intentional. In the intervention group the prevalence of adherence errors was lower than in controls (20% vs 59%; adjusted odds ratio 0.16, 95% confidence interval 0.07 - 0.39; p < 0.001) after adjusting for the person managing the medications, the adherence errors at baseline and for the number of prescribed drugs.
CONCLUSIONS: In an older outpatient population the intervention considered was effective in reducing the prevalence of adherence errors in the month following the visit.
TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN1261100034796
Il dolore cronico nel paziente anziano
No full textObjective. To analyze the prevalence of persistent pain in the elderly and estimate its impact on patients' usual daily activities and depression symptoms. Methods. 227 patients at the Geriatric Unit, Ospedale Maggiore Policlinico di Milano, or their caregivers filled up a questionnaire about presence of pain and its impact on functional autonomy. Further information was gathered from the charts and, 3 months later, patients and caregivers underwent a follow-up evaluation by phone interview. Results. 75% of patients reported persistent pain, occurring daily in 70% of subjects. Average intensity was 6.5 (on a 0-10 range) and it affected patients' common daily activities and was associated with depressive symptoms. 52% of patients did not use analgesics, NSAIDs were the most common class of analgesics (16%). The lower prevalence of pain among patients with dementia is likely associated with undervaluation by caregivers. Pain and depression do not correlate, whilst a greater use of antidepressants (SSRI) was observed among patients without pain. Conclusions. Persistent pain in the elderly seems to be poorly diagnosed and treated despite its influence on patients' mood and daily activities. Common acceptance of pain and scepticism towards analgesics, especially for patients that already assume several drugs, may contribute to the under-treatment of persistent pain. Lack of communication might further complicate the assessment in patients with dementia. In depressed patients, antidepressant treatment seems to avoid the risk of developing pain
Fattori di rischio per caduta a terra sincopale in una popolazione anziana ambulatoriale
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