[Nursing diagnosis. Response to Th. Herpers].
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Nursing Diagnosis↗
Biomedical subjects
C M Frederiks
Publications and source records attributed to C M Frederiks.
Why do elderly people seek professional home care? Methodologies compared.
In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed. To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n = 2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems. From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.
Aged↗
[The course of nursing home admission. A follow-up study in chronic and rehabilitation patients].
This article describes the course of the nursing home stays of 157 newly admitted patients (55 years and older) using the Behaviour Rating Scale for Elderly Patients ('Beoordelingsschaal Oudere Patiënten'). The follow-up period lasted maximally one year. Differences in the course in relation to the objective of the admission (rehabilitation versus continuous support) and possible factors which impeded or advanced the discharge of the rehabilitation patients, were investigated. For that purpose, information on diagnoses, prognosis, treatment goals and their achievement, and disability according to SIVIS (SIG Nursing Home Information System) was also obtained from the physicians in charge at the nursing home. The course of the nursing home stay appeared to differ for chronic and rehabilitation patients. In addition to physical disability and depressive behavior, the chronic patients, from the time of admission onwards, had more behavioural problems than the rehabilitation patients. Moreover, their dependency, physical and mental disability and inactivity increased in different degree during the stay. For two thirds of the rehabilitation patients, the stay did not end in discharge from the nursing home. For this group, the dependency, depressive behaviour, and to a lesser extent, aggressiveness increased during the stay. The outcome of rehabilitation appeared to be related to the extent of behavioural problems, to the level of disability, and to the medical condition on admission. The least disabled and the 'medically least complex' patients could usually be discharged with an improved level of functioning, which seemed to justify the nursing home stay. The absence of other services impeded discharge in a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
A scale for the functional status of the elderly living at home.
Many scales have been developed to describe the functional status of geriatric patients. These scales are of limited use for describing the functional status of elderly people living at home, because of their poor capacity for differentiation. This article reports the results of a postal questionnaire among elderly people living at home. The findings will be analysed to see whether the inventory on performance of household and daily living activities describes the functional status of elderly people in a useful manner. A combined scale was constructed, which has satisfactory Guttman coefficients when applied to elderly people living at home. In addition, the scale is informative for those providing home care with regard to the elderly person's quantitative and qualitative needs for assistance. As such, it could be an instrument to be applied in community nursing. The applicability of the scale to institutionalized elderly people remains to be investigated.
Activities of Daily Living↗
[Nursing home admission; a study among elderly applicants].
This article describes the care needs, social network, housing conditions, utilization of care and diagnoses of 157 elderly applicants to nursing homes in Maastricht. The study was conducted during the period of February 1987 to July 1988. Possible differences in these characteristics in relation to the goal of the admission (rehabilitation versus continuous support) and in relation to prior living arrangements (home versus hospital) were investigated. In addition, the question to what extent substitution of care is possible is discussed. Within the group of nursing home applicants, a fairly clear distinction could be made between a number of subgroups, although care needs, social network (with the exception of the number of visits paid), and demographic characteristics showed no differences in relation to admission goals and prior living arrangements. The distinction was based particularly on the nature of the disorders (psychogeriatric versus somatic and chronic versus more or less acute), which was reflected not only in the main diagnosis itself, but also in differences in housing conditions, numbers of visits paid to others, and utilization of care prior to admission. Under the proposed policies for substitution, about a quarter of the applicants would be eligible for substitution. However, the major care needs, and the levels of formal and informal care prior to admission, as well as the shortage of alternative services, would seem to indicate that the actual possibilities for substitution are more limited.
Activities of Daily Living↗
The functional status and utilization of care of elderly people living at home.
A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international. The more limitations, the higher the proportion of professional care utilization. The factors "use of informal care" and "not living alone" were inversely related to the utilization of professional care. The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful. The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.
Activities of Daily Living↗
[Health care needs and wish to be admitted of subjects with positive indications; a comparison with residents of homes for the aged].
The care needs, utilization of care and the wish to be admitted on a short or long term basis of 135 applicants to homes for the aged are presented and their interrelations considered. The care needs of the applicants to and 207 residents of homes for the aged are compared. With an increasing number of housekeeping disabilities, depressive complaints, memory disorders and, as expected, the use of formal and informal care increased. The care needs of the applicants were at least as large as those of the residents. They had (nearly) as much housekeeping and ADL disabilities and even more feelings of loneliness and depressive complaints. Yet, for those applicants with few housekeeping disabilities the necessity of admission to a home for the aged can be questioned. That is, the wish to be admitted on short term was strongly associated with depressive complaints and feelings of loneliness. Provided that these mental problems can be handled effectively, (more) home care may be an alternative for them.
Activities of Daily Living↗
[Are preventive home visits to the elderly by district nurses sensible? The debate in The Netherlands and research abroad].
There has been a tradition of preventive home visiting to the elderly by Public Health Nurses for quite a time. There is no agreement as to the effect of these visits; until now no study has been performed on this topic in the Netherlands. Studies from other countries suggest a positive effect: viz. a reduction in mortality and hospital admissions. Recommendations for a replication study in the Netherlands are made.
Aged↗
[The decision tree].
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Clinical Protocols↗
[Preventive medical examination in the aged; pros and cons].
Preventive medical examination in aged people has some disadvantages when executed as a form of screening of the general population. There are almost no diseases to be found in aged persons, which meet the criteria for screening. It is likely that more needless disturbance is caused than actual case-finding achieved. Non-response in aged people will be high. And at last multiple pathology in aged people brings about that the total health-state is more important than the occurrence of specific diseases. These disadvantages can be partly solved by way of pre-selection of high risk aged persons. This increases the predictive value of the diagnostic tests; partly precluding non-response by means of having the first preventive examination at home; and determining the state of health in first instance by asking questions about ADL, house-keeping abilities, state of mental health, nutrition, a.o. The possibility of the community nurse paying home visits in stead of preventive medical examination will be discussed.
Activities of Daily Living↗
[Depressive symptoms and the utilization of professional care by the elderly living at home].
In Geleen, a survey was held among the total population aged 75-84 years on activities of daily living, housekeeping performance and use of professional and lay care. Out of 860 respondents to this postal questionnaire 334 were selected for a semistructured interview. Two groups with the same physical limitations, one using professional care and the other not, were compared on several characteristics. These characteristics were: 1. mental state (depression, dementia); 2. social network; 3. social-economical situation; 4. housing conditions. By means of multivariate analysis, associations between these characteristics and utilisation of professional care were identified. A major finding of the study was a twice as high prevalence of depression among users of professional care compared to non users. If depression is a causative factor in the demand for professional care, early detection and prevention of depression might be important in reducing professional care demand. Recognising depression in applicants for professional care may assist in adjusting the content of care.
Activities of Daily Living↗