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PubMed2006

The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan.

BACKGROUND: Agitated behaviours are identified by caregivers as the most challenging in dementia care. Alternative approaches reducing occurrence of agitated behaviours and the need for chemical or physical restraints become valuable for institutionalized elders with dementia. OBJECTIVE AND SETTING: This study was to evaluate the effects of group music with movement intervention on occurrence of agitated behaviours of institutionalized elders with dementia in Taiwan. METHODS: A randomized controlled trial was used. Thirty-six institutionalized elders with dementia completed the study, with 18 in the experimental group receiving group music with movement intervention twice a week for 4 weeks and 18 in the control group receiving usual care without intervention. Modified Cohen-Mansfield Agitation Inventory was used to assess agitated behaviours at baseline, weeks 2 and 4. RESULTS: Agitated behaviours were significantly reduced in the experimental group following 4 weeks of group music with movement intervention compared to that of the control group (p<0.001). CONCLUSIONS: Group music with movement intervention can be beneficial in managing agitated behaviours of those with dementia and should be incorporated into care routines in residential facilities.

Aged↗

PubMed2006

Seroprevalence of hepatitis E virus infection among institutionalized psychiatric patients in Taiwan.

BACKGROUND: Hepatitis E virus infection (HEV) remains unclear in institutionalized psychiatric patients. OBJECTIVES: To investigate the prevalence and risk factors of HEV infection in a psychiatric institution in Taiwan. STUDY DESIGN: A total of 754 patients with psychiatric disorders were enrolled in the study. Clinical features, review of patient charts, and interviews with families were recorded for analysis. Antibody to HEV was tested using a commercial enzyme-linked immunosorbent assays. RESULTS: The prevalence of HEV infection in institutionalized patients was as high as 14.5%. Males had higher prevalence than females. It was also found prevalence increased significantly by age group. When compared with patients 30 years old or less, those in the 31-40 year old age group had an odds ratio of 4.89 [95% confidence interval (CI), 1.15-20.82], 41-50 years old of 6.30 (95% CI, 1.48-26.83), and 50 years or older of 6.20 (95% CI, 1.44-26.74). In multivariate logistic regression analysis, age and male gender were the independent risk factors. CONCLUSIONS: Institutionalized psychiatric patients had higher prevalence of HEV infection. In addition, there was an age-related increase in exposure to HEV with males that had a higher HEV seropositivity.

Adult↗

PubMed2004

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study.

BACKGROUND: Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. METHODS: The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. RESULTS: Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH. CONCLUSIONS: Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.

Adolescent↗

PubMed2001

[Prevalence of hypovitaminosis D in elderly institutionalized residents: influence of a substitutive treatment].

BACKGROUND: Osteoporosis in the elderly is a common and severe disease, vitamin D deficiency being an important causative factor. Hypovitaminosis D is frequent in old people, particularly those living in nursing homes. SUBJECTS AND METHOD: We performed a cross-sectional study of 100 randomly recruited elderly institutionalized subjects. The prevalence of hypovitaminosis D and its possible repercussion on the phosphocalcium metabolism were assessed. The degree of sun exposure and the existence of co-morbidity were also recorded. Individuals with hypovitaminosis D were included in a longitudinal study (6 months' duration) aimed at assess the efficacy of treatment with calcium and two different therapeutic regimens with calcidiol (16,000 IU/week or 16,000 IU every 3 weeks). RESULTS: 87% of individuals had hypovitaminosis D; 21.8% of them had secondary hyperparathyroidism. The study population had a low degree of sun exposure and a high level of co-morbidity. The two doses of calcidiol led to a normalization of 25-OHD3 levels, increased calciuria and compensated secondary hyperparathyroidism, yet higher 25-OHD3 levels were achieved with the weekly therapeutic scheme. CONCLUSIONS: Hypovitaminosis D prevalence appears to be very high In the elderly institutionalized population. Calcium and calcidiol supplementation normalized 25-OHD3, improved calcium absorption and compensated secondary hyperparathyroidism. Calcium and vitamin D supplementation should be employed routinely in the elderly institutionalized population.

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PubMed1977

A comprehensive, interdisciplinary approach to the care of the institutionalized person with epilepsy.

This report summarizes the experience of a comprehensive, interdisciplinary pilot program for improved care of institutionalized persons with epilepsy. From a hospital population of nearly 3,000 persons with diseases of the nervous system, virtually all having varying degrees of retardation, 892 persons were identified as epileptic and classified by seizure frequency: 13% uncontrolled, 24% partially controlled, and 63% controlled. These three categories were similar in respect to levels of retardation and functional disability. The project personnel consisted of a full-time nurse specialist in epilepsy, a part-time health resource analyst, and neurological consultants. Effects on health status were identified by comparing demographic and health data collected during the project. The typical patient was an adult epileptic, functioning at a severely to profoundly retarded level and institutionalized for over 15 years. A significant reduction in anticonvulsant toxicity was observed. A 48% decrease in episodes of status epilepticus and a 73% decrease in the number of seizure-related deaths were demonstrated. During the second year, 23% of the uncontrolled group, representing all retardation levels, became seizure free. In addition to improved care, an effective model for dealing with institutionalized epileptics is proposed.

Adolescent↗

PubMedDate not supplied

Dependence of Mini-Nutritional Assessment scores with age and some hematological variables in elderly institutionalized patients.

BACKGROUND: Nutritional imbalance is a serious problem in developing countries, especially for the older population, which makes simple and rapid instruments for nutritional evaluation very necessary in order to have a detailed picture of the undernutrition epidemiology in those places. OBJECTIVE: This work aimed to evaluate the nutritional status of elderly institutionalized patients by use of the Mini-Nutritional Assessment (MNA) test and compare the MNA scores with some hematological variables. METHODS: We performed a cross-sectional study in elderly institutionalized patients (153) of all nursing homes in the Brazilian city of Uberlândia, using the MNA questionnaire and quantitative analysis of erythrocytes, hematocrit, hemoglobin, serum iron and transferrin. The subjects were classified by gender, nutritional state and age range. The nutritional categories were compared by analysis of variance and the dependence between the considered variables was tested with the Spearman correlation analysis. RESULTS: 60% of the subjects were female. The average age was 74.6 +/- 9.5 and 78.5 +/- 9.5 years for male and female individuals, respectively. 18.3% of the patients presented undernutrition, 45.7% presented risk of undernutrition, and 36.0% were well nourished. These three nutritional categories showed statistically significant differences among the MNA scores, age and all the hematological parameters, for the sum of both genders, but not for the age, iron and transferrin values of the male individuals and hematocrit and hemoglobin values of the female patients. Significant differences between genders were not observed only for the MNA and transferrin values. MNA values presented positive correlations with erythrocytes, hematocrit, hemoglobin, and serum iron levels, and also a negative correlation with age, which was attributed to a worsening of the nutritional state with age. CONCLUSION: Based on the MNA, 64% of the elderly institutionalized patients of Uberlândia presented risk of undernutrition and undernutrition, and their nutritional state is aggravating with the age increase, which is consistent with the age-dependent decrease observed in some hematological variables. Since the low MNA scores were not necessarily associated to subnormal mean values of the hematological variables, we can conclude that the low MNA values are predicting situations that still did not manifest pathologically in those variables.

Aged↗

PubMed2006

Posturography and risk of recurrent falls in healthy non-institutionalized persons aged over 65.

BACKGROUND: A poor postural stability in older people is associated with an increased risk of falling. The posturographic tool has widely been used to assess balance control; however, its value in predicting falls remains unclear. OBJECTIVE: The purpose of this prospective study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls, including a comparison with standard clinical balance tests, in healthy non-institutionalized persons aged over 65. METHODS: Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested. Postural control was evaluated by posturographic tests, performed on static, dynamic and dynamized platforms (static test, slow dynamic test and Sensory Organization Test [SOT]) and clinical balance tests (Timed 'Up & Go' test, One-Leg Balance, Sit-to-Stand-test). Subsequent falls were monitored prospectively with self-questionnaire sent every 4 months for a period of 16 months after the balance testing. Subjects were classified prospectively in three groups of Non-Fallers (0 fall), Single-Fallers (1 fall) and Multi-Fallers (more than 2 falls). RESULTS: Loss of balance during the last trial of the SOT sensory conflicting condition, when visual and somatosensory inputs were distorted, was the best factor to predict the risk of recurrent falls (OR = 3.6, 95% CI = 1.3-10.11). Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition, contrary to Non-Fallers and Single-Fallers. The Multi-Fallers showed significantly more sway when visual inputs were occluded. The clinical balance tests, the static test and the slow dynamic test revealed no significant differences between the groups. CONCLUSION: In a sample of non-institutionalized older persons aged over 65, posturographic evaluation by the SOT, especially with repetition of the same task in sensory conflicting condition, compared to the clinical tests and the static and dynamic posturographic test, appears to be a more sensitive tool to identify those at high-risk of recurrent falls.

Accidental Falls↗

PubMed2002

Impact of invasive strategy on management of antimicrobial treatment failure in institutionalized older people with severe pneumonia.

The aim of the study was to investigate the etiology and the impact of invasive quantitative sampling on the management of severe pneumonia in institutionalized older people with antimicrobial treatment failure. Fifty-two institutionalized patients aged 70 years and older hospitalized with a presumptive diagnosis of severe pneumonia and failure to respond to treatment after 72 hours of initiation of outpatient antimicrobial therapy were enrolled. Microbial investigation included blood culture, serology, pleural fluid, and bronchoalveolar samples. A definite etiology could be established in 24 of 52 (46%) patients. Methicillin-resistant Staphylococcus aureus (33%), enteric Gram-negative bacilli (24%), and Pseudomonas aeruginosa (14%) accounted for most isolates. Atypical infections (2%) were uncommon. Invasive bronchial sampling directed a change of microbial therapy in 8 (40%) and discontinuation of antibiotics in 2 of 20 cases (10%) of definite pneumonia. Overall hospital mortality was 42%. There was no difference in mortality among definite or unverified cases or those who had invasive bronchial sampling-guided change in therapy. We conclude that antimicrobial therapy should be targeted toward "nosocomial" pathogens in those institutionalized patients who received prior antibiotic treatment. When combined with microbial investigation, direct visualization of the tracheobronchial tree might be useful in determining the presence of bacterial pneumonia.

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PubMed2004

Institutionalization of a community action program targeting licensed premises in Stockholm, Sweden.

The objective of this article is to evaluate the level of institutionalization of a community action program targeting licensed premises in Stockholm. Five key factors were identified for institutionalization: adoption, sustainability, key leader support, structural changes, and compliance. A scale was developed to assess the strength of each factor. The results indicate a high degree of institutionalization (score 13 on a scale from 5 to 15). The authors conclude that the program activities have been sustained at a high level. A written agreement ensures that the participating organizations take responsibility for the continuing work.

Alcoholic Beverages↗

PubMed2003

Institutionalization of a school health promotion program: background and rationale of the CATCH-ON study.

Research is lacking on how to make effective programs available on a large scale and how to maintain levels of implementation. CATCH: A Study of Institutionalization (CATCH-ON) was designed to help us understand the conditions under which such programs are institutionalized after the trial has ended. The Child and Adolescent Trial for Cardiovascular Health (CATCH) was the largest field trial of school-based health promotion in the United States conducted in 96 schools in four geographic areas of the United States: California, Louisiana, Minnesota. and Texas. The intervention was multicomponent, targeting school policy and practices in nutrition, physical activity, health education, and smoking. This report provides background on the CATCH study design, the conceptual framework for research on institutionalization of the CATCH program, and an overview of the seven original reports that present results from the CATCH-ON study in this theme issue.

Adolescent↗

PubMed1998

Durability, dissemination, and institutionalization of worksite tobacco control programs: results from the Working Well trial.

Durability, dissemination and institutionalization o f tobacco control activities are reported, based on the Working Well worksite cancer control intervention study (n = 83 worksites). Tobacco control activities increased significantly in intervention worksites as a result of research-supported activities but were not sustained 2 years after the conclusion of the intervention. Intervention sites were more likely than control sites to initiate and maintain structures for institutionalizing programs, such as assigning a committee responsibility for health-promotion programs or providing a budget for health-promoting activities. Dissemination of the program to control worksites had little impact on the level of smoking control activities in control worksites. Although program durability was not a primary aim of this intervention study, these analyses provide an important assessment of program maintenance beyond a funded intervention and underscore the need for additional research to identify effective organizational strategies for institutionalization of worksite health-promotion programs.

Journal Article↗

PubMed1991

Promoting health among the institutionalized elderly.

1. Although health promotion is a current focus of nursing practice, the institutionalized elderly have not been a target of health promotion research by nurses. 2. Health promotion research in nursing home settings by other disciplines has shown that institutionalized elderly benefit from humanistic approaches and that lifestyle enhancement is possible in nursing home settings. 3. Long-term care nurses are in a unique position to empirically investigate the benefits and efficacy of health promotion interventions in institutionalized settings.

Aged↗

PubMedDate not supplied

Project Salsa: development and institutionalization of a nutritional health promotion project in a Latino community.

PURPOSE: Project Salsa was a community-based effort seeking to promote health through nutritional behavior change in a Latino community of San Diego, California. The purpose of this article is to report on program factors related to long-term institutionalization of Project Salsa interventions. DESIGN: Project Salsa was a demonstration rather than an experimental project. To ensure maximum sensitivity to the needs and values of the community, Project Salsa began with an extensive health needs assessment, including development of an advisory council, telephone survey, archival research, and key informant interviews. SETTING: Project Salsa interventions took place in San Ysidro, California, located near the U.S.-Mexico border adjacent to Tijuana from 1987 to 1992. SUBJECTS: The intervention community had 14,500 residents, of which nearly 83% were Latino. INTERVENTIONS: Interventions included coronary heart disease risk factor screenings, meal preparation classes, newspaper columns, point-of-purchase education, school health and cafeteria programs, and breast-feeding promotion. MEASURES: Institutionalization of intervention components. RESULTS: Two of the interventions, the risk factor screenings and school health programs, are still in operation 4 years after the end of project funding. CONCLUSIONS: Four factors common to institutionalized components are presented in the paper.

Adult↗

PubMed1995

The institutionalization of public hygiene in Korea, 1876-1910.

On the whole, the major impetus for the institutionalization of public hygiene in Korea came from two directions. On one hand, the self-enlightened intellectuals had introduced a variety of Western ideas and theories on public hygiene since the mid-eighteenth century. On the other hand, Japan strongly influenced the modern systems of Korean health care and medical education, especially through Japanese efforts at the sanitary control of infectious diseses such as smallpox and cholera. The institutionalization of Korea's public hygiene in this period corresponded not to the high ideas of the progressive intellectuals but to the larger social and institutional changes caused by the major political events. Ideas of public hygiene were institutionalized as a powerful strategy of linking the imperial capital and colonial domains.

Colonialism↗

PubMed2005

The frequency of drug history documentation in an institutionalized tertiary care setting in Nigeria.

PURPOSE: The study set out to investigate the frequency of institutionalized patients' drug history documentation in a tertiary care setting in Nigeria and identify opportunities for intervention to improve documentation. METHOD: A cross-sectional retrospective study was carried on June 1st to August 31st 2002 at a 900-bed tertiary care facility located in South Western Nigeria. Stratified random samples of 450 case notes of institutionalized patients who were admitted, discharged or who died at the study site was evaluated for comprehensiveness of drug history documentation with the aid of two pre-piloted data collection forms. RESULT: Drug history documentation was done mainly by attending physicians in all 450 case notes studied (100%). Past use of prescription, over-the-counter and herbal drugs were documented in 33.3%, 12.9% and 6.9% of patients respectively. The dose, frequency and duration of use were documented in 6.4% and 8.4% while past side effects experienced were documented in only 1.6%. Allergy to drug(s), food and chemical(s) were documented in 1.4%, 1.8% and 0.8% respectively. Documentation of use of alcohol, cigarette and illicit drugs were done in 36.6%, 23.2% and 4.2% of patients. Patient adherence with drugs used in the past and source(s) of purchase of these drugs were documented in only 10.2% and 6.6% of patients respectively. CONCLUSION: The documentation of institutionalized patients' drug history in Nigeria is currently not as detailed as it should be. A planned intervention is on going to identify factors responsible for the observed inadequacy and assess the impact of pharmacists' involvement on the quality of drug history documentation.

Cross-Sectional Studies↗

PubMed1990

[Oral health in institutionalized elderly].

In Denmark, approximately 7% (50,000) of the population above 65 years of age live in nursing homes (NH), where they stay for the rest of their lives, whereas elderly in hospital long-term care (LTC) are institutionalized only for a few months. Numerous studies report generally poor oral health among the institutionalized elderly, and the existing oral health care services are far from satisfactory. Attitudes towards the elderly, transportation problems, age, and dental status are among the variables that have been mentioned as possible determinants for utilization of dental services and for the standard of oral health among the residents. Utilization of health care services, including dental services, depends not only on the characteristics of the consumer, but also on the society and the provider. The planning of dental care for the institutionalized elderly requires information about the need for treatment, the existing possibilities for oral health care, and the institutional staff's attitude towards the elderly and dental care. It is also necessary to take into account the perceived need and the expressed demand for treatment as well as the mental and physical health of each individual in order to estimate what in the present study is defined as the realistic treatment need.

Aged↗

PubMed1989

Anemia and iron status in the free-living and institutionalized elderly in Kentucky.

A study of the iron status and anemia in 101 elderly persons, age 60 to 95, included 50 free-living and 51 institutionalized subjects. Daily iron intakes and biochemical parameters including hemoglobin, hematocrit, mean corpuscular hemoglobin concentration (MCHC), plasma iron levels and total iron binding capacity (TIBC) were determined. In the free-living group, only 4% male and 8% female subjects had iron-deficiency anemia. Whereas about 40% of the institutionalized group had iron deficiency anemia with low hemoglobin, hematocrit, MCHC, plasma iron levels, and elevated TIBC. Hemoglobin, hematocrit, MCHC and plasma iron levels were significantly higher, and TIBC was significantly lower in the free-living group than the institutionalized group. The lack of correlation between dietary iron intakes and plasma iron levels suggest that iron deficiency anemia in these elderly subjects was not due to lack of iron intakes. The possible causes might be medications and diseases in these elderly subjects.

Aged↗

PubMedDate not supplied

[Cognitive and mnemonic information processing in institutionalized and noninstitutionalized elderly patients].

Older subjects (institutionalized in a home for the aged and non-institutionalized) were compared in a test battery according to the recommendations of the NINCDS-ADRA. The institutionalized subjects were not distinguishable from the controls when only a small amount of information was to be processed or when the information had to be recalled with no distraction. Possible reasons for the observed differences are discussed.

Aged↗