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PubMed1975

Perceived latitude of choice of institutionalized and noninstitutionalized elderly women.

An Importance, Locus and Range of Activities Checklist, designed to assess self-perceived latitude of choice, a self concept and a life satisfaction scale were administered to 25 institutionalized and 25 noninstitutionalized elderly females. The checklist contained statements about 37 activities of daily living which subjects rated for personal importance and degree of choice available to them. The derived latitude of choice score was based jointly on importance and choice ratings for each activity. Institutionalized respondents, living in a relatively restrictive environment, earned significantly lower latitude of choice scores than did noninstitutionalized subjects. Latitude of choice, self concept and life satisfaction scores were significantly correlated. These findings attest to the appropriateness of the technique used to assess perceived latitude of choice. Modifications of the Importance, Locus and Range of Activities Checklist designed to provide a more profound measure of latitude of choice and to improve the applicability of the scale to different categories of respondents were discussed.

Activities of Daily Living↗
PubMed2000

FRAXA screening in Brazilian institutionalized individuals with nonspecific severe mental retardation.

Individuals with mental disabilities are a heterogeneous group, mainly when we consider the etiology of mental retardation (MR). Recent advances in molecular genetics techniques have enabled us to unveil more about the molecular basis of several genetic syndromes associated with MR. In this study, we surveyed 85 institutionalized individuals with severe MR, 38 males and 47 females, by two molecular techniques, to detect CGG amplifications in the FMR1 gene. No FRAXA mutations were found in the FMR1 gene, reinforcing the low prevalence of Fragile X syndrome among institutionalized individuals with severe MR. We considered the PCR protocol used adequate for screening males with mental retardation of unknown etiology. The use of the Southern blot is still necessary for the decisive diagnosis of the Fragile X syndrome. To exclude chromosomal abnormalities associated with MR as a possible cause of the phenotype in these individuals, G-banded chromosome analysis was performed in all patients and 7.3% of chromosomal aberrations were found. Our results are similar to those reported previously and point to the necessity of expanding the molecular investigation toward other causes of MR, such as subtle chromosomal rearrangements, as suggested recent by a combination of fluorescence in situ hybridization (FISH) and PCR studies.

Adolescent↗
PubMed1984

Institutionalization and the elderly: international comparisons.

This paper is an exploratory attempt to examine international differences in the proportion of old people living in non-private households. The aim of the study was to provoke further discussion of the role which institutions play in the care of the elderly in various settings and to examine the effect of certain demographic and economic parameters on the proportion of elderly people in non-private households. Data were drawn from national censuses and indirect standardization was used to allow comparison of the probability of institutionalization in the countries considered. Considerable variation in standardized institutionalization ratios was found but this variation was not significantly associated with any of the demographic or economic variables considered.

Aged↗
PubMed1996

Prevalence of Helicobacter pylori infection in elderly inpatients and in institutionalized old people: correlation with nutritional status.

Helicobater pylori plays an important role in the aetiology and development of peptic ulcer disease. The prevalence of H. pylori infection increases with age, and is influenced by low socioeconomic status and poor hygiene owing to person-to-person transmission of the organism by the oral-faecal route. The aim of this study was to investigate the prevalence of H. pylori infection, detected serologically, in elderly patients admitted to a geriatric rehabilitation ward and in a sample of institutionalized old subjects. Nutritional status was also evaluated in order to examine its relation to H. pylori infection. The overall prevalence of H. pylori infection was 70.8%, the prevalence in hospitalized patients being 72.9% and in institutionalized subjects 68.7%. No significant correlation was observed between anti-H. pylori IgG levels and either age or length of stay in the institution. We found no difference between H. pylori positive and negative patients as regards their self-sufficiency and cognitive functions. The prevalence of anti-H. pylori antibodies in the serum was not related to blood variables (including nutritional indices), history of drug consumption (in particular nonsteroidal anti-inflammatory drugs), dyspeptic symptoms, or alcohol and smoking habits.

Aged↗
PubMed1999

Relationship between the response to influenza vaccination and the nutritional status in institutionalized elderly subjects.

BACKGROUND: Influenza is a major health problem among elderly people in industrialized countries. Nursing homes may be a particularly good setting for outbreaks of influenza. Thus, the aim of the present study was to evaluate some aspects of the nutritional status of institutionalized elderly subjects in relation to their response to influenza vaccination. Certain aspects of the cellular immune response were also investigated. METHODS: Twenty-three patients participated in this cross-sectional study. All patients were vaccinated on day 0 with FluviralR, 1994-95 preparation: A/Shangdong/09/93, A/Texas/36/91, B/Panama/45/90. At the same time the prevaccination antibody titer, the nutritional status by the Mini Nutritional Assessment, biochemical parameters, and lymphocyte proliferation were assessed. On day 28, the postvaccination antibody titer was determined. The determination of pre- and postvaccination antibody titers against the various influenza antigens was carried out by the hemagglutination inhibition test. An increase of 4x for any of the virus antigens was considered as a seroconversion. A titer higher than 40 at the prevaccination period was considered as protective. RESULTS: Eleven elderly subjects were responsive and 12 were not. We have shown that the nutritional parameters such as hemoglobin, hematocrit, total protein, iron and vitamin E levels, as well as the DHEA level and the cellular immune response were significantly lower in the nonresponsive group as compared to the responsive group. Thus, they might be associated with the influenza vaccine responsiveness of institutionalized elderly subjects. CONCLUSIONS: These results will help design intervention studies for improving the immune response by achieving an optimal nutritional status, mainly in the frail elderly population, that could have a great public health impact.

Aged↗
PubMed2000

Circadian rhythm abnormalities of wrist activity of institutionalized dependent elderly persons with dementia.

BACKGROUND: The study objective was to clarify the descriptive characteristics of circadian rhythm abnormalities of wrist activity of the institutionalized elderly with dementia. METHODS: We studied 82 elderly persons with dementia who were institutionalized in a long-term medical care facility. The ambulatory continuous monitoring of their wrist activity was conducted for 7 days at 1-minute intervals. The time series data were analyzed using the double-plotted chronogram, spectral analysis was performed using the fast Fourier transformation and periodogram analysis was performed as well. RESULTS: The frequency of circadian rhythm abnormalities of wrist activity rhythm in elderly persons with dementia was 57.3% (47 out of 82). The abnormalities were classified into four categories: severely impaired circadian rhythm type with no boundary between day and night, free-running rhythm type, decreased circadian amplitude type, and accentuation of ultradian rhythm type. CONCLUSION: This four-category classification system provides a scientific approach for studying the mechanisms of circadian activity rhythm abnormalities of elderly persons with dementia.

Activity Cycles↗
PubMed1995

Factors underlying the institutionalization of elderly persons in Canada.

Using data from the Survey of Old Age Security and Canadian Pension Plan Retirement Recipients conducted by Health and Welfare Canada in 1987, this article estimates the relationship between sociodemographic characteristics and institutionalization of elderly persons in Canada. Region of residence was introduced in our model as a proxy for system effects. Logistic regression showed that age, marital status, health, family income, and region of residence all have a significant effect on institutionalization. We look at policies specific to different provinces to elaborate some hypotheses on how they affect the likelihood of residing in an institution. When trying to estimate the future needs and costs of institutional housing, this study shows the importance of considering not only the number of persons aged 65 years and over, but also expected changes in their sociodemographic characteristics and in the policies concerning long-term care services.

Aged↗
PubMed2000

Predictors of institutionalization of cognitively impaired elders: family help and the timing of placement.

Although predictors of nursing home placement have attracted a good deal of attention in gerontological research, the type and amount of family assistance offered to caregivers prior to institutionalization has not been extensively examined. This study analyzed the impact of family help on the timing of placement among cognitively impaired care recipients. Using longitudinal data from the Adult Day Care Collaborative Study, an event-history analysis was performed to determine the effects of family help after sociodemographic characteristics, caregiving stressors, and indicators of caregiver well-being were taken into account. Results showed that caregivers were far less likely to institutionalize their relatives when family members provided overnight help and assisted with activities of daily living care. These findings suggest that specific types of family help play an important role in delaying nursing home placement among older adults suffering from dementia.

Aged↗
PubMed1986

Dementia in elderly adults: prevalence and institutionalization.

A formula for age-specific dementia prevalence is derived using data from a New Zealand study. Six other studies of dementia prevalence selected according to certain criteria are analyzed and their results shown to be not significantly different from those expected on the basis of the formula. Moreover, the small standard error estimate for the studies in aggregate indicates that the observed results are in close agreement with those expected. Dementia prevalence is estimated in both current and projected Australian aged populations using the age-specific prevalence formula. Comparison of the number of confused persons in institutions with the estimated number in the total population suggests that almost half of the moderate or severe dementia cases may be institutionalized, a much higher proportion than reported in other studies. Variations in overall levels of institutionalization are suggested as the main reason for such differences.

Age Factors↗
PubMed1987

Changes in relative weight among institutionalized elderly adults.

Weight-for-height and weight changes over a 2-year period among 335 institutionalized elderly adults at a geriatric care facility are described. Weight-for-height at admission was compared with several current standards for elderly persons. Mean relative weight and proportions of underweight and obese patients varied with the standards used. Although changes in group mean weights were slight, 73% of the patients gained or lost 4.5 kg or more in 2 years. Patients who lost 4.5 kg or more in the interval had a lower 4-year survival rate (p less than .05) than patients who gained weight or remained stable. Fluctuations in weight may be more prevalent among institutionalized elderly persons than previously thought, or than are apparent in analyses of group trends. Monitoring an individual's weight is simple and may be more meaningful than comparison to a standard, especially because weight loss is associated with mortality, until age appropriate standards are developed.

Age Factors↗
PubMed1988

Taste acuity in institutionalized and noninstitutionalized elderly men.

Taste detection thresholds were determined in young men (18 to 25 years of age, n = 15), noninstitutionalized elderly men (63 to 88 years of age, n = 17), and institutionalized elderly men (61 to 92 years of age, n = 15). The technical procedure utilized a single blind format. The tastants were presented to the subjects in a multiple forced-choice sample presentation with an ascending series. Additional testing conditions included adequate oral hygiene, 10 ml of tastant, timed intervals, and deionized water rinses. The major findings were that sour, salt, and bitter thresholds increased with age. Sweet threshold did not change with age. The institutionalized elderly men had significantly higher sour detection thresholds when compared with the noninstitutionalized elderly men. The use of salt and tobacco had no apparent effect on detection thresholds for sweet, salt and bitter, but medication ingestion elevated the sour thresholds. Elderly subjects on antihypertensive medications had significantly higher salt detection thresholds.

Adolescent↗
PubMed1990

Overwhelming odds: caregiving and the risk of institutionalization.

In this study we explored whether informally or formally provided long-term care services reduce the risk of institutionalization among the impaired elderly and the nature of the relationship between support and risk. We relied principally on the 1982 National Long-Term Care Survey (NLTCS) with supplementary data from the 1984 NLTCS and the national American Housing Survey. Five specific types of effects were tested: direct effects of formal and informal care on institutional risk; buffering effects of support moderating risk factors; supplementation effects of formal support on the risk-reducing impact of informal care; facilitating effects of the housing environment in enabling support to continue; and intervening effects mediating the direct effects. The effects of each type of support differ substantially. The analyses do not confirm the notion that formal, paid care reduces institutional risk. In fact, the use of paid caregivers is associated with greater risk of institutionalization, other things equal. The results for informal care are more mixed. A general measure that accounts for all types of informal support has no effect on institutional risk in any of the formulations tested. But the marginally significant effects of quality and proximate support in the direct effects model are consistent with the hypothesis that caregiving reduces institutional risk. The findings also indicate that a small number of housing or locational features are facilitators of formal support and particular types of informal support.

Activities of Daily Living↗
PubMed1988

Localization of urinary tract infection in elderly, institutionalized women with asymptomatic bacteriuria.

We determined the site of urinary tract infection in 51 elderly, institutionalized women (mean age, 80.5 years) with asymptomatic bacteriuria by using the Fairley bladder washout technique. Thirty-four (67%) infections were localized in the kidney and 17 (33%) in the bladder. Women with renal infection were older than those with bladder infection (81.9 vs. 77.6 years of age; P = .04). The antibody-coated bacteria test had a sensitivity of 58%, specificity of 71%, positive predictive value of 82%, and negative predictive value of 43% for upper-urinary-tract infection. A quantitative urinary leukocyte count of greater than or equal to 20 leukocytes/mm3 had a positive predictive value of 80% and a negative predictive value of 88% for upper-urinary-tract infection. This study suggests that the majority of elderly, institutionalized women with asymptomatic bacteriuria have upper-urinary-tract infection. Both the antibody-coated bacteria test and the quantitative urinary leukocyte count may be useful as noninvasive tests for localization of urinary tract infection in this population.

Age Factors↗
PubMed1981

Contextual and sociodemographic antecedents of institutionalization among aged welfare recipients.

Data obtained in the 1973 Survey of Low-Income Aged and Disabled were used to predict 1974 institutionalized status among aged (65+) welfare recipients. Principal factor analysis was used to derive an index of self-care based on activities of daily living items. Two levels of ability were determined and separate logistic analyses were performed for demographic, contextual and community contact variables. County and other contextual indicators were used to test effects of bed supply and concentration of poverty. The following characteristics were associated with greater probabilities of institutionalization: functional impairment, advanced age, household isolation, presence of nonrelatives and white racial background. Variables associated with greater probabilities of noninstitutionalization included: southern residence, residence in counties with greater concentrations of poverty, frequent contact with friends and relatives, and propinquity of children. Receipt of services was associated with greater probability of institutional placement.

Activities of Daily Living↗
PubMed2003

Growth, morbidity, and mortality in a cohort of institutionalized HIV-1-infected African children.

OBJECTIVE: As a result of the HIV epidemic in Africa, much debate exists on whether institutionalized compared with community-based care provides optimum management of infected children. Previous reports calculated 89% mortality by age 3 years among outpatients in Malawi. No similar data are available for infected children in institutionalized care. We characterized patterns of morbidity and mortality among HIV-1-infected children residing at an orphanage in Nairobi. METHODS: Medical records for 174 children followed over 5 years were reviewed. Mortality was analyzed by Kaplan-Meier methods with adjustment to account for survival in the community before admission. Anthropometric indices were calculated to include mean z scores for weight for length and length for age. Low indices reflected wasting and stunting. Opportunistic infections were documented. RESULTS: Of 174 children, 64 had died. Survival was 70% at age 3 years. Morbidity included recurrent respiratory tract infections, gastroenteritis, parotitis, and lymphoid interstitial pneumonitis. No new cases of tuberculosis disease were noted after admission. Mean z scores for length for age suggested overall stunting (z = -1.65). Wasting was not observed (z = -0.39). CONCLUSION: The optimal form of care for HIV-infected children in resource-poor settings may be the development of similar homes. Absence of tuberculosis disease in long-standing residents may have contributed to improved survival. Stunting in the absence of wasting implied that growth was compromised by opportunistic infections and other cofactors.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Clinical and cytogenetic survey of institutionalized mentally retarded patients with emphasis on the fragile-X syndrome.

A detailed clinical and cytogenetic survey for the fragile-X syndrome was undertaken on 201 institutionalized mentally retarded males with no previously recognized cause of retardation, and the causes of mental retardation were summarized from a total of 595 institutionalized male and female patients after the review of their medical records including clinical and cytogenetic data. Among the 201 males clinically and cytogenetically examined, five (2.5%) had abnormal chromosome findings with four (2%) having the fragile-X syndrome. Twelve of the males (6.0%) were diagnosed with a single gene disorder. In the present study, mental retardation was classified as possibly due to multifactorial causes when a genetic syndrome, chromosome abnormality or environmental insult was not identified, but mental retardation was present in one or more first and/or second degree relatives, but did not follow a recognizable inheritance pattern. Hence, mental retardation was recorded in other family members and may indicate possible multifactorial causes in 45 males (22.4%). An environmental insult was noted in 25 males (12.4%); unexplained birth defects in three males (1.5%); a specific condition or diagnosis identified, but cause unknown (e.g. Rubinstein-Taybi syndrome) in 10 males (5%); and no diagnosis made in the remaining 101 males (50.2%). Of all 595 patients (334 males and 261 females), including the 201 males who had undergone a detailed clinical and cytogenetic evaluation, 39 (6.6%) had abnormal chromosome findings, with Down's syndrome noted in 31 of the patients. Twenty-five patients (4.2%) were diagnosed with a single gene disorder while mental retardation was noted in other family members and may indicate possible multifactorial causes in 64 patients (10.8%). An environmental insult was noted in 170 patients (28.6%); unexplained birth defects in 17 patients (2.9%); a specific condition or diagnosis but cause unknown in 27 patients (4.5%); and no diagnosis made in 253 patients (42.5%). Clinical and cytogenetic screening of mentally retarded patients for the fragile-X syndrome and other causes of mental retardation is helpful in identifying individuals and their families who may benefit from genetic services such as counseling and treatment. This study was performed over an approximate 2 year period from 1987 to 1989.

Adolescent↗
PubMed2004

Relationship between dental care and oral health in institutionalized elderly people in Japan.

This study examined the relationship between dental care and dental health status in institutionalized elderly people in Japan through a 6-year prospective cohort study. All the 719 subjects received both baseline and follow-up surveys. The uptake of dental care was examined at the follow-up survey. We examined the relationship between baseline variables and the provision of dental care, and the relationship between dental care and change of oral health status. About 47% of the subjects and about 60% of the baseline dentate subjects received some dental treatment during the 6-year follow-up period. The subjects who were in better systemic and dental health at baseline used dental services frequently. The number of teeth needing extraction decreased in the subjects who received dental treatment, and increased in the untreated subjects. Denture status was better in the treated subjects than in the untreated subjects. Dental care appears to be an important factor in maintaining a healthy oral status for the institutionalized elderly.

Aged↗