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PubMed1997

Withdrawal of neuroleptic medications from institutionalized dementia patients: results of a double-blind, baseline-treatment-controlled pilot study.

Among dementia patients in long-term care facilities, neuroleptics (NL) are frequently prescribed for the treatment of agitation. Although good clinical practice and federal law mandate attempts at withdrawal of these medications, empiric data regarding the cessation of NL treatment are limited in this population. The objective of the present study was to assess through direct observation the effects of short-term NL withdrawal on physically aggressive behavior and other aspects of agitation. We carried out a randomized, double-blind, baseline NL-controlled 4-week trial of the effects of NL withdrawal in 36 institutionalized patients with possible or probable Alzheimer's disease. Patients were directly observed for four 2-hour sessions during baseline, a prerandomization week, and during weeks 1, 2, and 4 of the double-blind portion of the study. Completion of the 4 weeks of double-blind medication and number of observed episodes of physically aggressive behavior (PAB) were the two primary outcome measures. Of the 22 patients who were withdrawn from NL, 20 (91%) completed the 4-week double-blinded withdrawal. Two patients were discontinued from the study due to unacceptable levels of agitation at the request of their nursing staff. Of the 14 patients not withdrawn, all completed the 4-week trial. The chi-square test for the difference between groups was not significant (P > .05). Based on the observed instances of PAB, there was no significant difference (P > .05) between withdrawn and not-withdrawn subjects. Half of the withdrawn patients remained off NLs for an extended period of time after the end of the study, even after the blind was broken. Withdrawing institutionalized dementia patients from NLs was successful in most but not all study patients. Generalization of these results is limited by the highly selected nature of the participants. Unmasking of unmanageable agitation and physical aggressiveness in a small minority must be weighed against the benefits of removing unnecessary medication in the majority of dementia patients in whom NL withdrawal is attempted. PAB itself should not drive continuing NL use without regard to objective assessment of efficacy of the NL treatment.

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PubMed2006

An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors.

BACKGROUND: To examine the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual and/or motor disability. METHODS: We conducted a cross-sectional study at a public facility for people with intellectual and/or motor disability in Ibaraki prefecture, Japan. Health checkup data obtained in 2001 from 477 people with intellectual disability (male: 286, average age 40.6 +/- 12.3; female: 191, average age 45.1 +/- 11.6) were retrospectively reviewed. RESULTS: The prevalence of anemia among male participants was higher than in female participants for each disability category (intellectual disability, 41.1%, 4.2%; cerebral palsy, 37.5%, 4.8%; Down's syndrome, 15.0%, 0%; severe motor and intellectual disabilities, 61.9%, 16.7%). Most participants with anemia (93.8 - 100%) showed a normocytic normochromic anemia pattern. Multivariate analysis revealed that factors related to an increase in frequency included sex (male), low body mass index (BMI), use of anticonvulsants or major tranquilizers, and a high zinc sulfate turbidity test (ZTT) value. No clinically diagnosed co-morbid condition was found to be related to the presence of anemia. CONCLUSION: A high frequency of mild normocytic normochromic anemia in institutionalized people with intellectual and/or motor disability was observed, particularly among males. Medications and chronic inflammation may increase the risk of anemia.

Adult↗

PubMed1977

Adolescent Rorschach responses as a function of age at first institutionalization.

To test the hypothesis that age of first separation from a home environment is a factor in the emotional health of institutionalized boys, Rorschach protocols of 82 residents of Saint Francis Vocational School, a facility for deprived nondelinquent nonretarded youth aged 10 to 18, were examined. Seven Rorschach variables were used as dependent variables of emotional status. It was found that boys who had first been institutionized before age 10 gave more color-dominant and pure color responses (p less than .005), and more responses with pathological overtones (p less than .005), than did youth first placed at ages 10 to 13 or ages 14 to 17. Fixation was proposed as the basis for the group differences.

Adolescent↗

PubMed1987

Early-onset Alzheimer's disease: clinical predictors of institutionalization and death.

Follow-up observations were made of 92 white patients with early-onset Alzheimer's disease to determine the demographic, clinical, and neuropsychological factors predictive of institutionalization or death. The cumulative mortality rate 5 years after entry into the study was 23.9%, compared with an expected rate of 9.5%. The 5-year cumulative rate of admission to nursing homes was 62.8%. The language ability of the patients on entry to the study, their scores on a brief screening test of cognitive function, and their overall ratings of clinical dementia were found to be predictors of subsequent institutional care and death. The age of the patients had a significant modifying effect on these predictive factors, resulting in a greater risk of institutionalization and death in younger patients with severe cognitive impairment as compared with older individuals with the same degree of dysfunction.

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PubMed1983

Targeting community services to high-risk elders: toward preventing long-term care institutionalization.

Data from a probability sample of 1,625 elderly participants in the Massachusetts Health Care Panel Study were used to identify elders at high risk of long-term care (LTC) institutionalization. Advancing age, living alone, using assistance to perform basic and instrumental ADL, using an ambulation aid, and mental disorientation were significant predictors of entering a LTC facility during the six-year study period. A comparison of selected characteristics from the Massachusetts sample with a random sample of Massachusetts' Home Care Corporation recipients showed that the statewide approach to delivering home care successfully targeted services to high-risk elders. Future research should examine the extent to which targeting services to high-risk elders actually prevents or delays LTC institutionalization.

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PubMed2006

Deciding on institutionalization for a relative with dementia: the most difficult decision for caregivers.

The decision to move a family member with dementia to a nursing home is a difficult experience for caregivers. Complex psychosocial factors are involved and knowledge of predictive factors alone is insufficient. Using grounded theory, this study explores the decision-making process with regards to institutionalization, from the perspective of family caregivers. Fourteen people who moved a relative to long-term care in the preceding 6 months were interviewed. Data analysis using comparative analysis and line-by-line dimensional analysis was used to develop a theoretical model of the decision-making process. Three factors within the model were central to the process: (a) caregivers' perceptions of their ability to provide care, (b) caregivers' evaluations of their relatives' ability to make care decisions, and (c) the evolving influence of contextual factors and interactions with healthcare professionals. The contribution of these findings to new conceptualizations of institutionalization is discussed.

Adult↗

PubMed2004

Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders.

STUDY OBJECTIVES: Poor dental hygiene has been linked to respiratory pathogen colonization in residents of long-term care facilities. We sought to investigate the association between dental plaque (DP) colonization and lower respiratory tract infection in hospitalized institutionalized elders using molecular genotyping. METHODS: We assessed the dental status of 49 critically ill residents of long-term care facilities requiring intensive care treatment. Plaque index scores and quantitative cultures of DPs were obtained on ICU admission. Protected BAL (PBAL) was performed on 14 patients who developed hospital-acquired pneumonia (HAP). Respiratory pathogens recovered from the PBAL fluid were compared genetically to those isolated from DPs by pulsed-field gel electrophoresis. MEASUREMENTS AND RESULTS: Twenty-eight subjects (57%) had colonization of their DPs with aerobic pathogens. Staphylococcus aureus (45%) accounted for the majority of the isolates, followed by enteric Gram-negative bacilli (42%) and Pseudomonas aeruginosa (13%). The etiology of HAP was documented in 10 patients. Of the 13 isolates recovered from PBAL fluid, nine respiratory pathogens matched genetically those recovered from the corresponding DPs of eight patients. CONCLUSIONS: These findings suggest that aerobic respiratory pathogens colonizing DPs may be an important reservoir for HAP in institutionalized elders. Future studies are needed to delineate whether daily oral hygiene in hospitalized elderly would reduce the risk of nosocomial pneumonia in this frail population.

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PubMed1975

Drinking patterns of institutionalized and noninstitutionalized Wyoming youth.

The drinking attitudes and patterns among institutionalized and noninstitutionalized Wyoming youth were examined. The majority appeared generally to support a norm of approval of drinking but those institutionalized for antisocial behavior were more likely to drink often, to become drunk and to have gotten into trouble with parents or the police because of drinking.

Adolescent↗

PubMed1982

A prospective study of long-term care institutionalization among the aged.

A statewide probability sample of 1,625 elders living in Massachusetts are studied prospectively to identify key determinants of long-term care (LTC) institutionalization. One-hundred forty-seven elders, 9 per cent of the original cohort, entered a LTC institution during the six-year investigation. Using logistic multiple regression, we examine the predictive power of 19 independent variables grouped into six categories: demographic characteristics, attitude, social context, long-term care needs, physical disability, and mental/emotional disability. Five variables are significantly related to institutionalization: advancing age, using ambulatory aids, mental disorientation, living alone, and using assistance to perform "instrumental" ADL (activities of daily living). These results may be helpful to those trying to target non-institutional services to elders for use as substitutes for institutional long-term care. They may also help explain why recent experimental tests of substituting non-institutional care for institutional services have been less than successful.

Activities of Daily Living↗

PubMed2002

The interrelationship among achievement patterns of activities of daily living for institutionalized dependent elderly.

The purpose of the present study was to examine the interrelationship of achievement patterns between 74 activities by selecting nine ADL domains, including 27 items used in existing ADL index for the institutionalized disabled elderly (Disabled-ADL). For these 74 ADL items, 706 institutionalized dependent elderly were assessed using a dichotomous scale of "possible" or "impossible" by staff working at the subjects' institutions. The difficulty of each item was examined by calculating the proportion of "possible" responses. The interrelationships among activities were determined by calculating phi coefficients. Furthermore, the degree of agreement assessed between ADL items was calculated by dividing the total response by the number of "possible-possible" and "impossible-impossible" responses, in order to examine the similarity of the achievement pattern of ADL. The phi coefficient values were high among ADL items with comparable difficulty where the item proportions were within about 10%. Even if belonging to a different ADL domain, the relationship was high among ADL items with similar difficulty and kinds of activity. All of the 27 activities used in Disabled-ADL indicated high agreement of over 80% with one or more activities among the other 47 activities used in this study. Especially, three lower extremity activities of "putting on trousers while standing", "going up and down stairs" and "squatting down from a standing posture" agreed more than 90% with many other lower extremity activities. The possibility is suggested in determining lower extremity functional levels by assessing these three activities. The selection of ADL items considering these influences is necessary to comprehensively assess ADL ability of disabled elderly.

Activities of Daily Living↗

PubMed1980

Locus of control, perceived constraint and morale among institutionalized aged.

Examination of the relationship between locus of control and life satisfaction was prompted by a report that external locus of control (belief in the controlling influence of others) promotes good morale for the institutionalized elderly. Contrary to this report, life satisfaction of fifty-six institutionalized elderly women was associated with internality (belief in personal influence). Life satisfaction was also inversely related to perception of institutional constraint (r = -.61), which was its most powerful determinant.

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PubMed1990

Notion of control and self-esteem of institutionalized older men.

12 institutionalized elderly men (those over 65 yr.) participated in an investigation to assess the influence of control on the self-esteem (feelings of self-worth) of the respondents. Langer's 1983 concept of perception of control guided the use of a modified pretest-posttest design. Analysis indicated that having input in decision-making process can enhance institutionalized elderly males' self-esteem and contribute toward improving their quality of life. Possibilities for extending and refining this research are addressed.

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PubMed1989

Social support, self-esteem, and depression in the institutionalized elderly.

Psychosocial studies of the elderly have been limited primarily to noninstitutionalized elderly living at home in the community. Only a few studies have explored the psychological implications of being institutionalized despite the fact that approximately 5% of the 25.6 million elderly 65 years or older in the United States reside in nursing homes (Rovner & Rabins, 1985). This correlational study was a beginning effort to investigate the relationships among depression, social support, self-esteem, and selected demographic variables in a sample of 26 institutionalized elderly individuals. The Norbeck Social Support Questionnaire (NSSQ) was used for measuring social support. The Geriatric Depression Scale (GDS) and Rosenberg's Self-Esteem Scale were used to measure depression and self-esteem respectively. The applicability of these instruments for studies of the elderly is discussed. Findings indicated that the demographic characteristics of the subjects had no significant effect on their feeling of self-esteem or depression. However, social support significantly correlated with depression and there was some indication that the type of institutional setting and frequency of religious participation also interacts with the level of depression. The article concludes with recommendations for future research.

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PubMed1997

[Improvements in mental and physical status of elderly patients with dementia after institutionalization--assessment with a minimum data set].

Using a Minimum Data Set, we studied how the mental and physical status of elderly people with dementia was modified by institutionalization. We assessed patients with dementia at the time of their admission in Kyoto Higashiyama geriatric hospital, and again three months later. On admission, both mental and physical problems were noted with a Resident Assessment Protocols. The former included cognitive loss/dementia, delirium, behavioral problem, activities, and mood state; the latter included visual function, activities of daily living (functional), urinary incontinence and indwelling catheter, nutritional status, dehydration/fluid maintenance, and dental care. Three months later, marked improvements were observed in 8 areas: delirium, psychological well-being, mood state, activities, urinary incontinence and indwelling catheter, nutritional status, dehydration/fluid maintenance and dental care. Cognitive loss/dementia and visual function were changed little. The unchanged areas were considered to be "core" manifestations of dementia, and those that changed were believed to reflect emotional problems and to be affected by the environment. Therefore, individualized care for elderly institutionalized patients with dementia should focus on these "peripheral" problems rather than on those that cannot be changed.

Activities of Daily Living↗

PubMed1983

Blood selenium and glutathione peroxidase levels and dietary selenium of free-living and institutionalized elderly subjects.

The purpose of this study was to evaluate the selenium status of healthy free-living and institutionalized elderly people. For the 36 free-living elderly dietary selenium intake averaged 94 +/- 44 micrograms Se/day and a positive correlation coefficient was found between dietary selenium and dietary calories (r = 0.46; P less than 0.05), dietary protein (r = 0.60; P less than 0.01), and dietary fat (r = 0.43; P less than 0.05). Diet histories from the institutionalized subjects revealed a strong correlation coefficient between selenium and carbohydrate (r = 0.51; P less than 0.005) and selenium and calories (r = 0.44; P less than 0.05). Mean erythrocyte and plasma selenium levels for the free-living subjects were 0.20 +/- 0.06 micrograms/ml and 0.10 +/- 0.03 micrograms/ml, respectively, while mean erythrocyte glutathione peroxidase (GSH-Px) activity was 27.5 +/- 5.0 units/g protein. For the free-living subjects positive correlation was found between dietary selenium and erythrocyte selenium levels (r = 0.38; P less than 0.05) but no correlation existed between dietary selenium and plasma selenium (r = 0.13; P greater than 0.05) and RBC GSH-Px (r = -0.15; P greater than 0.05). The dietary selenium levels and blood selenium and GSH-Px levels were above the levels found in populations proposed to be at risk for selenium deficiency. Thus, these elderly appear to have adequate selenium status.

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PubMed1990

Homelessness among the institutionalized elderly.

Home is the experience of a dynamic relationship between the individual and the environment. It can be viewed as a lived experience that possesses deep existential meaning for the individual. Homelessness is the experience of the negation of home; the relationship between the individual and the environment loses its intimacy and becomes severely damaged. This painful experience brings about deep existential despair. The data supports the strong probability that the institutionalized elderly are homeless and that the elder's attempts to cope with this unendurable pain results in behaviors that are often misinterpreted as indicating acceptance or adjustment to the nursing home setting. Nursing must recognize the possibility that to be institutionalized is to be homeless. This intolerable state must be alleviated either through significant modification of nursing home psychosocial environments or the identification of alternative settings for the care of chronically ill and debilitated elderly persons.

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PubMed1992

[A survey on urinary incontinence in the institutionalized elderly].

A survey on urinary incontinence in 161 (41 male, 120 female) institutionalized elderly was independently performed by urologists and attending nurses. Urinary incontinence was found in 107 cases (66%), with 76 cases (47%) suffering from severe leakage (more than 5 times a day and needs diaper). The prevalences of incontinence and severe leakage were 63% and 52% at geriatric hospitals, 59% and 29% at intermediate care centers and 78% and 63% at nursing homes, respectively. The risk factors for incontinence were consciousness disturbance, urinary urgency, impaired mobility and dementia, and those for severe leakage were apathy, loss of urinary sensation, dementia and impaired mobility. The type of incontinence was considered functional one in 81% of cases. The agreement of the incontinence type evaluated by urologists and that by nurses was found in 90% of incontinent cases. Incontinence was estimated "incurable" in 54% of cases by attending nurses. These observations indicate a high prevalence of severe and "incurable" incontinence in the institutionalized elderly, urgently warranting an effective remedy for the increasing aged society.

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PubMed1999

Levels of disability among the elderly in institutionalized and home-based care in Bahrain.

We compared the levels of disability between the elderly admitted to an institution and those cared for at home. Of the 74 elderly people in this study, 56 were institutionalized and 18 were living at home. The Clifton Assessment Procedure for the Elderly (CAPE) was used to assess and compare the behavioural disabilities between the two groups. In addition to their younger age, the home-cared elderly were less incontinent, more social, better communicators and less confused than the institutionalized group, despite the fact that they had more physical disabilities with regard to bathing and walking.

Activities of Daily Living↗