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PubMed1992

Predictive validity of factors influencing the institutionalization of elderly people with psycho-geriatric disorders.

The predictive validity of certain items was tested with respect to their influence on the institutionalization of elderly people with psycho-geriatric disorders (n = 69). Twelve items measuring both the patient's condition and the exhaustion around the patient were tested. Two outcome measurements were used, the first measuring the number of patients who were institutionalized after the end of 12 months and the second measuring the number of days at an institution during 12 months. The items "Exhaustion of spouse" and "Supervision need" showed the highest correlation with institutionalization and predicted institutionalization, better than items describing the degree of dementia.

Aged↗

PubMed1990

[Short-stay hospitalization of elderly persons: first step toward institutionalization?].

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence. The level of dependence of institutionalized patients was particularly high for dressing or bathing, technical care, mental status and security. A multivariate analysis showed that the only independent predictors of institutionalization were: sex, living alone, mental status and hospital type. The role played by physical disability must be counterbalanced by the effective physical assistance, brought to the elderly by institutional or informal home care after hospitalization. These results allow early identification of persons at high risk of institutionalization.

Activities of Daily Living↗

PubMed1989

[Advance of disability and prognosis in Duchenne muscular dystrophy--a comparison between institutionalized care and home care].

Rate of advance of disability and age at death were studied in patients with Duchenne muscular dystrophy (DMD). A comparison was made between DMD patients under care in their own homes and those hospitalized in National Suzuka Hospital. In 45 patients with home care, rate of advance of disability was considerably high in their age of 6 to 12 years, the average being 0.83 stage per year after the N.Y. University-Ueda's rating stage of disability. In the age of 12 to 17 years, however, the disease progression was much slower, the average being 0.14 stage per year. Beyond 18 years old, the average stage of disability was constantly 7.7, meaning almost bedridden stage. On the contrary, in 56 patients with institutionalized care, the average rate of advance was lower, being 0.5 stage per year in the age of 7 to 15 years and 0.13 stage per year from 15 to 23 years of age. The result of statistical analysis indicated that the stage of disability was significantly higher in the patients under the home care than those with institutionalized care at the age of 12-16, 18 and 19 years. The age when the patients became unable to walk was 9.7 +/- 1.8 years (mean +/- SD) in those with home care and 10.9 +/- 2.3 years in those with institutionalized care. The difference was statistically significant (p less than 0.01). The age at death was 18.3 +/- 3.8 years in 19 DMD patients with home care and 20.4 +/- 3.6 years in 33 patients with institutionalized care. The difference was also statistically significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Factors influencing survival and need for institutionalization following stroke: the Framingham Study.

The distinction between factors that influence survival after stroke and those that increase the likelihood of institutionalization is an important health issue. Estimates of survival and frequency of institutionalization after stroke vary widely, depending on the patient population. A precise picture of variability of outcome from stroke may be obtained from a prospective epidemiologic study. This report uses the Framingham Study population sample of 5,184 men and women, aged 30 to 62 at entry in 1948, who were free of cardiovascular disease. All completed strokes that occurred between 1971 and 1981 were evaluated. Of the 213 patients with completed strokes, 154 survived more than 30 days. Multivariate logistic regression analysis indicated that acute survival was negatively influenced by stroke type, severity of neurologic impairment, and age. For those who survived at least 30 days, independent living was determined by social factors as much as by severity of disability. Being married protected men but not women from institutionalization. Older women, married or not, with moderate to severe residual impairment and minimal education, were at highest risk of institutionalization. In acute stroke, medical factors dominated rates of survival. However, in those who survived, family and social factors had an equal impact in determining final outcome from stroke.

Activities of Daily Living↗

PubMed1979

Intellectual and personality differences between community-living and institutionalized older adult females.

The purpose of the present study was to investigate simultaneously differences between normal institutionalized older adults and community-living older adults with respect to intelligence/cognitive test performance and personality. Participants were 25 community-living females (M age = 72.9 yrs, SD = 6.34) and 25 institutionalized females (M age = 80.0 yrs, SD = 6.46). Intellectual/cognitive ability was assessed by the WAIS, Stanford-Binet Intelligence Scale (Form L-M), Ravens Coloured Progressive Matrices; personality was assessed by the Hand Test, a projective technique. Several multivariate analyses (discriminant analysis) were conducted. Results suggested that even when controlling for age and level of education, institutionalization appears to be associated with intellectual/cognitive as well as personality deficits. The findings were discussed in terms of the potential implications for the professional working with institutionalized older adults.

Aged↗

PubMed1989

Arthritis in nursing home residents. A validation of its prevalence and examination of its impact on institutionalization and functional status.

We studied nursing home residents to validate the method used in national surveys for estimating the prevalence of arthritis, and to examine the impact of arthritis on institutionalization and on the physical function of residents. Five homes were studied using a 3-phase approach. Directors of nursing in each home classified residents (n = 629) with respect to the presence of arthritis and senile dementia. The presence of osteoarthritis or rheumatoid arthritis and their impacts on a resident's initial placement were separately assessed by a physician through a chart review of a stratified subsample. The physician also rated a resident's likelihood of returning to community living. Finally, the functional impact of arthritis was assessed by a physical therapist. The nurses' estimate of the prevalence of arthritis in this population was 23.33%, while the physician estimate was 23.03%. These results are consistent with the 24.6% prevalence found in a 1977 national survey. Arthritis itself was a major cause of nursing home placement in 15% of all residents without dementia. Among those without dementia who also had arthritis, arthritis was a major cause of institutionalization in 31%. None of the residents without dementia showed substantial potential for reintegration into the community. Controlling for age, residents with arthritis had more pain, were more likely to require assistance in functional tasks, and were more likely to use a wheelchair daily than were their fellow residents. Nevertheless, our results suggest that arthritis, despite its impact on function, in and of itself is not a major cause of nursing home placement or ongoing institutionalization.

Activities of Daily Living↗

PubMed1990

A comparison of cognitive function in community-dwelling and institutionalized old people of normal intelligence.

Two carefully matched groups of normal old people living in institutions or in the community were administered a neuropsychological cognitive test battery. In general, the institutionalized group performed worse than the community group. Discriminant function analysis identified a subgroup of high-functioning institutionalized subjects whose performance more closely resembled that of the community group than the remainder of the institutionalized group. Differences between the various groups were not due to differences in IQ, age, health, or other controlled variables. The critical tests that differentiated the groups were sensitive to impaired function in frontal and medial-temporal lobe brain regions. The results suggest a complex interaction involving effects of age and environmental factors on brain function and cognition.

Aged↗

PubMed1975

A comparative computer content analysis of the verbal behavior of institutionalized and noninstitutionalized retarded children.

Previous studies have indicated structural language differences favoring the noninstitutionalized retarded when compared to matched institutionalized retarded children. In this study, a sociological and psychological deficit hypothesis for institutional retardates was explored by using a verbal content analysis system. Unstructured speech samples from 20 institutionalized and 20 noninstitutionalized retarded children were employed using the computerized General Inquirer System and the Harvard III Psychosociological Dictionary. Differences were found between the groups but all except two were negated or attenuated by additional extended manual analysis treatments. The findings of this study do not support a psychological or sociological deficit hypothesis for institutionalized educable retardates as measured by this content analysis system.

Adaptation, Psychological↗

PubMed1978

Psychotropic drug use among institutionalized and noninstitutionalized Medicaid aged in California.

Previous research has shown that prescription drug use is higher for the aged than for the general population. The present study uses the California Medicaid data base to compare the amount and pattern of prescription drug use among the aged to that of the general population and then compares, within the aged population, drug use by the institutionalized and noninstitutionalized. It was found that prescription drug use was higher for the aged as compared to the general population; among the aged, however, prescription drug expenditures were almost three times as high for the institutionalized as compared to the noninstitutionalized. The bulk of the difference in prescription drug expenditure among the aged subgroup was found to be due to a much higher level of psychotropic drug use among the institutionalized. Data from a sample of aged in a day health program raises questions about the appropriateness of this level of psychotropic drug use.

Aged↗

PubMed1991

Factors affecting decisions to institutionalize demented elderly.

This study followed 321 community-based patients with documented dementias, 22% of whom were institutionalized after 1 year. Multivariate analyses indicated that none of the patient characteristics, such as level of cognitive, psychiatric, or neurological impairment, predicted institutionalization. Social psychological characteristics, type and number of caregivers, and subjective caregiver distress did predict which patients were ultimately institutionalized. Implications for treatment planning are discussed.

Aged↗

PubMed1988

The prevalence and transmission of hepatitis B virus infection in urban, rural and institutionalized black children of Natal/KwaZulu, South Africa.

The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.

Adolescent↗

PubMed1990

Race/sex comparisons of elderly living arrangements. Factors influencing the institutionalized of the unmarried.

This article describes recent trends in the total institutionalization rates among unmarried Black and White populations, by sex. In addition, an analysis is provided that evaluates the individual attributes associated with the probability of institutionalization for these same groups in 1980. To accomplish these goals, U.S. Census data from the 1960, 1970, and 1980 Public Use Samples are employed. The evidence suggests convergence over time in age-standardized rates across both race and sex groups. Also, there is considerable consistency among the groups in the factors that predict the likelihood of being in a formal long-term care situation. Although the Black population continues to access formal institutions less frequently than does the White population, the findings suggest that forecasters and planners need to take into account the increasing rate of elderly Black institutionalization along with the individual characteristics that influence these rates.

Black or African American↗

PubMed1976

Sexual knowledge and attitudes of institutionalized and noninstitutionalized retarded adolescents.

Sixty-one noninstitutionalized and 60 institutionalized mentally retarded adolescents were psychometrically assessed on three measures: sexual knowledge, sexual attitudes, and self-concept. The two groups differed on total score on sex knowledge only, with the non institutionalized group being more knowledgeable. With regard to sexual attitudes and self-concept, the two groups did not differ in terms of total correct statements. Internal consistency demonstrated on all the measures ranged from .50 to .90. Intercorrelations of relevant variables for each group (10 for the noninstitutionalized, 13 for the institutionalized) produced several significant correlations. Results were discussed with reference to the development of a standardized instrument for assessing sex-education programs for mentally retarded persons.

Age Factors↗

PubMed1990

Vitamin C and nutritional status of institutionalized and noninstitutionalized elderly women in Rome.

A cross-sectional study on 64 institutionalized and 65 noninstitutionalized elderly women has been undertaken. The age range was 60 through 90 years. Vitamin C status was assessed by serum ascorbic acid measurement and the nutritional status was evaluated by a three-day dietary record and main anthropometric measurements. Mean concentration of ascorbic acid was 1.03 mg/dl in the noninstitutionalized and 0.67 mg/dl in the institutionalized group (p less than 0.001). A serum ascorbic acid level less than 0.2 mg/dl was found in one (1.5%) and seven (10.9%) subjects respectively (p less than 0.03). Mean intake of vitamin C was 104.1 mg/d in the former and 87.3 mg/d in the latter group (p = NS), being less than 45 mg/d in 16 living at home and 11 institutionalized women. Serum ascorbic acid level did not correlate significantly to dietary nutrient intake but correlated to activity of daily living level (r = 0.29), vitamin C intake (r = 0.23), ideal body weight (r = -0.15), relative body weight (r = 0.15) and body mass index (r = 0.14). Suggestions are made concerning a higher intake of vitamin C and a more careful catering to improve the health status of the elderly people living in large institutions. The authors also suggest to include the serum ascorbic level determination in the assessment of the general health status of the elderly.

Aged↗

PubMed1990

Hypotensive responses to common daily activities in institutionalized elderly. A potential risk for recurrent falls.

Transient hypotension may be one of many factors contributing to the high prevalence of falls among elderly people. To determine the frequency and magnitude of hypotensive responses to common daily activities, and their potential relationship to falls in the elderly, we examined blood pressure (BP) and heart rate during a standardized series of activities in 38 institutionalized recurrent fallers (age, 87 +/- 6 years), 20 institutionalized nonfallers (age, 85 +/- 5 years), and 10 healthy young control subjects (age, 24 +/- 3 years). The coefficient of variation for systolic BP during all activities was higher in elderly subjects (fallers, 14% +/- 5%; nonfallers, 12% +/- 3%) than in young control subjects (8% +/- 1%). In contrast, the coefficient of variation for heart rate during all activities was higher in young subjects than in the elderly subjects. Elderly subjects had marked BP reduction following meals and nitroglycerin, which was significantly greater in fallers than in nonfallers, independent of the cause of the fall. Thus, institutionalized elderly have marked BP variability and hypotensive responses to meals and nitroglycerin. A decline in BP during common preload-reducing stresses may predispose some elderly people to falls.

Accidental Falls↗

PubMed1990

Lactose maldigestion: increased age-related prevalence in institutionalized children.

A study was performed to determine whether the age-related prevalence of lactose maldigestion is increased in healthy institutionalized children. Previous malnutrition did not exclude children from study. The control children had no prior history of malnutrition or hospital admissions for diarrhea. The anthropometric comparison showed the institutionalized children to be shorter and lighter than the controls, but they were of normal weight by stature, suggesting a normal recent nutritional state. Fasting breath hydrogen tests were performed following an oral dose of lactose 1 g/kg, given as a 10% solution. A rise of breath hydrogen of greater than or equal to 20 ppm was considered to indicate lactose maldigestion. Twenty-two of 44 controls and 39 of 49 study children were lactose maldigesters (p less than 0.01). The control children showed an age-related increase in the prevalence of lactose maldigestion, from 31.6% at age less than 5 years to 75% at age greater than 9 years. The institutionalized children, by comparison had an increased prevalence of 78.8% in the group under 5 years of age (p = 0.002). Equally high prevalence rates were found at all ages tested. At follow-up, lactose maldigestion was persistent in the majority of the study children. This had no nutritional impact despite a regular milk intake. The distinction between acquired and primary lactose maldigestion is of no practical significance in these children.

Adolescent↗

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↗

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↗