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PubMed1995

Training food service supervisors using hand-held computers to conduct nutritional screening of institutionalized elderly patients.

Six food service supervisors (FSSs) working in skilled nursing facilities were trained to use a hand-held computer, COMPU-CAL/PRO 5.1, to screen institutionalized elderly patients for selected nutritional variables and to record results in the medical record. The study demonstrates that hand-held computer-assisted nutritional screenings: (1) are readily adaptable to on-going efforts, (2) are useful in identifying potential indicators of poor nutritional status in institutionalized elderly patients, (3) can be taught to FSS in a relatively short time, (4) increase nutritionally relevant variables that can be assessed, and (5) improve the quality of documentation in the medical record.

Adult↗

PubMedDate not supplied

[Institutionalization of nursing teaching in Paraiba: a trip to the past].

The purpose of this study was to carry out an historical rescue of the institutionalization of nursing education as it occurred in Paraíba. Due to the lack of written information on this subject, the authors carried out the research relying on primary and secondary oral sources. The authors verified that the institutionalization of nursing education in Paraíba occurred in the 1950's, period in which the so-called medical-sanitary model was in vogue at public health services. Among the many significant moments of the study, the authors highlight an interview with Mrs. Doralice Kluppel, a nurse which participated in the team of teachers which established the first School of Nursing in Paraíba, for she brings out feelings of worth and respect for the work carried out by this group of forerunners in nursing education in Paraíba.

Brazil↗

PubMedDate not supplied

Institutionalizing the evaluation of health programs and policies in France: "cuisine internationale" over fast food and "sur mesure" over ready-made.

The purpose of this article is to describe several chronological milestones in institutionalizing the evaluation of public programs and policies in France from a governmental perspective and in the health sector, situating such references in the international context. The institutional nature of evaluation implies integrating it into an action-oriented model, linking analytical activities to management, thus constituting the formulation of an evaluation policy for policy evaluation. The study focuses on issues related to the structure, practice, and utilization of evaluation results as well as other characteristics providing the French model with a certain resistance to traditional "fast-food" or "ready-made" methodological approaches. The institutionalization of sectorial evaluation appears more promising than that of the government's centralized channel, despite the work developed by a Scientific Evaluation Council, and suggests avenues for reflection and debate pertaining to the Brazilian Unified Health System.

France↗

PubMed1972

Developing proper mealtime behaviors of the institutionalized retarded.

The institutionalized mentally retarded display a variety of unsanitary, disruptive, and improper table manners. A program was developed that included (1) acquisition-training of a high standard of proper table manners and (2) maintenance procedures to provide continued motivation to maintain proper mealtime behaviors and decrease improper skills. Twelve retardates received acquisition training, individually, by a combination of verbal instruction, imitation, and manual guidance. The students then ate in their group dining arrangement where the staff supervisor provided continuing approval for proper manners and verbal correction and timeout for improper manners. The results were: (1) the trained retardates showed significant improvement, whereas those untrained did not; (2) the trained retardates ate as well in the institution as non-retarded customers did in a public restaurant; (3) proper eating was maintained in the group dining setting; (4) timeout was rarely needed; (5) the program was easily administered by regular staff in a regular dining setting. The rapidity, feasibility, and effectiveness of the program suggests the program as a solution to improper mealtime behaviors by the institutionalized mentally retarded.

Journal Article↗

PubMedDate not supplied

Performance of institutionalized and community-active old persons on concrete and formal Piagetian tasks.

This study investigates the effects of age, level of education, and institutionalization on the development of logical thinking. Seven Piagetian tasks, encompassing three levels of difficulty, were administered to thirty-four persons sixty-eight years of age or older. A significant positive relationship was found between success on task and educational level. With education controlled, Community-active elders performed significantly better than Institutionalized elders. Within the limitations of a cross-sectional design, results supported the hypothesis that cognitive abilities in old age retain an orderly structure.

Aged↗

PubMed1980

Construct validation of the Hand Test Withdrawal score on institutionalized older adults.

The Hand Test Withdrawal score was correlated with an independent criterion measure of general intactness, the Mental Status Questionnaire, for a sample of 57 "normal," institutionalized, elderly (M age = 77.26 yr.) to establish the construct validity of the Withdrawal score for older adults. A Pearson r of .43 (p < .001) was obtained, suggesting that the Withdrawal score is a valid measure of mental status or general intactness for institutionalized older adults.

Aged↗

PubMed1999

[Compliance concerning external protectors for hip fractures among the institutionalized elderly in Japan].

An external protector (EHP) which was developed in Europe to protect the femoral neck from direct impact on falling is available but has not been examined sufficiently in Japan. In order to explore the compliance of use of the EHP among the institutionalized elderly with in case of hip fracture who are at high risk of falling, we conducted the four-week intervention study using two types of a EHP. The subjects of a study consisted of 10 elderly people (2 men, 8 women) with a mean age 85.7 living in nursing home in a village. Informed consent was obtained from all participants. At the end of the study, rate of subjects who wore EHP was relatively high for the Finnish EHP (Safety Pants) group compared to the Danish EHP (Hip Protector) group. There were no significant differences between variables in age, sex, fall experience during the previous year, history of diseases etc. The reasons for dropout were first: difficult in wearing EHP and accompanying delay in toilet, secondly: taking much time to wear, thirdly: a sense of incongruity, too small or too tight'. If the EHP is redesigned to suit Japanese elderly, the compliance might increase. Thorough explanation to institutionalized elderly who may have cognitive impairment, physical problems, or both, is required.

Aged↗

PubMed2001

The institutionalization of children's feeding programs in Atlantic Canada.

This study traces the evolution of children's feeding programs established in Atlantic Canada from a few months to over 15 years ago. Our qualitative analysis of nine children's feeding programs in Atlantic Canada revealed that they began as an ad hoc, community-based effort to feed hungry children. All subsequently experienced stress related to community mobilization. In order to recover from this stress, programs "routinized," often with fewer volunteers or by adopting measures that ensured efficiency and stability. While one program remained routinized, others gradually assumed more features of institutionalization as a response to externally or internally imposed crises. They did so by adopting professional management strategies and often hiring professional personnel. As the institutionalized programs continued, they became driven by the need to feed themselves, which was often greater than their mission to feed hungry children. The challenge for dietitians assisting children's feeding program operators, policy makers, children's advocates, and citizens is to reflect upon which organizational models of children's feeding programs should be supported.

Canada↗

PubMed1975

Preinstitutional social deprivation, responsiveness to social reinforcement, and IQ change in institutionalized retarded individuals.

Mentally retarded individuals who had been examined on a task measuring responsiveness to social reinforcement after 3 weeks and after 3 years of institutionalization were examined after 6 years of institutionalization. IQ changes were also examined. For familially retarded subjects, a linear decrease in responsiveness to social reinforcement and a linear increase in IQ was found from the 1st to the 6th year of institutional life. No changes in responsiveness to social reinforcement or IQ were found over the 6 years for nonfamilially retarded subjects.

Hospitalization↗

PubMed2002

[Factors associated with self-rated health for non-institutionalized aged persons].

OBJECTIVE: To determine factors affecting self-rated health among the non-institutionalized elderly in Japan. METHODS: In 20 municipalities in Japan, 6,094 persons aged 65 years and older who were not institutionalized were selected at random. A questionnaire survey was conducted from September through November 2000. The distribution of self-rated health was rated in terms of dependent variables, with odds ratios and their 95% confidence intervals calculated using unconditional logistic models. RESULTS: Of the study population, 5,565 persons (91.8%) responded to the survey. Of the respondents, 64.4% answered that they were healthy, while 28.8% were not. The necessity for periodical visit to hospitals and clinics, and lowering of the activity of daily living greatly lowered self-rated health. Compared with those who were 85 years of age or older, a high health status was observed among those aged between 75 and 84 years, but not those aged 65 to 74 years. Those who tried to have exercise periodically, who had a vice-leadership role in a group, who joined social activities, who lived what they considered a worthwhile life, and who had positive positive activities in daily life, had high levels of self-rated health. Joining social activities for passive reasons elevated the health as well as joining for active reasons such as "because it is fun." CONCLUSION: Even if the reason is passive, joining social activities may elevate the self-rated health levels of elderly people.

Aged↗

PubMed1993

[Population aging and institutionalization of elderly persons: some possible projections for Canada].

The consequences of population aging on the demand for institutional lodging will undoubtedly be considerable. The authors have estimated this future demand in relationship with the evolution of certain socio-demographic characteristics of tomorrow's elderly. Based on a multivariate analysis (logit model), their projections will demonstrate the need for an approach which takes into account the replacement of generations among the ranks of aged persons. In fact, in future the latter will be appreciably different from today's generations. Their sociodemographic characteristics will have an impact on the risk of living in an institution and, thus, on the proportion and the number of institutionalized elderly people. Furthermore, they will probably be in a position to be able to contribute towards a greater portion of the costs of institutional living. Certainly, the burden of institutionalization will be further weighed down by the arrival of the Baby Boomers into the 65 years and over age bracket. This article nevertheless distinguishes some significant nuances within the scope of this phenomenon.

Americas↗

PubMed2002

Recommended micronutrient supplementation for institutionalized elderly.

A committee nominated by the Israel Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily micronutrient supplementation for institutionalized elderly living in institutions supervised by the Ministry of Health. The micronutrient preparatory, tailored for this population, is designed to contain about half the RDA for most of the vitamins and some microelements. Biotin and vitamins C, D and B12 as well as zinc, copper, chromium and molybdenum are suggested at a level higher than half the RDA, whereas fluorine, at a lower level. Major elements (calcium, magnesium and phosphorus) are excluded and should be supplied separately. Vitamin K and iron are also excluded. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation for institutionalized elderly is part of the Ministry of Health s balanced nutrition policy. The committee s recommendations are also applicable to the free-living elderly population.

Journal Article↗

PubMed2002

Enteral nutrition in French institutionalized patients: a multicentric study.

BACKGROUND: No previous studies have demonstrated either a nutritional improvement, or a survival benefit from tube placement in an institutionalized population. OBJECTIVE: The aim of this study was to determine current indications for tube feeding in French geriatric centers and to evaluate clinical outcome and mortality rates in these frail very old patients. DESIGN: Between November 1, 2000 and April 31, 2001, we prospectively recruited all hospitalized or institutionalized patients who received enteral nutrition (EN) in 7 Departments of Geriatric Medicine in France. Nutritional parameters and main indications of EN were recorded at the time of feeding tube placement. Pneumonia and mortality rates were observed over a period of one year. RESULTS: 57 patients of mean age 81.6 7.8 yrs underwent placement of a feeding tube. Mean BMI value was 20.7 4.8 and mean serum albumin level 26.1 6.1 g/L. The most frequent indications for EN included stoke (39%) and other neurologic diseases (42%). Fourteen patients (25%) died within 30 days, and 27 (47%) died over the 12-month follow-up period. During the first month, an episode of pneumonia was noted in 26 cases (55%). CONCLUSION: The similarity between rates of early mortality reported in our study and those reported in several previous studies involving younger, ambulatory subjects is surprising because we might expect poorer survival in our frail elderly patients. We can think that French geriatric teams have changed their attitudes toward EN in recent years, EN being less frequently used in patients with advanced dementia and at the end-stage of life.

Journal Article↗

PubMed2002

Energy balance and malnutrition in institutionalized elderly people.

Screening tools and more extensive assessment methods have signaled that malnutrition is common in institutionalized elderly. There are multiple factors - physiologic and non-physiologic - which hereby increase the risk of negative energy balance leading to weight loss and subsequent undesirable outcomes. Addressing this problem a number of controlled intervention studies have shown positive effects of 'simple' nutrition interventions in institutionalized older persons.

Journal Article↗

PubMed2003

Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women.

Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score < 17: malnourished, 2 degrees score >17 and < 24: at risk of malnutrition, 3 degrees score >24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p < 0,01). The subjects "at risk of malnutrition" had significant lower BMI, ADL score (p < 0.01), tricipital skin fold and serum albumin (p < 0.05). Ultrasound parameters were low independently of the nutritional status. MNA score correlated significantly with tricipital skin fold (r = 0.508, p < 0.01), ADL (r = 0.538, p < 0.01) and albumin serum level (r = 0.409, p = 0.01). There was a trend for a correlation between the MNA and the ultrasound parameter BUA (r = 0.207, p = 0.07), whereas no correlation was found with SOS and SI. A multivariate analysis showed that tricipital skin fold and ADL explained 61% of the variance of the MNA. In conclusion, using simple and non invasive methods, this study showed that malnutrition and osteoporosis are frequent in institutionalized elderly persons in our country, and the ultrasound parameters are influenced by many others factors in addition to nutrition, especially at this age and in elderly residents of nursing homes.

Activities of Daily Living↗

PubMedDate not supplied

A cross-national comparison of institutionalized tube-fed older persons: the influence of contrasting healthcare systems.

OBJECTIVE: Different health care settings may influence the type of patients selected for long-term tube-feeding. Clinical characteristics of older, tube-fed institutionalized subjects living in Ontario, Canada were compared with those in the United States (US). DESIGN: A cross-sectional cohort study Setting: Nursing homes in the states of Mississippi, Texas, and Vermont (US) and chronic care facilities in Ontario. PARTICIPANTS: Tube-fed residents older than age 65 living in facilities in the US between January 1, 1996, and March 31, 1997 (n = 859), and in institutions in Ontario between January 1, 1996, and December 31, 1997 (n = 913). MEASUREMENTS: Data were obtained from Minimum Dataset assessments at both sites. Demographic and clinical characteristics were compared between tube-fed subjects living in the US and those in Canadian facilities. RESULTS: In a logistic regression model, the following characteristics were significantly more likely to be found among tube-fed subjects in the US than in those in Ontario: greater impairment of cognitive performance, cardiopulmonary disease, a diagnosis of dementia, female, and age greater than 80 years. Characteristics that were significantly less likely to be present among the US tube-fed subjects included: recurrent lung aspirations, a chewing or swallowing problem, do not resuscitate status, restraint use, weight loss, and stroke. CONCLUSIONS: Clinical characteristics differ between older, institutionalized tube-fed subjects in Ontario and in US nursing homes. In order to put these differences into context, consideration must be given to how the contrasting healthcare systems in these two countries may drive decision-making for long-term tube-feeding.

Journal Article↗

PubMed2003

[Prevalence and risk factors of pseudoexfoliation syndrome in institutionalized geriatric patients in Navarra].

PURPOSE: To establish the prevalence of pseudoexfoliation syndrome (PSX) in an institutionalized geriatric population in Navarra. To study the risk factors for the development of this disease. MATERIAL AND METHODS: 268 nursing home residents were studied, with a mean age of 81 years. The presence of PSX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. We assessed its association with 13 ocular factors and 14 systemic factors. RESULTS: We found 10.1% (27) of subjects with PSX, 19 cases were unilateral and 8 bilateral. The frequency detected in subjects from Navarra was 7.9% versus 21.2% in subjects from other regions (p=0.02), although the significance was lost after multivariant logistic regression. The PSX was 3.5 times more frequent in patients suffering heart failure (p=0.01). The PSX was associated with anti-glaucomatous treatment, which multiplies the risk by 3.2 times (p=0.02); patients affected with age-related geographic macular atrophy had a 2.6 fold increased frequency (p=0.03), both after adjusting for age remained significant. We did not find any association between the PSX and other systemic factors (systemic hypertension and diabetes mellitus) or ocular factors (senile arc and cataract). CONCLUSIONS: The prevalence of PSX syndrome seems to be lower in an institutionalized population in Navarra than in other Spanish regions. The correlation with heart failure and age-related geographic macular atrophy suggests the possibility of a vascular role. The epidemiological association with increased IOP is confirmed.

Age Factors↗

PubMed1977

Antibody to hepatitis A antigen in institutionalized mentally retarded patients.

Institutionalized patients with Down syndrome and matched controls with other causes of mental retardation were tested by immune adherence hemagglutination for the presence of antibody to hepatitis A antigen (anti-HA). Altogether 75.1% (175 of 233) exhibited presence of anti-HA, with no differences by sex or age. Patients reactive for hepatitis B surface antigen (HBsAg) or its antibody (anti-HBs) were reactive for anti-HA significantly more frequently than those with a negative reaction for these markers. In contrast to serologic markers of hepatitis type B, prevalence of anti-HA does not depend on the cause of mental retardation or on the age at primary infection. The rate of anti-HA positivity was found to be closely correlated with duration of institutionalization. The study confirmed that many closed institutions for the mentally retarded are hyperendemic for hepatitis type A and that formation of anti-HA is not greatly affected by either immune deficiency or immune immaturity.

Adolescent↗