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PubMed1996

[Food intake and biochemical variables: overall nutrition and metabolic status of a group of non-institutionalized elderly in Venezuela].

To evaluate the quality of life, and to establish local reference standards, the nutritional and metabolic status were assessed in two-hundred-eleven non-institutionalized adults divided in two groups: the experimental (> or = 60 years old), and the control (< 60 years old). The anthropometric nutritional status was assessed with the Quetelet Index with no significant differences between the age groups. The 24-hour recall method in the dietetic evaluation showed a high lipid and protein diet, which is characteristic of the region. The diet is deficient in energy, carbohydrates, fiber, copper, and zinc. Biochemical determinations of zinc, copper, total protein, albumin, alkaline phosphatase, triglyceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, glucose, and insulin, were performed on 12-hours fasting subjects without significant (p < 0.05) age-based differences, except albumin levels, which reflects overall protein status. On the other hand, albumin, trygliceride, total cholesterol, HDL-cholesterol, LDL-cholesterol, and copper levels showed sex-based and age-sex-based significant differences (p < 0.05). Similar studies should be made on institutionalized or free-living individuals, from different socioeconomic levels and a nutritional status assessed by anthropometric measures, body composition, and food intake.

Aged↗
PubMed1998

Hospitalization, inpatient physical therapy and institutionalization after hospital discharge of prostate cancer patients in south Florida.

PURPOSE: Explaining survival variation in prostate cancer requires the identification of new predictive factors, of which physical function is attractive hypothetically. To understand physical dysfunction in prostate cancer better, we examined medical claims. Our aims were to describe the consumption of inpatient resources, examine the association of physical therapy with institutionalization after hospital discharge and determine the association of disease stage with frequency of hospitalization, inpatient physical therapy and discharge to a skilled nursing facility. MATERIALS AND METHODS: We used 1994 Medicare claims for patients in South Florida who had prostate cancer. To examine the association of disease stage with use of health services, we inferred disease stage from stage specific treatment. Multiple linear regression was used to examine the interaction of inferred disease stage with health services while adjusting for age. RESULTS: A total of 22,279 residents of South Florida a mean of 78.3 years old with prostate cancer billed Medicare in 1994. Of these patients 2,507 were admitted to a hospital 4,606 times, resulting in total charges of $70 million. Many claims indicated physical dysfunction, including 1,896 charges for physical therapy, which was associated with more institutionalization after hospital discharge. Disease stage and patient age were individually associated with the frequency of hospitalization, inpatient physical therapy and discharge to a skilled nursing facility. CONCLUSIONS: Inpatients with prostate cancer have substantial stage dependent physical dysfunction. If the hypothesized interaction of physical dysfunction with mortality is confirmed in prospective studies and outpatient settings, theoretically the door will have been opened to new interventions for prolonging survival in patients with prostate cancer.

Aged↗
PubMed1995

Upper gastrointestinal tract bleeding in institutionalized mentally retarded adults. Primary role of esophagitis.

BACKGROUND: Upper gastrointestinal (UGI) tract bleeding is a common reason for hospitalization of mentally retarded adults. The purpose of this study was to determine the frequency and cause of and risk factors for UGI tract bleeding in institutionalized mentally retarded adults admitted to our hospital. METHODS: Case-control study, with a retrospective review of medical records. SETTING: Inner-city tertiary care hospital. PATIENTS: Mentally retarded adults who reside in one of three long-term care facilities. MEASUREMENTS: Data on demographic features, clinical features, and concurrent medical conditions were collected on mentally retarded adults admitted to our hospital for UGI tract bleeding (n = 40). Data from these patients were compared with those from a control group of mentally retarded adults admitted for nonbleeding conditions (n = 124). Endoscopic data were reviewed on the patients who bled to further clarify the causes of UGI tract bleeding. The patients who bled were compared with those who did not bleed using the chi 2 and Mann-Whitney rank sum tests. RESULTS: Upper gastrointestinal tract bleeding was the most common reason for hospitalization in this patient population. Such bleeding was most commonly caused by erosive esophagitis (70% of patients who bled). Conditions associated with an increased risk for UGI tract bleeding were hiatal hernia, reduced activity, incontinence, hypoalbuminemia, kyphoscoliosis, and spastic quadriplegia. CONCLUSIONS: Upper gastrointestinal tract bleeding is a common cause of hospitalization in mentally retarded adults and is usually due to erosive esophagitis. It is hoped that vigorous efforts to treat gastroesophageal reflux disease may reduce hospitalization in these patients.

Adult↗
PubMed1996

Frequency of Fra X syndrome among institutionalized mentally retarded males in Poland.

Results of cytogenetic studies, performed in a group of 201 institutionalized mentally retarded males, are presented. At least two cytogenetic methods for eliciting the Xq27.3 fragile site, recommended by the Fourth International Workshop on the Fra X Syndrome were used. A subgroup of 67 out of 201 studied males was also examined using molecular methods. In 6 (2.9%) males fra X syndrome was diagnosed. All cytogenetic positive results were confirmed by molecular analysis. Five patients had full expansion CGG repeats and one had both premutation and full mutation. Postulated frequency of fra X syndrome in Polish population being 0.2-0.4/1,000 males seems to be lower than it could be expected on the basis of previous literature data.

Fragile X Syndrome↗
PubMed2000

Relocation of the institutionalized aged.

The effects of relocation and institutionalization upon frail older people have been studied extensively for the past several decades and have been a topic of some controversy. Because of varying methodologies, differing populations, overlooked variables, and mistakes in interpretation, this area of epidemiological research has resulted in debate among scholars in the field. It may be helpful to review some of the research that has been done, examine a theory of why mortality seems to increase when older people are involuntarily relocated, speculate upon how this effect might be minimized, and introduce some data that seemingly would confirm that careful planning for relocation might, in fact, reduce subsequent morbidity and mortality.

Adaptation, Psychological↗
PubMed1998

Tardive dyskinesia in a chronically institutionalized population of elderly schizophrenic patients: prevalence and association with cognitive impairment.

BACKGROUND: Chronically hospitalized geriatric inpatients with schizophrenia are at particular risk for both tardive dyskinesia (TD) and cognitive impairment but have been insufficiently studied in this regard. Similarly, the relationship between TD and cognitive impairment has not be adequately addressed in this population. OBJECTIVES: (1) To determine the prevalence of TD in a cohort of chronically institutionalized schizophrenic geriatric inpatients. (2) To examine the relationship between the manifestations of TD in various body regions and several potentially related variables including current pharmacological regimen, age, age at first hospitalization and cognitive status. METHOD: TD was assessed by the Modified Simpson Dyskinesia Scale and cognitive status by the Mini-Mental State Examination (MMSE). The relationship between manifestations of TD and other variables was examined by t-tests, ANOVA, MANOVA and correlational analysis. RESULTS: The prevalence of TD was 60%. Prevalence increased with age but was not related to current antipsychotic or anticholinergic regimen. Mean MMSE score did not differ between groups of patients with and without TD as defined by the criteria of Schooler and Kane (1982); however, the mean MMSE score was significantly (p < 0.0004) lower in subjects with orofacial TD as defined by Waddington and Youssef (1996), and the difference was not entirely accounted for by the older age of the latter group. CONCLUSIONS: TD and cognitive impairment both increase with age. However, TD alone does not account for the severity of cognitive impairment in this population. The present study provides further support for the hypothesis that the correlation between TD and cognitive impairment holds primarily for the orofacial manifestations of TD.

Age Factors↗
PubMed1991

Personality stability of institutionalized mentally retarded adults as measured by the Hand Test.

Eighty-two institutionalized mentally retarded individuals were administered the Hand Test and a measure of intellectual/cognitive functioning (Stanford-Binet or WAIS-R) in a 3-year test-retest paradigm (longitudinal research design) to investigate the stability of personality during adulthood. Stability of both personality and intellectual functioning during adulthood was observed. Implications are discussed.

Achievement↗
PubMed1990

A prevalence study of Rett syndrome in an institutionalized population.

An institution for the mentally retarded was surveyed to determine the prevalence rate of Rett syndrome (RS). Four patients with definite RS and one with probable RS were identified in a population of 350, yielding a prevalence rate of 1 in 87, about 1% of institutionalized male and female patients with mental retardation. In this population of patients with severe and profound mental retardation (N = 297), 138 females were surveyed, suggesting a prevalence rate among females of 1 in 34 in an institutional population of persons with mental retardation. Surveys of institutions for persons with mental retardation may be an effective method to identify adults with RS.

Adolescent↗
PubMed2002

The institutionalization of a concept.

Government involvement with psychiatry creates potentially great opportunities, as hitherto neglected problems receive attention and funding. When seriously harmful behaviour is involved, however, such opportunity can be limited or lost. Parallel consideration of legal restraints on those people with serious disorder who commit harm to others seems to spill over into restraints on clinical conceptualization of the disorder, on the shape of clinical treatment programmes and even on the people who deliver treatment. Greater clarity for everyone about the individuality and variety of people with personality disorders and a propensity for serious offending will be a critical factor in avoidance of new forms of institutionalization, the dangers of which have only been hinted at in literature to date.

Commitment of Persons with Psychiatric Disorders↗
PubMed2004

Reasons of informal caregivers for institutionalizing dementia patients previously living at home: the Pixel study.

CONTEXT: Study of the problems and requirements of the main caregiver providing home care for dementia patients that have resulted in the patient being institutionalised. OBJECTIVES: To determine the reasons for placing the dementia patient in an institution. RESOURCES: Self-administered questionnaire of 48 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the geriatrician. RESULTS: Data were collected from 109 questionnaires concerning 75 females with dementia (84.7 +/- 6.7 years) and 34 demented males (80.8 +/- 7.4 years). In two-thirds of cases the main caregiver was a female, aged 61.1 +/- 12.1 years. Cognitive disorders were not the main reasons for institutionalizing patients. The most frequent caregiver complaint at the time of institutionalisation was incontinence, followed by withdrawal. The caregiver's main problem resulting in institutionalisation was dependence, with behavioural disorders in second place. A treatment with anticholinesterase for dementia was associated with a live-in career being provided for 20 months longer than in the case of patients not receiving this treatment. Statistical analysis revealed 6 groups of separate caregiver-patient situations. On the one hand there were those patients who appeared to be easy for the caregiver to cope with: those with no problems, docile patients and passive patients not opposing care. In these cases the caregiver was most often young and male, or not directly related to the patient. On the other hand there were 3 other groups: patients with inappropriate motor behaviours, violent/agitated patients and unmotivated patients who opposed care. These patients lived with an elderly caregiver who had been looking after the patient for several years. DISCUSSION: Caregivers' requirements are for help with coping with and preventing dependence. The caregiver suffers terribly from a lack of relief, particularly when young. CONCLUSION: It is necessary to change the focus of home care for dementia patients towards preventing loss of autonomy and its consequences and to allow for periods of relief for home caregivers.

Adaptation, Psychological↗
PubMedDate not supplied

The relationship of hardiness and depression to disability in institutionalized older adults.

Disability is an often expensive and sometimes preventable consequence of chronic illness. This study explored the relationship of hardiness and depression to disability in a sample (N = 58) of aged, institutionalized persons, controlling for length of stay (LOS) in the nursing home and physical health status. Using hierarchical regression analysis, LOS and physical health status accounted for 14.7% of the variance in disability (p = .01). Hardiness explained an additional 10.5% of the variance (p = .008). Depression accounted for an additional 7.4% (p = .02) of the variance in disability. The results of this study support the premise that psychological factors may increase a person's degree of disability beyond what might be expected from the physical illness or injury alone.

Aged↗
PubMed1995

Development of health risk appraisal functions in the presence of multiple indicators: the Framingham Study nursing home institutionalization model.

A health risk appraisal function is a mathematical model designed to estimate the risk or probability of a person's mortality or morbidity for various diseases based upon risk factors such as age, medical history and smoking behaviour. The Framingham Study has contributed substantially to the development and use of these for endpoints such as mortality and incidence of coronary heart disease and other cardiovascular diseases. This paper discusses a methodology for the development of health risk appraisal functions when the number of potential risk factors is large and illustrates it with sex specific functions for nursing home institutionalization. The methodology involves grouping variables substantively into sets, applying principal component factor analysis and variable clustering to obtain substantively meaningful composite scores, ranking these in order of substantive importance, and then entering these with a hierarchical ordering into a Cox proportional hazard regression.

Adult↗
PubMed1992

Optimal drug and behavior therapy for treatment-refractory institutionalized schizophrenics.

Institutionalized persons with a deteriorating form of schizophrenia that was refractory to neuroleptic medication were titrated downward in their haloperidol dose. Based on ratings of their clinical status, an optimal dose was reached that was an average 66 percent reduction from their initial levels. Patients then participated in a personalized, intensive behavior therapy program to remediate their extreme, persisting deficits and disturbances in behavior.

Adult↗
PubMed1981

Dimensions of problem behavior in institutionalized retardates.

A factor analysis of teacher ratings of 55 items of deviant behavior in a sample of 252 institutionalized retardates resulted in the emergence of three interpretable factors. Two factors clearly represented the broad-band dimensions of conduct disorder and anxiety-withdrawal, while the third reflected psychotic behavior. Only conduct disorder was related to age, sex, race, or intellectual level.

Adolescent↗
PubMed1977

Perceptions of family relationships by institutionalized and noninstitutionalized dependent children.

This paper reports research findings obtained regarding family relationships for three groups of adolescents: institutionalized, dependent children; noninstitutionalized, dependent children who are candidates for placement in institutions; and children living with their parents. It also describes a relatively novel, nonverbal, research instrument, the Family Relations Test, used to obtain the data. The conclusion is drawn that one of the major tasks of child care institutions is to restore children's self-esteem and confidence--yet it is far from certain as to whether these settings are capable of accomplishing this important task.

Adolescent↗
PubMed1989

Psychiatric day hospitals--another route to institutionalization?

Nineteen long-stay day patients were referred to a rehabilitation team and their outcome after a year is compared with 19 day patients who were not referred, but were matched for age, sex and diagnosis. Seven rehabilitation team patients had been discharged at 12 months as against 3 of the non-rehabilitation patients, but this was not a significant difference. Discharged patients were less disturbed at the beginning of the study and had fewer negative symptoms throughout. Discharge did not reduce the frequency of social contact. There was a suggestion that morale was sustained better in the rehabilitation patient and in their nurses. We conclude that rehabilitation planning may have beneficially accelerated the discharge of less ill day-patients, but that more resources are needed to prevent 'institutionalization' within the day-hospital.

Adult↗
PubMed1989

Family functioning in families with older institutionalized retarded offspring.

Psychological distress, marital satisfaction, family adaptability, and cohesion are explored in 31 families with mentally retarded (MR) institutionalized offspring (late adolescence and young adulthood) and 38 comparison families. Multivariate analyses indicate no differences between the groups, although univariate analyses point to higher levels of cohesion in the families with MR offspring and the importance of the construct of adaptability in understanding family functioning. The results are discussed in terms of the adaptive coping mechanisms of the families with MR offspring and the implications of this for intervention, research, and policy.

Adaptation, Psychological↗