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PubMed1994

The incidence of hip fractures in independent and institutionalized elderly people.

The incidence density of hip fractures in the population of Amsterdam, aged 70 years and over, was studied according to the type of residence. In 1989, 655 patients were admitted to nine hospitals within Amsterdam for a hip fracture. Postal codes were used to classify the residence of the population and the hip fracture cases as independent, home for the elderly or nursing home. Stepwise logistic regression was used for data analysis. The risk of hip fracture increased with age and was 1.7 times higher for women than for men. In the age group 70-74 years the relative risk (RR) was 7.6 for those in homes for the elderly and 5.8 for those in nursing homes, when compared with the independent elderly. This RR was approximately 1 for those in homes for the elderly aged 85 years and over. However, in nursing homes the RR was still 2.8 in the age group 95+. We concluded that, despite protective measures against falls, the institutionalized elderly are at greater risk of hip fracture than the independent elderly of the same age and sex. This higher risk is especially apparent in the 'younger' age groups.

Age Factors↗

PubMed1980

Bone mineral status measured by direct photon absorptiometry in institutionalized adults receiving long-term anticonvulsant therapy and multivitamin supplementation.

The effects of long-term anticonvulsant drug therapy and multivitamin supplementation on bone mineral status were evaluated by direct photon absorptiometry in 53 adult residents of an institution for the mentally disturbed. Results demonstrated a similar amount of osteopenia for control subjects and those on anticonvulsant drugs. Average osteopenia was 8% for control subjects and 6% for subjects taking anticonvulsant drugs. Significant osteopenia was found in 25% of subjects taking anticonvulsant drugs and 20% of control subjects. Multivitamin supplementation had a beneficial effect on bone status in both subject groups. The use of anticonvulsant drugs had a significant effect on levels of alkaline phosphatase. Elevated alkaline phosphatase was found in 37% of subjects taking anticonvulsant drugs and 22% of control subjects. Hypocalcemia was found only in subjects taking anticonvulsant drugs (19%). Average calcium values were similar for both subject groups. Multivitamins were shown to have no significant effect on alkaline phosphatase or calcium values. Because both control subjects and those taking anticonvulsant drugs showed similar levels of osteopenia, factors other than anticonvulsant drug therapy appeared to adversely affect bone mineral status in this population. Conversely, multivitamin supplementation and the dietary control present in the institutionalized setting appear to have ameliorated the osteopenia commonly seen in anticonvulsant-treated populations without greatly modifying elevated alkaline phosphatase and hypocalcemia.

Adult↗

PubMed1987

Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women.

Fifty elderly (mean age, 83.4 +/- 8.8 years) institutionalized women with asymptomatic bacteriuria were randomly assigned either to receive therapy for treatment of all episodes of bacteriuria identified on monthly culture or to receive no therapy unless symptoms developed. Subjects were followed for one year. The therapy group had a mean monthly prevalence of bacteriuria 31 +/- 15 percent lower than those in the no-therapy group, but periods free of bacteriuria lasting six months or longer were documented for only five (24 percent) subjects. For residents receiving no therapy, 71 percent showed persistent infection with the same organism(s). Antimicrobial therapy was associated with an increased incidence of reinfection (1.67 versus 0.87 per patient-year) and adverse antimicrobial drug effects (0.51 versus 0.046 per patient-year) as well as isolation of increasingly resistant organisms in recurrent infection when compared with no therapy. No differences in genitourinary morbidity or mortality were observed between the groups. Thus, despite a lowered prevalence of bacteriuria, no short-term benefits were identified and some harmful effects were observed with treatment of asymptomatic bacteriuria. These data support current recommendations of no therapy for asymptomatic bacteriuria in this population.

Aged↗

PubMed1994

Functional recovery after operative treatment of femoral neck fractures in an institutionalized elderly population.

Agreement that hip fracture is best treated surgically stems from the fact that early mobilization of the patient reduces morbidity and mortality. This concept was tested in 54 elderly, institutionalized patients with femoral neck fractures who were operatively treated. The patients were reviewed within 12 months after being injured. Their average age was 81.2 years, and 94% of the patients were women. Seventy-five percent of the study population had neurological disease or heart disease and were thus limited in their motivation or ability to participate in a rehabilitation program. Only 16.7% of the patients regained their overall functional ability and only 12.9% returned to their pre-injury, ambulatory status. The therapeutic concept should be reviewed and the conservative approach be given serious consideration.

Activities of Daily Living↗

PubMed1991

Social-learning procedures for increasing attention and improving basic skills in severely regressed institutionalized patients.

Seven severely debilitated and chronically institutionalized forensic psychiatric patients were enrolled in intensive shaping classes as part of a comprehensive social-learning treatment program. Results compiled over 1 year reveal that six of these patients demonstrated marked improvements in their ability to attend to basic academic tasks and five also showed consistently high rates of successful task completion or increased rates over time. Evidence for the generalization of these effects comes from the fact that all four of the residents who went on to regular academic classes demonstrated consistently high rates of successful task completion. Recommendations are made for further applications of intensive shaping procedures for such severely impaired subgroups.

Achievement↗

PubMed1981

Milk and vegetables in the diet of institutionalized elderly people in Finland.

More than 95% of the institutionalized elderly subjects drank milk, and more than 50% ate raw vegetables one or more times a day. There were no statistical differences between the frequencies of men and women, and the mean frequency index for age groups 65 to 74, 75 to 84, and greater than or equal to 85 years was the same for milk throughout. For vegetables, the mean value rose slightly toward to older age groups. More than half of the edentulous denture wearers and of the dentulous subjects ate raw vegetables every day, while only 38% of the edentulous without dentures did. The availability of vegetables alone is not enough; the intake of these vegetables must be actively encouraged.

Aged↗

PubMed1986

Prevalence of drugs causing hyposalivation in an institutionalized geriatric population.

The types and numbers of drugs prescribed for nursing home residents were enumerated in order to determine the prevalence of drugs that cause hyposalivation. Drugs were coded as having a definite or probable hyposalivatory side effect, or as having no effect, and were also categorized by therapeutic action. The average number of drugs prescribed for each patient was approximately four. Approximately half of the institutionalized elderly received one or more drugs with a hyposalivatory side effect. The hyposalivatory drugs were mainly antipsychotics, antidepressants, antihistamines, and analgesics.

Aged↗

PubMed1991

Immune parameters in a population of institutionalized elderly subjects: influence of depressive disorders and endocrinological correlations.

Twenty-six institutionalized elderly subjects, selected as healthy according to the SENIEUR protocol, were compared to adult controls to establish correlations between affective disorders and immune abnormalities and to investigate underlying neuroendocrine mechanisms. After an extensive psychodiagnostic examination, 35% of the aged subjects were classified as depressed. Cutaneous delayed hypersensitivity tests showed reduced responses in the aged, but no correlation was found with the psychological status. Examination of the peripheral blood lymphocyte subsets revealed no imbalance in the percentages of CD3+, CD4+, CD8+ cells in the aged. A slight reduction in the CD4+/CD8+ cell ratio could however be detected in the non-depressed aged, as compared to adult controls. The CD4+/CD45R+ cell subset was reduced in non-depressed aged. The percentage of B lymphocytes was reduced in the aged, mostly in the non-depressed subjects. No changes were detected in the percent of OKDR+ cells. The percentage of CD16+ cells was found unchanged, while that of Leu7+ cells was significantly higher in the aged than in the adults and in the non-depressed than in the depressed aged. Leu7+ cell levels were negatively correlated with the depression score. On double labelling, the percent of CD16+/Leu7+ cells appears increased in the subgroup of depressed aged and positively correlated with age. Plasmatic and urinary cortisol levels were both positively correlated with depression score. Urinary cortisol level was higher in the depressed aged. These parameters, as well as plasmatic ACTH, beta-endorphin and urinary catecholamines, were not correlated with immune responses. Based on these findings, we recommend that the neuroendocrinological conditions should be taken into account when healthy subjects are examined in studies of immune senescence.

Aged↗

PubMed1995

Effect of bright light treatment on agitated behavior in institutionalized elderly subjects.

This study examined whether exposure to bright light treatment would reduce agitated behavior in institutionalized elderly subjects. Six demented elderly subjects (mean age = 89.2 years) living in a skilled nursing facility were studied. Light (2500 lx) was administered for 2 hours in the morning for two 10-day periods. The Bliwise Agitation Behavior Rating Scale was used to rate agitated behavior once every 15 min between 16:00 h and 20:00 h during 3 days of baseline, the light treatment periods, and 5 days of posttreatment follow-up evaluation. The entire protocol was then repeated in an ABABA design. A planned comparison revealed a significant difference between light treatment days and nontreatment days, with less agitation being observed on treatment days. The study suggests the efficacy of the clinical use of bright light treatment to reduce agitation.

Aged↗

PubMed1990

A comparison of biochemical indices of bone turnover in elderly institutionalized and free-living subjects.

Plasma concentrations of calcium-phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25(OH)D) and albumin, and fasting urinary sodium/creatinine (Na/Cr), calcium/creatinine (Ca/Cr) and hydroxyproline/creatinine (HPr/Cr) were measured in a survey of 208 Chinese elderly subjects living in chronic care institutions, and compared with values from free-living elderly subjects. Plasma parathyroid hormone estimations were also performed on a subpopulation of women living in an institution. Subjects in institutions had higher urinary HPr/Cr ratios in both men and women, as well as higher urinary Ca/Cr ratios in women, suggesting increased bone resorption. These values show significant variation depending on the degree of mobility. Factors which could contribute to the increased bone loss among institutionalized subjects are: reduced physical activity, reduced exposure to sunlight and hence reduced plasma 25(OH)D concentrations, low calcium intake, protein calorie malnutrition and possibly higher sodium intake. Correction of these factors may reduce the risk of fractures among the elderly living in chronic care institutions.

Activities of Daily Living↗

PubMed1986

Poor seroconversion rate after hepatitis B vaccination in high-risk institutionalized mentally retarded patients.

We studied the rate of seroconversion to positivity for antibody to hepatitis B surface antigen (anti-HBs) after immunization with hepatitis B vaccine in a group of mentally retarded institutionalized patients. Eight hundred sixty-eight individuals were screened for seromarkers of hepatitis B infection (hepatitis B surface antigen and anti-HBs), and 287 seronegative patients were vaccinated with the recommended schedule of hepatitis B virus vaccine (20 micrograms IM at 0, 1, and 6 months). Overall, 59% of patients responded to vaccination with detectable anti-HBs. We found a high correlation of lack of response with both intragluteal injection and increasing age (p less than 0.0008), although the design of the study did not allow these factors to be analyzed separately. We conclude that buttock injection and advancing age may be risk factors for poor immunogenicity of the hepatitis B vaccine in mentally retarded populations.

Adult↗

PubMed1993

Immunization of institutionalized asthmatic children and patients with psychomotor retardation using live attenuated cold-adapted reassortment influenza A H1N1, H3N2 and B vaccines.

Live attenuated cold-adapted reassortant (CR) influenza virus vaccines were evaluated in institutionalized asthmatic children and severe psychomotor-retarded (SPR) patients. Almost all the vaccinees were seropositive to the vaccine strains before immunization. Trivalent CR vaccine (containing A H1N1 (CR-125), A H3N2 (CR-149) and B (CRB-117)), bivalent CR vaccine (CR-125 and CR-149) and monovalent CRB-117 were inoculated to 19 asthmatic children and 36 and 16 SPR patients, respectively. Overall 49, 22, and 11% of vaccinees were infected by A H1N1, A H3N2 or B vaccine viruses, respectively, as indicated by significant haemagglutination-inhibition (HI) antibody titre rises 4 weeks after inoculation. No severe adverse reactions associated with CR vaccination were observed in the handicapped patients. A nosocomial outbreak of influenza A H1N1 occurred in the ward with asthmatic children, but none of the 19 CR-trivalent vaccinees became infected. However, five of 20 non-vaccinees in the same ward, and ten of 30 vaccinees in another ward that received inactivated split vaccine became infected. The CR vaccines demonstrated significant protective effects against natural exposure to the A H1N1 virus, and were well tolerated and safe when given to patients with bronchial asthma and severe psychomotor retardation.

Adolescent↗

PubMed1982

Verbal interaction patterns of depressed and non-depressed institutionalized mentally retarded adults.

Data obtained through 18, 5-minute observations of nine depressed and nine nondepressed institutionalized mentally retarded adults revealed five patterns of verbal interaction including: (a) other individuals were more likely to request action from depressed individuals than to make declarative statements; (b) the depressed subjects were more likely to gain compliance by exhibiting negative affect; (c) the depressed subjects were more likely to resist request by exhibiting negative affect; (d) other individuals were more likely to exhibit negative affect when interacting with depressed subjects; (e) staff rather than peers were more likely to interact with depressed subject. Depressed and non-depressed subjects could not be differentiated by the number of communications initiated which did not require a response from others and on the percentage of communications initiated with staff.

Adult↗

PubMed2004

Pet-therapy: a trial for institutionalized frail elderly patients.

Twenty-eight subjects with chronic age-related disabilities living in the nursing home"Istituto di Riposo per la Vecchiaia" in Torino were assigned to a pet-therapy intervention group, consisting of 3/week sessions of almost one-hour visit for 6 weeks with a little cat, of to a control group undergoing usual activity programs. The purpose of this study was to evaluate the effects of pet-therapy on nursing home inpatients. There were no differences in demographic or clinical characteristics and in mean duration of institutionalization between the two groups. Results showed that patients with animal interaction had improved depressive symptoms and a significant decrease in blood pressure values. The pet-therapy programs are desirable components of the multidisciplinary treatment for frail elderly patients in long-term care.

Aged↗

PubMed2005

Identifying the relationship among mental status, functional independence and mobility level in Turkish institutionalized elderly: gender differences.

The purpose of this study was to examine gender differences in older people living at a rest home in terms of functional independence, mental status and mobility level and to describe the relationship among the three outcome variables. One hundred and thirty-three elderly people (60 women, 73 men), aged 65 years and above were included in the study. The average age was 75.3 +/- 6.7 years (range, 65-90 years). Mental status was assessed using the Hodkinson Mental Test (HMT). Functional independence was measured using Functional Independence Measurement (FIM). Mobility level was evaluated using the Rivermead Mobility Index (RMI). Elderly women had lower scores regarding all the outcome variables when compared to older men. The older men had higher cognitive performance than women. In addition, women were at low level of mobility and depended upon the daily living activities (p < 0.05). Both genders showed a significant negative correlation between mental status and functional independence or mobility level, while the correlation between functional independence and mobility level was significantly positive. The data showed that mental impairment decreases both functional status and mobility level of the institutionalized elderly people. Gender difference was found to be an important factor affecting the outcome variables of the study.

Activities of Daily Living↗

PubMedDate not supplied

A new option in the treatment of skin tears for the institutionalized resident: formulated 2-octylcyanoacrylate topical bandage.

Skin tears are a common phenomenon in elderly institutionalized adults (EIAs). Incidence ranges from 0.92 to 2.5 per person/year. Little supportive literature exists regarding optimal treatment with many regimens reported. A convenience sample of 20 patients with Payne-Martin Category II and III skin tears of less than 8 hours' duration were prospectively evaluated with the use of a formulated 2-octylcyanoacrylate topical bandage. Patients were followed weekly until the tear healed. Complete healing occurred with 1 application of 2-OTB in 90% (18/20) of study subjects; 5% (n = 1) reported transient mild pain (less than 15 seconds), and 90% (n = 19) reported no pain. There were no incidents of cellulitis or infection. Shower and bathing routines were not interrupted. Cost averaged less than $1 per application. Clinician time averaged 1.5 minutes per application. Clinicians reported high satisfaction because repeated dressing changes were eliminated.

Administration, Topical↗

PubMed2006

Predictors of institutionalization in demented patients discharged from a rehabilitation unit.

BACKGROUND: The decision to place a patient with dementia in long-term care is complex and based on the patient's and the caregiver's characteristics, and on the sociocultural context. Most studies assessing predictors of nursing home placement focused primarily on the characteristics of either the patient, such as dementia severity and difficult behaviors, or the caregiver, such as subjective burden and health status. However, only a few studies comprehensively investigated how both a caregiver's and a patient's characteristics influence nursing home placement. OBJECTIVE: To identify the patient's and the caregiver's characteristics that influence discharge to a nursing home in demented patients consecutively admitted to an intermediate care setting. METHODS: Observational study of 214 patients with dementia consecutively admitted to a Rehabilitation Unit for Dementia in Northern Italy (length of stay 35.1 +/- 14.9 days). The main evaluated outcome was the final destination (home vs nursing home). RESULTS: In a multivariate logistic regression analysis, adjusted for age, gender, cognitive status, and behavioral disturbances, 4 predictors were associated with nursing home placement: living alone (OR 8.79, 95% CI 2.33-33.16; P = .001), degree of dementia severity (CDR, OR 1.69, 95% CI 1.02-2.83; P = .04), compromised functional status (Barthel index admission, OR 3.15, 95% CI 1.05-9.48; P = .04), and caregiver's burden (CBI, OR 2.89, 95% CI 1.15-7.29; P = .02). CONCLUSIONS: Data suggest that living alone, patient's functional impairment, severity of dementia, and caregiver's burden were independent predictors of institutionalization. The interaction between a patient's and a caregiver's characteristics has an important effect on the rate of nursing home placement in demented patients.

Activities of Daily Living↗

PubMed1997

Fluid intake in the institutionalized elderly.

OBJECTIVE: Actual fluid intake in the institutionalized elderly was compared with three established standards to determine adequacy of fluid intake. DESIGN: Consecutive 3-day food and fluid intake was observed directly and analyzed by computer for water content. Number and frequency of medications and Minimum Data Set (MDS) information about cognitive skills, physical locomotion, and ability to understand were obtained from medical records. Recommended fluid intake was determined using three established standards for two age groups: 65 through 85 years and 86 through 100 years. The standards were 30 mL/kg body weight (standard 1); 1 mL/kcal energy consumed (standard 2); and 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, and 15 mL for remaining kg (standard 3). SUBJECTS/SETTING: Data were collected in one nursing home. Subjects were 40 residents who were free from acute illness and infection and/or were not receiving enteral feedings. MAIN OUTCOME MEASURES: Fluid intake and MDS data were collected. Data about medications were obtained after preliminary data collection observations. STATISTICAL ANALYSIS PERFORMED: A two-tailed t test was used to compare actual fluid intake with recommended fluid intake. Interaction effect of age on fluid intake was analyzed using multiple analysis of variance. Correlations were used to evaluate relationships among fluid intake, number and frequency of medications, age, weight, and MDS data. RESULTS: This population received adequate or more than adequate fluid according to the standards of 30 mL/kg body weight or 1 mL/kcal energy consumed, but inadequate fluid according to standard 3, which adjusted for extremes of underweight or overweight. Age was not a factor in adequacy of fluid intake. Positive correlations existed between fluid obtained from nonmeal feedings and number and frequency of medications. APPLICATIONS: When the standard of 30 mL/kg body weight is used, underweight residents have unrealistically low fluid recommendations. Standard 3, which adjusts for extremes in body weight, is more reasonable for patients whether they are of normal weight, underweight, or overweight. This standard more closely supports other recommendations of 1,500 to 2,000 mL fluid intake per day. Number and frequency of medications influences the amount of fluid residents obtain during nonmeal feedings.

Age Factors↗