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PubMed2000

Hepatitis C virus infection in institutionalized psychiatric patients: possible role of transmission by razor sharing.

The objective of this study was to determine if HCV can be transmitted from patient to patient in psychiatric institutions and to determine possible routes of infection. We did a cross-sectional survey of 196 Japanese psychiatric patients tested for HCV and HBV markers and 400 age- and sex-matched controls. Anti-HCV was detected in 10.2% and antibody to hepatitis B core antigen was detected in 44.4% of the patients, a significantly higher prevalence than found among matched controls. A multiple regression logistic analysis was used to identify risk factors that could indicate the route of infection by HCV. Duration of hospitalization, age, razor sharing, and history of surgery proved to be statistically significant independent risk factors associated with positive anti-HCV results [odds ratio (OR), 4.00; 95% confidence interval (CI), CI, 1.74-9.19; OR, 2.19; 95% CI, 1.27-1.3.77; OR, 4.90; 95% CI, 1.29-18.86; OR, 3.35; 95% CI, 0.997-11.3, respectively]. These observations suggest that razor sharing played an important role in the spread of the HCV infection in the institutionalized psychiatric patients we studied.

Adult↗

PubMed2003

Institutionalization, behavior and international adoption: predictors of behavior problems.

Since the mid-1990s, over 10,0000 children have immigrated to the United States annually via international adoption. These children bring to their families unique strengths, as well as the possibility, for some, of physical, emotional and behavioral health risks, and challenges. This article presents predictive models on behavioral health problems for one group of international adoptees from Romania (n = 216). It is a companion piece to an earlier article that described behavior issues and compared the international adoptees to a group of children adopted through the public child welfare system using a cross-sectional approach. This article illustrates that a history of institutionalization had minimal long-term adverse effects on a child's behavioral health. The parent-child relationship was a strong resource for parents at both time periods. However, there was a strong relationship between parental negative reports with the relationship and child behavior problems.

Adoption↗

PubMed2001

Suicidal ideation and self-determination in institutionalized elderly.

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

Aged↗

PubMed1990

Application of social skills training in a group of institutionalized aggressive elderly subjects.

A social skills training program consisting of instructions, modeling, role playing, and feedback was carried out with a group of 6 verbally aggressive institutionalized elderly patients. Dependent measures included confirmed incidents of verbal aggressive behavior monitored across an ABAB design with a 5-month follow-up period. Results indicated that verbally aggressive behavior can be significantly decreased in a group-training setting and subsequently generalized to ward and other socialized behavior. Ancillary aspects of the study include the role of social reinforcement, participant modeling, and staff attitude, perception, and motivation. Implications for future research are discussed.

Aged↗

PubMed2002

Illicit drug initiation among institutionalized drug users in China.

AIMS: To examine the circumstances and correlates associated with initiation of illicit drug use among institutionalized drug users in China. DESIGN: Cross-sectional, retrospective study. SETTINGS: Six compulsory drug cessation programs in Yunnan Province and Gunagxi Zhuang Autonomous Region of China. PARTICIPANTS: A gender-stratified random sample of 833 drug users (88% males and 12% females) enrolled in compulsory drug cessation programs in November 1996. MEASUREMENTS: Circumstances of illicit drug initiation (age, type of drugs, routes of drug administration, social setting, source of drugs, reasons for drug use), the risk behaviors and risk perceptions prior to drug initiation. FINDINGS: The majority of participants initiated drug use with heroin (90%). Initial drugs were frequently administered through sniffing/snorting (55%) and smoking cigarettes mixed with a drug (38%). First drug use occurred most commonly at a friend's home (65%) and in the company of other drug users (83%). Drugs were generally provided free for first-time use by other drug users (72%). Reasons for first drug use included experimentation (90%), being lured into drugs by other people (44%) and relaxation (42%). Most drug users had a history of regular cigarette smoking (89%), alcohol consumption (49%) and deviant behaviors (51%) prior to their drug initiation. The majority perceived that their friends (90%) and neighbors (88%) used illicit drugs. CONCLUSIONS: The findings are similar to studies in western countries with respect to the pattern and correlates of illicit drug initiation, and underscore the need for drug prevention efforts in China.

Adolescent↗

PubMed2001

Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability.

A screening of hearing and visual function was performed using clinical assessment methods in a Dutch institutionalized population of 672 people with mild to profound intellectual disability (ID). Because the studied population was not comparable to the total Dutch population with ID, subgroups were distinguished according to level of ID, age younger and older than 50 years, and the presence or absence of Down's syndrome (DS). The prevalences of both hearing and visual impairment were considerably increased in all subgroups, as compared with the general population. In the least affected group, i.e. those < 50 years with a mild or moderate ID by other causes than DS, the prevalences of hearing and visual impairment were 21% and 4%, respectively (as opposed to 2-7% and 0.2-1.9% in the general Dutch population <50 years, respectively). The prevalence of hearing impairment showed a sharp and highly significant increase in individuals with DS and subjects > or = 50 years. To a lesser extent, young adults with severe or profound ID had an increased risk of hearing impairment. Visual impairment and blindness were specifically highly prevalent in people with severe or profound ID (51% < 50 years of age). Down's syndrome and an age > or = 50 years were also significant risk factors for visual impairment. There was an alarmingly high prevalence of combined sensory impairment, especially in those with severe or profound ID (20%). Although hearing impairment had been diagnosed prior to this screen in 138 people and visual impairment in 65 individuals, a first diagnosis of hearing impairment was made in 128 subjects and of visual impairment in 90 cases. This highlights the tendency for sensory impairments to go unnoticed in people with ID, which is not restricted to those with severe or profound ID. Therefore, the present authors stress the importance of regular screening as outlined in the existing IASSID international consensus statement.

Adolescent↗

PubMed2002

Low prevalence of abnormal cervical cytology in an institutionalized population with intellectual disability.

BACKGROUND: The present study was designed to determine the prevalence of abnormal cervical cytology in an institutionalized population with intellectual disability. METHOD: A retrospective review of charts for 162 women at a large state-owned facility was performed. Slides from 310 cervical Papanicolau smears were re-screened by a cytotechnologist and then reviewed by a pathologist. RESULTS: The prevalence of abnormal cytology (three out of 162 participants) and biopsy confirmed that the prevalence cervical dysplasia (one out of 310 smears) was low. CONCLUSION: The present preliminary study suggests that further investigation of the optimal interval for cervical cancer screening is warranted in this population.

Cytodiagnosis↗

PubMed2002

Attentional dysfunction of chronic schizophrenia: No association with long-term institutionalization.

Attentional processes play a central role in information selection, which is impaired in schizophrenic patients. In the present study, we attempted to characterize the attentional performance of chronic schizophrenics using a computerized assessment of the multiple components of attentional function. Two comparable samples, consisting, respectively, of out-patients and in-patients, were tested in order to assess the effect of chronic institutionalization. Twenty-four subjects (half in-patients and half out-patients) fulfillling DSM-IV criteria for schizophrenia were examined with a standard computerized battery for the assessment of attention, namely Testbatterie zur Aufmerksamkeitsprufung (TAP). Both groups were impaired on all measures of attentional processing (in terms of both reaction times and number of errors). There were no significant differences in attentional performance between in- and out-patients. In conclusion, the present findings confirm the presence of pervasive attentional dysfunction in chronic schizophrenia; the lack of significant differences in performance between in- and out-patients supports the hypothesis that the cognitive deficits are inherently associated with the illness and cannot be attributed to environmental/social factors.

Adult↗

PubMed2002

Prospective study of fall risk assessment among institutionalized elderly in Japan.

The purpose of the present study was to identify risk factors for falls among institutionalized elderly, using the standardized risk assessment tool developed by Izumi. We examined 746 patients from three types of facilities: rehabilitation wards in four general hospitals, three long-term care facilities, and three nursing homes, for up to three months. The incidence of falls within all facilities was 12.5%. Patterns of relative risks of falling differed among types of facilities. The highest relative risk of fall in long-term care facilities and nursing homes was nurses' prediction, followed by history of fall and altered mentation. In contrast, that in general hospitals was mobility. In long-term care facilities, history of falls (odds 3.68, 95CI: 1.47-9.23) and interaction (history of falls and assistance with toileting) (odds 3.13, 95CI: 1.48-6.64) showed significance on adjusted-odds ratios for fall. History of falls, altered mentation, and assistance with toileting may be used to screen patients at a high risk for fall at admission.

Accidental Falls↗

PubMedDate not supplied

Outcomes of comfort touch in institutionalized elderly female residents.

Comfort touch as a holistic nursing intervention has gained considerable attention in the past decade. The purpose of this experimental study was to examine whether comfort touch improved the perceptions of self-esteem, well-being and social processes, health status, life satisfaction and self-actualization, and faith or belief and self-responsibility in 45 institutionalized elderly female residents. Results revealed that comfort touch significantly improved the perceptions of all elements. This article offers recommendations for practice, research, and education.

Aged↗

PubMed1975

Social and play behaviors of institutionalized mongoloid and nonmongoloid retarded children.

A total of 24 institutionalized retarded children, 12 mongoloid (Down's syndrome) and 12 nonmongoloid, were observed in dyadic interaction with peers in a free-play situation, and a number of specific peer-social and non-social behaviors were recorded as they occurred. Differences between mongoloid and nonmongoloid Ss were most apparent on several social behavior categories which support the stereotypic conception of mongoloids as more sociable, gregarious, etc. Differences were most apparent for the mongoloid boys. The possible influence of tranquilizer drugs and cottage placements on the observed differences was discussed.

Child↗

PubMed1979

Fears of institutionalized mentally retarded adults.

The patterns of fears of institutionalized mentally retarded adults were studied in a sample of i2 moderately retarded men and women between the ages of 21-49. The direct questioning method was employed. Two interviews were held, two weeks apart; the first interview elicited the Ss' fears, while the second concerned the fears of their friends. A total of 146 responses were obtained, and these were categorized according to the types of fears: supernatural-natural events, animals, physical injury, psychological stress, egocentric responses, and no fears. The Ss displayed a higher percentage of fears in the preoperational stage than in the concrete operational stage. In a comparison of male to female fears, only one category, that of fears of animals, reached significance. The study suggested that the same developmental trend of fears that appears in normal children appears in the retarded as well, and these fears follow Piaget's level of cognitive development, proceeding from egocentric perceptions of causality to realistic cause and effect thinking.

Adult↗

PubMed2000

Folate status worsens in recently institutionalized elderly people without evidence of functional deterioration.

OBJECTIVE: To follow folate status, hematological and cognitive changes during the first year of institutionalization among elderly subjects. DESIGN: Prospective study. SETTING: Long-stay unit of the Dijon University Geriatric Hospital. SUBJECTS: Twenty women and four men older than 65 years admitted consecutively. MAIN OUTCOME MEASURES: Folate and vitamin B-6 dietary intake was evaluated by a five-day record on admission (day 1 or d 1), at day 45 (d 45), day 90 (d 90), day 135 (d 135), day 180 (d 180), day 360 (d 360). Circulating levels of folate, vitamin B-6, total homocysteine (tHcy), blood counts and cognitive performance were determined in parallel. RESULTS: From d 1 to d 360, mean folate and vitamin B-6 intakes remained below the French RDA and mean folate intakes decreased significantly (delta = 10.2%, p < 0.05). Mean plasma or erythrocyte folate decreased significantly (delta = 33.7%, p <0.05 and delta = -30.2%, p < 0.001, respectively) from d 1 to d 360; no significant change was observed for the other blood parameters. The incidence of folate deficiency increased (8% vs. 37% for plasma folate <6.8 nmol/L and 8% vs. 17% for erythrocyte folate <340 nmol/L) from d I to d 360. Mean plasma pyridoxal 5'-phosphate (PLP) remained <20 nmol/L during the one-year follow-up. There was no difference between genders for plasma tHcy. Although mean plasma tHcy was <14 micromol/L. plasma tHcy was >14 micromol/L in about one-third of the subjects. At each period, 50% or more subjects were anemic (Hct <35% in women and Hct <40% in men), but the anemia was normocytic (MCV <100 fL). Subjects had a moderate dementia at admission, and no change was observed during the study. CONCLUSIONS: Subjects were already vitamin B-6 deficient at admission. Folate status was impaired during the study. Low vitamin intakes were the main cause of vitamin B-6 deficiency and folate status deterioration. Hematology and mental status capacity were not aggravated by folate status deterioration. Plasma tHcy didn't appear to be an earlier predictor of folate deficiency.

Aged↗

PubMed1983

Psychogenic mortality syndrome: choosing to die by the institutionalized elderly.

This article provides a literature review, conceptual framework, case history, and supportive data on the subject of psychogenic mortality, that is, the phenomenon of willing oneself to die that occurs among institutionalized elderly. The article is based on the observation of this phenomenon in a long-term care facility. The literature review provides background data from developmental studies in psychodynamic literature that may be applicable to this phenomenon as observed. The case history and supportive material suggests rationale and methods for intervention and treatment.

Aged↗

PubMed2004

The prevalence of emotional and behavioural problems in institutionalized childcare clients.

The objective of the study was to investigate the gender-specific prevalence of emotional and behavioural problems in children and adolescents in out-of-home childcare, compared with patients in child and adolescent psychiatric institutions. The total population of clients in residential childcare institutions in Oslo, Norway, was investigated by the use of standardized questionnaires (Achenbach's Child Behavior Checklist and Youth Self Report) and compared to all same-aged patients residing in child and adolescent psychiatric institutions in the same area at the same time. Boys in residential childcare had emotional and behavioural problem levels comparable to boys in child and adolescent psychiatric institutions, as measured by the questionnaires. Girls in residential childcare did not reach problem levels as high as those found in girls in psychiatric institutions, but problem levels were still well above those found in the general population. It was concluded that institutionalized childcare clients had a high prevalence of behavioural and emotional problems, as measured by Achenbach's Child Behavior Checklist and Youth Self Report.

Adolescent↗

PubMed1991

Wheelchair seat comfort for the institutionalized elderly.

Studies have reported many wheelchair problems faced by the institutionalized elderly. Because knowledge is limited regarding seat comfort in general and for the nursing home population in particular, we elected to investigate seat comfort in order to gain insight needed to solve seat discomfort problems. This study's primary objective was to identify quantifiable indicators of seat comfort. Seat comfort was investigated in relation to peak sitting pressure, asymmetry of sitting pressure distribution, and seat cushion type. Fifty nursing home residents who were able to reliably rate the comfort of their wheelchairs were surveyed. The survey consisted of several questions regarding wheelchair seat comfort, wheelchair use, and functional and cognitive abilities. Measurements included peak sitting pressures and parameters of sitting posture. This study failed to identify robust indicators of seat comfort. It failed to confirm the hypothesis that higher peak sitting pressures correspond to greater discomfort. No relationship was found between the asymmetry of sitting pressure and reports of seat discomfort. Although we were unsuccessful in achieving statistically significant results, we did identify seat comfort indicators that are not only statistically significant but are also of practical clinical usefulness. Further research with additional subjects is required to identify cushions that are both comfortable and pressure relieving.

Aged↗

PubMed2002

Televisits: sustaining long distance family relationships among institutionalized elders through technology.

The role of social support in the health of older persons is well documented. This support is particularly important for isolated nursing home residents. The purpose of this study was to test the feasibility of using low-cost videophones to enhance communication between nursing home residents and their families. Ten pairs of residents and family members received videophones and engaged in regular televisits for six months. All participants completed brief survey instruments prior to and after the study period to determine the effects of the televisits on the frequency and quality of contacts. A post-study survey assessed ease and satisfaction with using videophones. Findings include identification of technical and design problems, possible solutions, factors affecting actual use of equipment, and conditions under which benefits of use may be optimal. Categories for estimating potential actual users are suggested. Importantly, the study demonstrates that videophones can be used successfully by a wide range of frail nursing home residents and can enhance social interactions, regardless of distance. Affordable videophone technology offers the potential for reduced isolation among institutionalized elders and others with distance and mobility barriers.

Adult↗

PubMed2004

Effect of Meeting Centres Support Program on feelings of competence of family carers and delay of institutionalization of people with dementia.

The study tested the hypotheses that integrated support, in which patients and carers are both supported by one professional staff member, will be more effective in reducing the feelings of (over)burden of carers and in positively influencing some potential determinants of experienced burden than non-integrated support, such as psychogeriatric day-care. A quasi-experimental pre-test/post-test control group design was applied with matched groups and measurements at baseline and after seven months. Fifty-five of the eighty dyads (31% dropped out) of persons with mild-to-moderate dementia and their carers who presented for four community meeting centres and three day-care centres in nursing homes over an 18 month period, were included in the study. The carers in the Meeting Centres Support (MCS) Program participated in an integrated family support program together with the persons with dementia, while the carers in the control group only received respite through psychogeriatric day-care. Standardized questionnaires were applied to measure some indicators of burden experienced by the carers (feelings of stress, life dissatisfaction, psychological and psychosomatic complaints), as well as some potential determinants of experienced burden (feeling of competence, coping strategies, experienced support and loneliness). Furthermore, as an indicator of feelings of (over)burden of the carer, the time between start of participation in one of the programs and institutionalization in a nursing home was calculated. After seven months the carers in the MCS group (n = 36), compared to the carers in regular psychogeriatric day-care (n = 19), showed a moderate positive effect on the feeling of competence (effect size 0.45). No effect was found on feelings of stress, dissatisfaction or psychological and psychosomatic complaints. However, as compared to the control group in regular day-care, the persons with dementia in the MCS Program participated for a longer period of time before they were placed in a nursing home. The MCS Program proved more effective than psychogeriatric day-care in influencing the feeling of competence of the carers, and seems to lead to an increased delay of nursing home placement of the person with dementia, as compared to regular day-care. Because of the small sample and limited power of the study, and the possible influence of the selection of carers on the study outcome, further research into the value of meeting centres for carers of people with dementia is recommended.

Aged↗