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Results for “Institutionalization”

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PubMed1988

The effects of a three-month exercise programme on neuropsychological function in elderly institutionalized women: a randomized controlled trial.

This randomized controlled trial examined the effect of a 3-month exercise programme on neuropsychological function in a population of very elderly institutionalized women. Baseline neuropsychological testing was performed, and following 3 months of exercise or control intervention, subjects were retested 3-7 days after the completion of the study period. Apart from the Word Fluency Test, there was no significant improvement in any of the neuropsychological test scores. This study may not have shown any significant improvement in neuropsychological function because our exercise programme was too light to improve aerobic fitness, or because neuropsychological tests were repeated 3-7 days after exercise was completed and any acute effects of exercise may have disappeared by that time.

Age Factors↗

PubMed1989

Long-term nutritional status of an enterally nourished institutionalized population.

Growth and nitrogen nutriture were evaluated during a yearlong study of 11 profoundly retarded nonambulatory institutionalized youth who were fed by gastrostomy and received anticonvulsants. The effects of dietary fiber and vitamin D were assessed by determining plasma levels and balances of zinc, magnesium, calcium, and phosphorus in a subset of six patients. Increase in body weight was 3.4 +/- 2.4 kg (means + SD), in height, 5.9 +/- 3.9 cm during the year. N balance remained positive throughout the study. Zn and Ca balances suggested that needs for this population may be greater than or equal to 150% of the Recommended Dietary Allowance. Vitamin D supplementation had no effect. Soy polysaccharide fiber intakes of 18-24 g/d compared with 0 or 12-20 g fiber/d significantly improved N and P retentions. Although the determination of nutrient needs of a severely disabled population is complex, our results suggest N and energy but not Zn and Ca allowances for a healthy population may be satisfactory guidelines.

Adolescent↗

PubMed2003

Risk indicators for falls in institutionalized frail elderly.

The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany. The design was a prospective observational study with a 1-year follow-up (October 1998-September 1999). The study population included 472 long-term-care residents whose mean age was 84 years; 77% were female. Risk indicators for accidental falls were analyzed by using logistic regression. Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years. Multiple logistic regression analysis revealed short-term memory loss, transfer assistance, urinary incontinence, positive fall history, and use of trunk restraints as predictors of falls. In a further logistic regression analysis, depressive symptoms, transfer assistance, urinary incontinence, and positive fall history were associated with frequent falls. Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff. Study results encourage specifically addressing urinary incontinence, cognitive impairment, use of restraints, depression, and transfer difficulties as modifiable predisposing risk factors for falls. Fall history represents an important nonmodifiable marker to identify residents at high risk.

Accidental Falls↗

PubMed1999

The effectiveness of acupressure in improving the quality of sleep of institutionalized residents.

BACKGROUND: Elderly people often suffer from disturbed sleep. Because traditional Chinese medicine indicates that acupressure therapy may induce sedation, testing the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents with a well-designed scientific study is needed. METHODS: A randomized block experimental design was used. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used as a screening tool to select subjects with sleep disturbance. By matching the effects of hypertension, hypnosis, naps, and exercise, subjects were randomly assigned to an acupressure group, a sham acupressure group, and a control group. Each group had 28 subjects for a total of 84 subjects. The same massage routine was used in the acupressure group and the sham acupressure group, whereas only conversation was employed in the control group. RESULTS: There were significant differences in PSQI subscale scores of the quality, latency, duration, efficiency, disturbances of sleep, and global PSQI scores among subjects in the three groups before and after interventions. Furthermore, there was a significant reduction in the frequencies of nocturnal awakening and night wakeful time in the acupressure group compared to the other two groups. CONCLUSIONS: This study confirmed the effectiveness of acupressure in improving the quality of sleep of elderly people and offered a nonpharmacological therapy method for sleep-disturbed elderly people.

Acupressure↗

PubMed1979

Environment and face-hand test performance in the institutionalized elderly.

Long term institutionalized elderly people were tested over nine months on the Face Hand (FH) test. Orinally other neuropsychological tests also were to be given, but most patients could only respond to FH at first. Experimental subjects were transferred either to an enriched stimulation environment or a token economy program while control subjects remained in custodial care settings. Analysis of variance interaction between experimental condition and time of testing indicated significant improvement in performance in the enriched environment compared to the token economy and control groups. In supplementary analyses on a subsample capable of other tests at the end of nine months, FH correlated significantly with some neuropsychological measures and not with social skills.

Aged↗

PubMed1994

Attachment among adult children and their institutionalized parents.

Structural equation analysis using data from 424 adult children with parents living in long-term care facilities indicated that the attachment experienced by adult children for their institutionalized parents was predicted from child's report of parent's mood and child's sense of guilt regarding his/her parent. Parent's mood was predicted by parent's health, and child's sense of guilt was predicted by the amount of help provided to the parent by the adult child. Results are interpreted in the context of theories of attachment.

Adult↗

PubMed1990

Assessments of institutionalized dementia patients' competencies to participate in intimate relationships.

Although sexual interests in institutionalized elderly patients have long been recognized (Comfort, 1974; Wasow & Loeb, 1974), guidelines to help determine patients' competencies to participate in intimate relationships are not delineated in the literature. This paper describes the assessment technique used by an interdisciplinary staff on a coed Alzheimer's disease unit. Two case studies are presented to highlight how the assessment led to the treatment decisions.

Aged↗

PubMed1997

Comparison of health and functional ability between noninstitutionalized and least dependent institutionalized elderly in Finland.

Finland's active deinstitutionalization policy aims to reduce the number of elderly people in long-term residential care and to keep noninstitutionalized elderly people living at home as long as possible. As a contribution to the issue of the appropriateness of long-term institutional care, we compared the health and functional ability of elderly people living at home or in residential care to assess the theoretical possibility of discharging the least dependent elderly from residential homes. Findings from two separate data sets collected in 1992 were compared; one (n = 475) was obtained by computer-assisted telephone interview (elderly at home) and the other (n = 459) by postal survey (elderly in residential care). The direct method was used in age and gender standardization, and logistic regression analysis was applied. Elderly people living at home were found to be in better health and with better functional ability than those in residential care. However, a proportion of home-dwellers needing some help with Activities of Daily Living (ADLs) assessed their health as being even worse than those in care, and approximated that of institutionalized elderly judged by the personnel to be able to manage with home-based care. Compared with home-dwellers, those assessed as able to manage in-home care were mostly single and had less education and more restrictions in their Instrumental ADLs and medication. Our results indicate that one third of those assessed as able to manage in-home care could possibly be discharged if adequate servicers and housing were available.

Activities of Daily Living↗

PubMed2005

Early community-based service utilization and its effects on institutionalization in dementia caregiving.

PURPOSE: The present study attempts to determine whether utilizing community-based long-term-care services early in the dementia caregiving career delays time to nursing home placement (adjusting for severity of dementia). DESIGN AND METHODS: With a reliance on data from 4,761 dementia caregivers recruited from eight catchment areas in the United States and followed over a 3-year period, a Cox proportional hazards model was conducted that considered key components of the stress process (e.g., context of care, primary objective and subjective stressors, and resources), duration, and community-based long-term-care use. RESULTS: An analysis of interaction terms in the Cox regression model found that those individuals who utilized in-home help services earlier in their dementia caregiving careers were more likely to delay institutionalization. IMPLICATIONS: The findings suggest the practical importance and cost-effectiveness implications of early community-based service use, and they emphasize the role of timing when one is conceptualizing the proliferation of stress in the dementia caregiving career.

Catchment Area, Health↗

PubMed1991

Social support networks of white and black elderly people at risk for institutionalization.

The literature examining the role of social network size and support in moderating the relationship between stress and illness in the aged population has not taken racial differences into account. This study compares the potential moderating influence of social network size and support on the relationship between life stress and depressive symptoms for black and white community-dwelling elderly people at increased risk for institutionalization. Study data come from in-person interviews with a sample of 191 old-old (75 years and older) and poor residents of a three-census-tract area in Pittsburgh. Approximately 50 percent were white and 50 percent were black. Results indicate that the moderating effects of social network size and support were different for the black people than for the white people in this sample. For white aged people, having greater social support and a larger social network reduces the association between stress and depressive symptoms, as expected. For black elderly people, however, having more network members and receiving support from them is associated with a stronger relationship between stress and depressive symptomatology.

Black or African American↗

PubMed1993

Knee flexion contractures in institutionalized elderly: prevalence, severity, stability, and related variables.

BACKGROUND AND PURPOSE: The purpose of this study was to document the prevalence, severity, and progression of knee flexion contractures (KFCs) in a population of institutionalized elderly and to identify relationships between knee extension and other variables. SUBJECTS: The subjects were 112 nursing home residents who exhibited a broad range of ambulation and cognitive function abilities. METHODS: Data were collected initially (T1) and after a 10-month period (T2). RESULTS: Only 25% of the population had extension in the 0- to 5-degree (lacking full extension) range bilaterally at T1 and T2, leaving the majority of subjects with some degree of unilateral KFC. Most of the subjects with a KFC greater than 20 degrees were nonambulatory and had a significantly higher occurrence of resistance to motion than did nonambulators with a KFC of less than 20 degrees. Knee extension measurements did not change in most subjects between T1 and T2. The knees that did show a change in KFC (either an increase or a decrease) had a significantly higher occurrence of resistance to passive motion than did other knees. Compared with the subjects who gained extension, the subjects who lost extension over the study period more frequently had minimal KFC at T1, were ambulatory at T1, showed a regression in ambulation at T2, and developed resistance to motion at T2. CONCLUSION AND DISCUSSION: The data confirmed significant positive correlations between degree of KFC and presence of resistance to passive knee motion, cognitive impairment, impaired ambulation, and presence of knee pain. Physical therapy assessment and intervention may be appropriate in nonambulatory nursing home residents with resistance to passive motion, residents with KFC approaching 20 degrees, and ambulatory residents with minimal KFC who develop resistance and begin to regress in ambulation. Several areas for future study are suggested.

Aged↗

PubMed1988

Observations on the acoustic reflex threshold in institutionalized retarded adults taking mellaril and/or thorazine.

The present study was designed to investigate whether mellaril and thorazine, when used alone and in combination with other medications by mentally retarded clients, either abolish acoustic reflexes or compromise estimates of hearing sensitivity based on acoustic reflex measures. Acoustic reflex thresholds were determined in 35 normal-hearing institutionalized mentally retarded subjects who were regular users of the medications under investigation. Five sensitivity prediction methods based on acoustic reflex thresholds were applied to the data. The results of the study showed that acoustic reflexes were present in most subjects. However, the accuracy of all the acoustic reflex-based sensitivity prediction methods was quite poor with greatly exaggerated predictions of hearing loss. The methods based solely on noise reflex thresholds provided better accuracy than those based on noise-tone differences. In general, the accuracy of the prediction methods decreased as the number of medications used by the subjects increased. It is argued that the results provide evidence for reticular activating system mediation of acoustic reflex activity.

Adult↗

PubMedDate not supplied

Spinal bracing in the institutionalized person with scoliosis.

Twenty institutionalized children with scoliosis were treated with a spinal bracing program for an average of two years. The Boston brace with or without superstructure was employed. These children generally had neuromuscular disease and were often functional sitters only. Seizure disorders were common. Fifteen thoracolumbar curves were improved from a prebracing mean curvature of 4.25 degrees to a postbracing mean curvature of 31 degrees. The three lumbar curves improved from 39 degrees to 30 degrees. On patient was termed a failure. The program is considered to be of definite benefit.

Adolescent↗

PubMedDate not supplied

Scoliosis in the institutionalized cerebral palsy population.

A prospective review of 272 institutionalized cerebral palsy residents was undertaken in order to determine the incidence and characteristics of neuromuscular scoliosis in this population. The types of cerebral palsy in the group consisted of 75% spastic, 8% dyskinetic, 4% ataxic, 8% mixed, and 5% undefined. There was a 64% incidence of roentgenographic scoliosis greater than 10 degrees. Two distinct curve patterns were determined with equal frequency, single and multiple. The significance of the curve patterns could not be determined. Scoliosis was most common in the spastic group with the highest incidence in the spastic quadriplegics. The incidence directly paralleled the severity of the neurologic deficit but also appeared to be aggravated by the effects of gravity when the individuals were artificially placed in the sitting position. There was a definite inverse relationship between the level of ambulation and scoliosis: the higher the level of ambulation the lower the incidence of scoliosis. Hip stability per se could not be correlated with the incidence of scoliosis. The most important factors in predicting scoliosis in this population are the presence of spasticity and the severity of the neurologic deficit.

Adolescent↗

PubMed1997

The prevalence of gastro-oesophageal reflux disease based on non-specific symptoms in institutionalized, intellectually disabled individuals.

OBJECTIVE: The prevalence of gastro-oesophageal reflux disease (GORD) in randomly selected, institutionalized, intellectually disabled individuals (IQ < 50) in The Netherlands is high. DESIGN: In this study we investigated the prevalence of GORD and reflux oesophagitis (RO) in intellectually disabled individuals specifically selected for symptoms such as: behavioural difficulties such as automutilation, food refusal, fear and restlessness, vomiting, regurgitation and rumination. Predisposing factors were also evaluated. METHODS: One hundred and ten individuals from one institute underwent a 24-h oesophageal pH test and were scored for predisposing factors and non-specific reflux symptoms. A pathological pH test was defined as a pH lower than 4 more than 4.5% of the measured time. Subjects with a pathological pH test (patients) were compared to those with a normal pH test (controls). RESULTS: In seven cases (6.4%) the test failed for technical reasons. In 57 (55.3%) cases a pathological pH test was found. RO was diagnosed in 33 (64.7%) patients. The use of anticonvulsant drugs and cerebral palsy appeared to be predisposing factors, while the non-specific reflux symptoms did not discriminate for GORD. CONCLUSION: The prevalence of GORD was equal in a randomly selected group of intellectually disabled individuals, and in this group, specifically selected on account of possible reflux symptoms. This study confirms that in this particular group, it is nearly impossible to discriminate for the diagnosis of GORD on non-specific reflux symptoms only. However, GORD may be suspected where there are certain predisposing factors, particularly cerebral palsy and use of anticonvulsant drugs.)

Adult↗

PubMed2004

The incidence of adenocarcinoma in Barrett's esophagus in an institutionalized population.

OBJECTIVE: To ascertain the incidence rate of adenocarcinoma in Barrett's esophagus (ACE) in a stable population of 28,000 institutionalized intellectually disabled individuals (IDI) in whom the prevalence rate of Barrett's esophagus (BE) was previously estimated in a representative sample by 24 h pH monitoring and endoscopy, and in which all cases of ACE were ascertained over a 6-year period. These IDI do not smoke or drink alcohol and are known to have exceptionally high prevalence rates of gastro-esophageal reflux disease, and consequently of BE. METHODS: A population comprising 52,038 person-years was observed and all cases of ACE were ascertained. On the basis of the representative sample, the percentage of this population with BE was estimated to be 10.8%. ACE incidence rates could then be estimated and compared with those found in a free-living BE cohort after correction for age and gender differences. RESULTS: In IDI an incidence rate of ACE of 2.5/1000 person-years was found against 6.3/1000 person-years in the free-living BE cohort. However, the age distributions of the IDI and of the free-living BE cohort were very different, and after correction for this factor there was no significantly lower incidence rate of ACE in the IDI (relative risk, 0.79; P = 0.61). CONCLUSIONS: This is the first reported incidence study of ACE in a stable, well-defined population. In contrast to squamous cell carcinoma, our findings suggest only a minor role for smoking and alcohol in the etiology of ACE.

Adenocarcinoma↗

PubMedDate not supplied

A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects.

OBJECTIVE: Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects. DESIGN: Observational study. SETTING: Two facilities that included assisted living and nursing care. PARTICIPANTS: Residents with probable or possible AD (n = 32). MEASUREMENTS: Weight was measured monthly. At baseline, month 3, and month 6, a knowledgeable staff member provided information that included the Neuropsychiatric Inventory: Nursing Home Version (NPI-NH, ie, a measure of behavioral symptoms) and a questionnaire regarding eating habits, food intake, and appetite. Two-day calorie counts were done and accelerometers were worn to monitor physical activity. RESULTS: At baseline, the mean body mass index (BMI) was 24.0 (standard deviation, 3.5) with 12 subjects exhibiting a BMI <22. BMI was negatively associated with the baseline NPI-NH total score (Spearman Correlation Coefficient -0.52, P <0.01), which indicates that subjects with low BMIs were more likely to have higher frequency and severity of behavioral problems. Individual behavior scores for agitation/aggression (-0.40, P <0.05), depression (-0.31, P = 0.08), irritability/lability (-0.47, P <0.01), aberrant motor behavior (ie, pacing, -0.42, P <0.05), nighttime behavior (-0.37, P = 0.05), and appetite/eating (-0.48, P <0.01) at baseline were negatively correlated with baseline BMI. Behaviors not correlated with BMI were delusions, hallucinations, elation, apathy, and disinhibition. Although this was a small sample followed for a relatively short time period, change in specific NPI-NH scores from baseline to month 6 were correlated with the change in weight over the 6-month period. Both agitation/aggression (-0.37, P = 0.05) and disinhibition (-0.45, P <0.05) showed negative correlation with weight change, which indicates an association between changes in these behaviors and weight loss. There were no significant differences between those who lost weight (n = 13) and those who did not (n = 19) on baseline variables, which included age, comorbidity, functional status, and NPI-NH. However, those who lost weight had a significantly higher BMI at baseline than those who gained weight. CONCLUSIONS: These preliminary results suggest that behavioral disturbances play a role in low body weight and weight loss in AD subjects.

Aged↗

PubMed2005

Personal strengths and traumatic experiences among institutionalized children given up at birth (Les Enfants de Duplessis--Duplessis' children): I: Early experiences.

We examined childhood and early adult strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions into early adulthood. A follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included retrospective assessments of childhood experiences. Most participants reported multiple early adverse experiences, including, in descending order, unfair rules and excessive punishment, physical abuse, emotional neglect, witnessing violence, verbal abuse, physical neglect, sexual abuse, and serious illness. Adverse experiences were mainly due to lay caretakers, not peers or nuns. Twelve childhood strengths, such as self-protectiveness and athletic talent, were scored at each of four age periods, yielding a median score equivalent to one strength at each period. Over half had significant childhood attachments, but of limited intimacy. Childhood variables correlated with their respective variables in later adulthood. Overall, these older adults reported a high prevalence of adverse or traumatic childhood experiences, counterbalanced by modest levels of individual strengths and attachment relationships. Institutionalization of children--if unavoidable--must build in effective safeguards against adverse experiences.

Adaptation, Psychological↗