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PubMed1988

Cognitive disturbance in hospitalized and institutionalized elders.

The purpose of this study was to examine the relationship between empirical findings and a theoretical model of cognitive disturbance among 94 hospitalized and 78 institutionalized elders. Path analysis was used to determine the magnitude of relationships between variables described in the model. Neural function was the only variable in both groups that was significantly associated with greater cognitive disturbance. In the hospitalized group, neural structural changes and physiologic alterations contributed indirectly to cognitive disturbance by their effects on neural function. Further, neural function indirectly affected cognitive disturbance through its effects on sensory deficits. In the institutionalized group, environmental deficits and neural functions were significantly related to greater cognitive disturbance. Except for the direct effects of neural function on activity limitations and physiologic alterations on mental health, all the relationships between the variables described by the model were significantly different between hospitalized and institutionalized elders. The results suggest that different interventions to reduce cognitive disturbances may be required for institutionalized and hospitalized elders.

Activities of Daily Living↗

PubMed1996

Use of albumin as a predictor of mortality in community dwelling and institutionalized elderly populations.

This study was undertaken to identify variables that could explain the association between low albumin and a 9- to 12-year mortality follow-up among 287 community- dwelling and 176 institutionalized people aged 60 years and over. A wide array of nutrition assessment variables was simultaneously examined in this population to identify confounders of the association. The results show that the risk of mortality for subjects with albumin values of 40 g/liter and over was 0.46 of the risk for those with albumin values below 40 g/liter, after controlling for the confounders age, blood urea nitrogen, triglyceride, history of diseases, and inability to shop owing to medical conditions. Similarly, albumin was also inversely associated with mortality among institutionalized subjects even after controlling for the confounders age, sex, blood urea nitrogen, transferrin, and history of stroke. However, the association was no longer significant among the institutionalized population once the deaths that occurred within the first 3 years after study participation were eliminated. The results indicate that albumin is a long-term predictor of mortality among noninstitutionalized subjects and increased mortality is not only a result of age, history of chronic diseases, medication use, or protein intake. Among institutionalized subjects, albumin appeared to be a short-term predictor of mortality.

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PubMed1992

Social networks, institutionalization, and mortality among elderly people in the United States.

This study focuses on the effect of social networks on institutionalization and mortality among elderly people in the United States. Data are from the Longitudinal Study of Aging (LSOA), which incorporates a baseline interview in 1984 and a follow-up interview two years later. The study population consists of a sample of 5,151 noninstitutionalized elderly people who were 70 years of age or older in 1984. Multivariate analyses using logistic regression revealed that social networks are negatively related to the likelihood of institutionalization and mortality when controlling for sociodemographic characteristics and baseline health status. Elderly people who participated in some form of social activity decreased their risk of institutionalization by almost one-half, whereas living alone increased the likelihood of institutionalization. Participating in social activities and visiting or talking with friends or relatives was negatively related to the likelihood of mortality.

Activities of Daily Living↗

PubMed1997

Risk of institutionalization among community long-term care clients with dementia.

South Carolina Community Long-Term Care (CLTC) data were used to identify factors increasing the risk of institutionalization in people with dementia. Clients diagnosed with dementia and observed at least twice between June 1993 and December 1994 (N = 786) were studied. Logistic regression determined that clients with a decline in ADL function who were white, had a nonrelative or child as a caregiver, and were diagnosed with Alzheimer's disease were at increased risk of institutionalization. Identifying CLTC clients at increased risk of institutionalization could be useful in designing additional interventions to prevent institutionalization or in planning the transition to institutional care.

Activities of Daily Living↗

PubMed1986

Serum concentrations of 25-hydroxyvitamin D and vitamin D-binding protein in elderly people. Effects of institutionalization, protein-energy malnutrition and inflammation.

Serum concentrations of 25-hydroxyvitamin D (25-OH-D) and vitamin D-binding protein (DBP) were measured in institutionalized and non-institutionalized elderly people. The institutionalized subjects were found to have low serum 25-OH-D in confirmation of other studies, but their serum DBP levels were similar to those found in non-institutionalized elderly subjects. Serum DBP concentrations were slightly higher in elderly females than in males, while no age dependence was found for DBP. Elderly people with protein-energy malnutrition who lived in their own homes had slightly reduced serum DBP and 25-OH-D levels. Elderly subjects with infections or other diseases causing acute inflammation, as indicated by an elevated serum haptoglobin and C-reactive protein, had normal levels of DBP.

Adult↗

PubMed1995

Dental health and treatment needs in institutionalized psychiatric patients in Italy.

The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.001), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (t = 2.78; P = 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment; 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OHI-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.001) and with the length of institutionalization (t = 3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6% and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P<0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.

Adult↗

PubMed1994

Exercise and the psychological state of institutionalized elderly: a review.

The present review examined the hypothesis that exercise facilitates psychological processes among institutionalized geriatric and psychogeriatric elderly persons. Studies of long-term psychogeriatric patients showed significant cognitive change following a period of moderate aerobic exercise. However, no lasting cognitive effect of long-term exercise was observed for those who became mentally or physically impaired in old age or who could not tolerate strenuous exercise. On the other hand, improvement in cognitive function was reported immediately following an exercise session among geriatric institutionalized patients. Neither long-term nor short-term exercise brought about changes in affect. Although most studies suffer serious methodological shortcomings, the common finding of improved cognitive function immediately following exercise suggests that physical activity does have some arousal effect on cognition in institutionalized elderly persons. More studies are needed to clarify the immediate versus long-term effect of exercise on psychological variables among institutionalized elderly as well as the relationship between physical fitness and cognitive change.

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PubMed1992

Predictive validity of factors influencing the institutionalization of elderly people with psycho-geriatric disorders.

The predictive validity of certain items was tested with respect to their influence on the institutionalization of elderly people with psycho-geriatric disorders (n = 69). Twelve items measuring both the patient's condition and the exhaustion around the patient were tested. Two outcome measurements were used, the first measuring the number of patients who were institutionalized after the end of 12 months and the second measuring the number of days at an institution during 12 months. The items "Exhaustion of spouse" and "Supervision need" showed the highest correlation with institutionalization and predicted institutionalization, better than items describing the degree of dementia.

Aged↗

PubMed1980

Impact of institutionalization on the posture of chronic schizophrenic patients.

In this study the impact of institutionalization on the posture of chronic, undifferentiated schizophrenic patients was examined. The postures of a sample group of schizophrenic patients were measured: this group was then divided into those who had been continuously institutionalized and those who had been intermittently institutionalized. Patients who had been hospitalized for a longer, continuous period were found to have significantly poorer posture than those who were institutionalized for a similar period of time, but only intermittently. The authors raise questions about better understanding of posture and movement for more effective therapy programs.

Adult↗

PubMed1990

[Short-stay hospitalization of elderly persons: first step toward institutionalization?].

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence. The level of dependence of institutionalized patients was particularly high for dressing or bathing, technical care, mental status and security. A multivariate analysis showed that the only independent predictors of institutionalization were: sex, living alone, mental status and hospital type. The role played by physical disability must be counterbalanced by the effective physical assistance, brought to the elderly by institutional or informal home care after hospitalization. These results allow early identification of persons at high risk of institutionalization.

Activities of Daily Living↗

PubMed1989

[Advance of disability and prognosis in Duchenne muscular dystrophy--a comparison between institutionalized care and home care].

Rate of advance of disability and age at death were studied in patients with Duchenne muscular dystrophy (DMD). A comparison was made between DMD patients under care in their own homes and those hospitalized in National Suzuka Hospital. In 45 patients with home care, rate of advance of disability was considerably high in their age of 6 to 12 years, the average being 0.83 stage per year after the N.Y. University-Ueda's rating stage of disability. In the age of 12 to 17 years, however, the disease progression was much slower, the average being 0.14 stage per year. Beyond 18 years old, the average stage of disability was constantly 7.7, meaning almost bedridden stage. On the contrary, in 56 patients with institutionalized care, the average rate of advance was lower, being 0.5 stage per year in the age of 7 to 15 years and 0.13 stage per year from 15 to 23 years of age. The result of statistical analysis indicated that the stage of disability was significantly higher in the patients under the home care than those with institutionalized care at the age of 12-16, 18 and 19 years. The age when the patients became unable to walk was 9.7 +/- 1.8 years (mean +/- SD) in those with home care and 10.9 +/- 2.3 years in those with institutionalized care. The difference was statistically significant (p less than 0.01). The age at death was 18.3 +/- 3.8 years in 19 DMD patients with home care and 20.4 +/- 3.6 years in 33 patients with institutionalized care. The difference was also statistically significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Factors influencing survival and need for institutionalization following stroke: the Framingham Study.

The distinction between factors that influence survival after stroke and those that increase the likelihood of institutionalization is an important health issue. Estimates of survival and frequency of institutionalization after stroke vary widely, depending on the patient population. A precise picture of variability of outcome from stroke may be obtained from a prospective epidemiologic study. This report uses the Framingham Study population sample of 5,184 men and women, aged 30 to 62 at entry in 1948, who were free of cardiovascular disease. All completed strokes that occurred between 1971 and 1981 were evaluated. Of the 213 patients with completed strokes, 154 survived more than 30 days. Multivariate logistic regression analysis indicated that acute survival was negatively influenced by stroke type, severity of neurologic impairment, and age. For those who survived at least 30 days, independent living was determined by social factors as much as by severity of disability. Being married protected men but not women from institutionalization. Older women, married or not, with moderate to severe residual impairment and minimal education, were at highest risk of institutionalization. In acute stroke, medical factors dominated rates of survival. However, in those who survived, family and social factors had an equal impact in determining final outcome from stroke.

Activities of Daily Living↗

PubMed1995

[Prevalence of urinary incontinence among institutionalized persons aged 60 and over in Japan].

In order to estimate the prevalence of persons experiencing urinary incontinence among the institutionalized aged 60 and over in Japan, a questionnaire survey was conducted in 16 prefectures in February 1991. The questionnaires were distributed and collected by the nurses in hospitals and in other facilities. A total of 10,022 residents were asked to answer a questionnaire on their urinary incontinence condition and 9,798 responses were analysed. The main results were as follows; 1) The prevalence rate of urinary incontinence occurring almost daily in hospitalized persons aged 60 and over was 23.3% for men, 23.8% for women. 2) The prevalence rate of urinary incontinence occurring almost daily in institutionalized persons aged 60 and over in special nursing homes was 64.2% of the aged 60 and over for men, 67.9% for women. 3) The prevalence of urinary incontinence increased with age for both sexes especially in hospitalized persons. 4) The 95% confidence interval estimate for the number of the hospitalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 31,000 to 113,000 in men and from 60,000 to 182,000 in women. 5) The 95% confidence interval estimate for the number of the institutionalized in special nursing home over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 34,000 to 50,000 in men and from 97,000 to 119,000 in women. 6) The 95% confidence interval estimate for the number of the institutionalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 318,800 to 570,600 in both sexes. 7) A random sampling survey is required to elucidate the actual state of prevalence in all generations. 8) Future research should emphasize the assessment of preventive and medical interventions, as incontinence is preventable and medical and surgical treatment options are available.

Age Factors↗

PubMed1993

Time experience of selected institutionalized adult clients.

Time experiences of 25 selected institutionalized adult clients were studied using the Time Experience Scale. Subject selection criteria were age, ability to comprehend written and oral English, institutionalization, and willingness to participate in the study. The findings suggest that institutionalized adult clients experienced time moving faster as they get older. Meaning, referring to concerns about dying and "attention to death," was found to be more important than past orientation, suggesting that institutionalized older adult clients were concerned about their time experience, its meaning, and influence on death. Nursing interventions could be directed toward increasing meaningful and purposeful activities, such as planned reminiscence therapy and reorientation techniques.

Adult↗

PubMed1995

Prevalence and biological consequences of vitamin D deficiency in elderly institutionalized subjects.

The prevalence of vitamin D deficiency was evaluated in a population of elderly institutionalized subjects in seven long-term geriatric care facilities in France (Amiens, Francheville, Ivry, Lille, Montpellier, Oissel and Villejuif). Residents whose functional capability was relatively good were entered into the study. There were 126 patients (99 females and 27 males) with a mean age +/- SD of 84 +/- 6.6 years. All subjects had been institutionalized for over six months and were capable of walking at least as far as the dining room. None had received vitamin D or other compounds known to affect the metabolism of phosphorus and calcium within six months before the study. Vitamin D status was evaluated by determining serum 25 hydroxyvitamin D (25 OH D) levels using a radiocompetition assay after extraction and chromatographic separation. Mean serum 25 OH D was 3.17 +/- 2.52 ng/ml (median 2.5). Eighty-five per cent of subjects had serum 25 OH D values of less than 5 ng/ml and 98% had values under 10 ng/ml, which is the cutoff usually taken to define vitamin D deficiency. Mean serum levels of intact parathyroid hormone were increased approximately two-fold as compared with values in healthy adults (70 +/- 39 pg/ml versus 33 +/- 12 pg/ml). Biochemical markers for bone formation (alkaline phosphatase, osteocalcin) and bone resorption (TRAP, hydroxyproline, pyridinoline) were all increased, with mean values 1.4-fold to 3.4-fold those seen in healthy adults. Serum 25 OH D levels were negatively correlated with serum intact parathyroid hormone levels (r = 0.41; p < 0.0001). Serum intact parathyroid hormone levels were positively correlated with alkaline phosphatase activity (r = 0.30; p < 0.001) and serum osteocalcin levels (r = 0.36; p < 0.0001) and negatively correlated with corrected serum calcium levels (r = -0.20; p < 0.02). Conclusion. Our data demonstrate that severe vitamin D deficiency is present in virtually all elderly institutionalized subjects and is accompanied with secondary hyperparathyroidism responsible for increases in markers of bone remodeling. Routine vitamin D supplementation is warranted in elderly institutionalized subjects.

Adult↗

PubMed1979

Intellectual and personality differences between community-living and institutionalized older adult females.

The purpose of the present study was to investigate simultaneously differences between normal institutionalized older adults and community-living older adults with respect to intelligence/cognitive test performance and personality. Participants were 25 community-living females (M age = 72.9 yrs, SD = 6.34) and 25 institutionalized females (M age = 80.0 yrs, SD = 6.46). Intellectual/cognitive ability was assessed by the WAIS, Stanford-Binet Intelligence Scale (Form L-M), Ravens Coloured Progressive Matrices; personality was assessed by the Hand Test, a projective technique. Several multivariate analyses (discriminant analysis) were conducted. Results suggested that even when controlling for age and level of education, institutionalization appears to be associated with intellectual/cognitive as well as personality deficits. The findings were discussed in terms of the potential implications for the professional working with institutionalized older adults.

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PubMed1993

Development of level of institutionalization scales for health promotion programs.

This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.

Community Health Services↗

PubMed1996

Differences in breakfast habits between institutionalized and independent elderly Spanish people.

An investigation was made into the breakfast habits of 150 elderly people between 65 and 95 years of age. The food intake of 58 institutionalized subjects was followed by means of "precise individual weighing of food". The food intake of 92 subjects living independently was followed using a prospective method involving the keeping of a "weighed food record". For all subjects the study lasted 5 consecutive days including a Sunday. Institutionalized subjects spent more time at breakfast (p < 0.01 in women) and the food they consumed was more varied, both in terms of number of foods (p < 0.001) and food groups (p < 0.001). Their breakfasts included more fruit (P < 0.001), fibre (P < 0.05 in women) and vitamin A (P < 0.01) than those of independent subjects, 7% of whom took no breakfast at all with a further 8% consuming only a glass of milk or fruit juice. 62.7% of independent and 43.1% of institutionalized subjects consumed an inadequate breakfast (i.e. their breakfasts provided less than 20% of their energy expenditure). The breakfasts of institutionalized subjects contained a greater percentage of their total daily intake of carbohydrates (P < 0.001 in women), fibre (P < 0.01 in women), thiamine (p < 0.05 in women), vitamin B12 (p < 0.05 in women, p < 0.001 in men), vitamin D (p < 0.01 in women) and magnesium (p < 0.05 in women). Given the importance of breakfast in the maintenance of a satisfactory nutritive condition, these results suggest that both qualitative and quantitative improvements of elderly people's breakfasts are required. Residing at an old people's home seems to improve the quality of breakfast consumed, especially for elderly women.

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