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PubMed1987

Glaucoma of institutionalized geriatric patients.

362 glaucomatous eyes of 213 institutionalized geriatric patients 66-100 year of age (83.9 +/- 6.9 year) were studied. Of the eyes with open angle glaucoma (77%, 279/362) 51% had capsular glaucoma (CG). Of the secondary glaucomas (9%) half were neovascular glaucomas. The visual acuity (VA) of 13 patients could not be determined. More than half of the patients (114/200) were visually handicapped (VA in the better eye less than 0.3). 55 out of 114 patients were considered blind (VA less than 0.05 in the better eye). In the glaucomatous eyes the mean VA was 0.17, binocular VA for near was 0.28. 28 out of 110 eyes had Bjerrum scotoma, 21 eyes had complete arcuate scotoma and 41 eyes had a residual field in the temporal periphery. In the present study, the causes of blindness were distributed as follows: glaucoma was the only cause in 25%; cataract was one of the causes in 66% and macular degeneration in 24%. Because glaucoma is a major cause of visual impairment in the elderly population, and it is frequently discovered by chance, attention should be paid to this condition in persons over 65 years of age.

Aged↗
PubMed1981

Differences in social skills performance between institutionalized juvenile male offenders and a comparable group of boys without offence records.

Eighteen institutionalized young male offenders and 18 boys without criminal records, comparable in terms of age, academic performance and social background, were videotaped during a five-minute standardized interview with a previously unknown adult. The videotapes were then subjected to a behavioural analysis of 13 responses which had previously been suggested to be important social skill components. The tapes were also shown to six independent judges who rated each tape in terms of social skills performance, social anxiety, friendliness, and employability. The offender group was found to differ significantly from the non-offender group in terms of the level of eye-contact, head movements, amount spoken, fiddling movements, and gross body movements. The offender group was also rated in significantly less favourably terms on the scales of social skills performance, social anxiety, and employability, compared to the non-offender groups. No significant difference was found in terms of friendliness ratings. Correlation analyses between the specific behavioural measures and the subjective rating scales revealed statistically significant associations between six of the 13 behavioural measures and one or more of the subjective rating scales. The provides some indication of the type of responses important in determining the impression made by adolescent male in an interview situation.

Adolescent↗
PubMed2026

Impact of a CARE-ORIENT Education Program on Oral Hygiene Among Institutionalized Older Adults: A Double Blinded Cluster Randomized Controlled Study.

BACKGROUND: Older adults residing in long-term care facilities often depend on caregivers for daily oral care. Inadequate caregiver training may contribute to poor plaque control and denture hygiene. METHODS: A six-month parallel-arm cluster randomized controlled study was conducted in selected long-term care facilities in Northern India. Two old age homes were randomly selected, with one allocated to the intervention group and the other to the control group. A total of 150 older adults and 46 caregivers participated. Caregivers in the intervention group received a structured caregiver oriented oral health education. Clinical assessments were performed at baseline, 3 and 6 months. Outcomes included Debris Index, Turesky-Gilmore-Glickman Plaque Index, Denture Plaque Index and Denture Stomatitis Index. Caregiver knowledge and practice were evaluated using a validated questionnaire. RESULTS: Caregiver knowledge and practice scores improved significantly in the intervention group at 3 and 6 months. Significant differences were observed in Debris Index (DI), Plaque Index (PI), and Denture Plaque Index (DPI) in the intervention group over the six-month follow-up (p < 0.001). The Debris Index decreased from 2.76 &#xb1; 0.07 at baseline to 1.54 &#xb1; 0.05 at 6 months. Plaque Index scores declined from 3.26 &#xb1; 0.06 to 1.85 &#xb1; 0.08, and Denture Plaque Index scores reduced from 3.22 &#xb1; 0.03 to 1.74 &#xb1; 0.05. Denture Stomatitis Index improved over time; however, intergroup differences were not statistically significant. CONCLUSION: Structured caregiver-focused oral health education significantly improved oral hygiene among institutionalized older adults over six months, supporting integration of caregiver training within routine long-term care.

Humans↗
PubMed1995

Activities of oral antibiotics on Providencia strains isolated from institutionalized elderly patients with urinary tract infections.

More than 250 Providencia strains isolated from the urine of institutionalized elderly patients were tested against cefaclor, cefuroxime, cefetamet, cefpodoxime, ciprofloxacin, and amoxicillin-clavulanic acid. Our results confirm the strong activities of expanded-spectrum oral cephalosporins against Providencia isolates, f1p4ell as the marked differences in susceptibilities among accurately identified Providencia species.

Administration, Oral↗
PubMedDate not supplied

Relationship between somatotype and blood pressure in a group of institutionalized Venezuelan elders.

BACKGROUND: Somatotype, as an indirect measure of estimating body composition, provides an easy and comprehensive picture of body shape. Multiple investigations have shown the existence of an association between somatotype components and cardiovascular disease. OBJECTIVE: The aim of the present study was to examine the association of somatotype with blood pressure during ageing. METHODS: The Heath-Carter anthropometric somatotype and both systolic (SBP) and diastolic (DBP) blood pressures were recorded. The sample included 809 healthy institutionalized elders (370 males and 439 females) from geriatric units in Caracas, Venezuela. Ages ranged from 60 to 102 years. Product-moment correlation coefficients between somatotype components and both blood pressure readings were calculated. Principal component analysis and homogeneity analysis by means of alternative least squares tests were also performed. RESULTS: Females were more endomorphic and mesomorphic than males. Males were more ectomorphic than females. SBP showed a downward tendency with age in males, while in females the tendency was for the SBP to increase. Correlations among variables were from low to moderate and ranged from -0.37 to +0.34 in males, and from -0.18 to +0.32 in females. Correlations tended to be stronger in the younger age group and differences between sexes were found. A negative tendency in the correlation between ectomorphy and both SBP and DBP was found, except for the oldest age group, for which the correlation was positive. Endomorphy and mesomorphy showed a stable correlation pattern with blood pressure in males, while in females this pattern was more irregular and less consistent. CONCLUSION: Individuals with high levels of SBP and DBP had mean somatotypes, which were similar to those of other male groups characterized by myocardial infarct, coronary heart disease and the risk of hypertension, indicating that these somatotypes may be associated with cardiovascular risk factors. In particular, our results indicate that individuals who present a cardiovascular risk profile are more endomorphic and mesomorphic and less ectomorphic than those with a lower cardiovascular risk profile.

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PubMed2006

Factors related to institutionalization among the frail elderly with home-visiting nursing service in Japan.

A dramatic increase in the number of elderly people in Japan has led to a concurrent increase in the number of frail elderly in need of care. It is estimated that the number of frail elderly will reach 3.9 million by the year 2010. Family members are often both physically and mentally burdened with caring for the frail elderly. The present study was conducted to identify the risk factors for institutionalization among the frail elderly receiving in-home care in Japan.

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PubMed2007

Lifelong course of positive and negative symptoms in chronically institutionalized patients with schizophrenia.

BACKGROUND: Despite widespread policies of deinstitutionalization, a substantial number of patients with schizophrenia require continuous custodial care. The hospital records of such patients provide contemporaneous documentation of symptoms throughout the illness, permitting a longitudinal study of the course of symptoms. We sought to describe this course, and to determine the influences of sex, age of onset, and treatment on its evolution. METHODS: Using the modified Diagnostic Evaluation After Death, we performed standardized chart reviews of 99 chronic inpatients who remained in state institutions through the 1960's and 1970's and subsequently died in those institutions. Data were available from the onset of illness until death. RESULTS: We found significant decreases in positive symptoms and increases in negative symptoms over the course of the illness. Symptom patterns were analyzed by repeated measures ANOVA. Onset before age 25 was associated with greater numbers of negative symptoms at a given age (p = 0.05). Female sex was associated with greater numbers of positive symptoms (p=0.04). The widespread introduction of neuroleptic drugs in the mid-1950's did not affect the trends in symptom patterns. CONCLUSIONS: The lifetime course of schizophrenia in chronically institutionalized individuals is characterized by a decrease in positive symptoms and an increase in negative symptoms. Schizophrenia with earlier onset is associated with greater numbers of negative symptoms throughout life. In this sample of patients, chronically hospitalized until death, neuroleptic drugs failed to effect a persistent decrease in positive symptoms.

Activities of Daily Living↗
PubMed1996

Immunogenicity of an inactivated split influenza vaccine in institutionalized elderly patients.

The immunogenicity of influenza vaccination in elderly institutionalized patients, with a variety of clinical disorders, was tested in an open multicenter study involving 495 people (mean age 80 years). Vaccination with an inactivated split influenza vaccine (Fluarix) was clinically well tolerated. For all age ranges and all strains of virus, the vaccine elicited a humoral response which surpassed the European Community requirements for influenza vaccines in adults over 60 years. The geometric mean titers for all vaccine strains were significantly increased 28 days after vaccination, and remained higher than prevaccination levels after 6 months. These immunological parameters were unaffected by the clinical status of the patients.

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PubMed2002

Correlates of change in functional status of institutionalized geriatric schizophrenic patients: focus on medical comorbidity.

OBJECTIVE: Impairment in basic self-care skills is common in patients with schizophrenia and is even more severe in elderly patients with a chronic course of institutional care. While cognitive impairment has proven to be a major predictor of overall functional deficit in schizophrenia, other potential factors, such as medical comorbidity, need to be considered. METHOD: Geriatric institutionalized schizophrenic patients (N=124) were assessed three times over 4 years to determine levels of positive and negative symptoms, impairment in activities of daily living, impairment in cognitive functioning, and medical problems. Path analysis was used to determine which variables best predicted changes in self-care functions. RESULTS: Functional status, negative symptoms, cognitive functions, and health status all significantly worsened during the follow-up. The path analyses showed that change in health status did not predict change in activities of daily living after the analysis accounted for negative symptoms and cognitive functions. DISCUSSION: The results highlight the relative importance of cognitive impairments in the functional impairments of older schizophrenic patients with increased medical burden.

Activities of Daily Living↗
PubMed1992

Professionals' attitudes towards sex between institutionalized patients.

Sexual activity among institutionalized patients has always been an issue of concern to institutions. Despite this fact, there has been little consensus about how patient sexuality should be dealt with. Nor have clinical insights with respect to patient sexuality been empirically tested. Given the diversity of beliefs and policies in this area, guidelines concerning sexual activity among hospitalized mental patients seem to be badly needed. We examined the following six factors that we thought might influence staff decisions: (1) the competence of a patient to engage in sexual activity, (2) the degree of consent, (3) the nature of sexual activity (e.g., hugging vs. genital relations), (4) the location of sexual activity (e.g., in bedroom vs. on grounds), (5) the sex of the initiating patient (6) the sex of the other patients. We hypothesized that mental health professionals, both as members of the community at large and as professionals, would have conventional moral views (as defined by Kohlberg) towards sexual activity. Supporting this hypothesis, of the six factors listed above, only location of the sexual activity and form of the sexual activity affected judgements on sexual activity significantly. The professionals interviewed appeared to be most condemning of homosexual acts, and least condemning of hugging. Although we had hypothesized that profession norms of consent and competence would be significant factors, they were not. The core implication of our study is that mental health professionals need training on competence assessment and its use in decision making and must reexamine their own prejudices (e.g., homophobia) to clarify their decision making about institutional policies.

Adult↗
PubMed1989

Institutionalized disabled adolescents: gynecologic care. The pediatrician's role.

Severely handicapped and institutionalized teenage girls have a variety of gynecologic problems that can be readily addressed by a physician with an interest in adolescent medicine who makes "home visits" to the institutions. Disabled teens are a unique group of adolescents whose needs intersect with those of normal teens. Educating and listening to the caretakers, who can then prepare the patients, is essential. Key topics include menses and menstrual calendars, adolescent development, the pelvic examination, and contraception. The clinical problems most frequently encountered are vaginal discharge, menstrual cycle dysfunction, and oligomenorrhea. Basic on-site management is described. In this population, severe chronic illness and subnormal weights for age are not necessarily associated with secondary amenorrhea. Patients, parents, and staff are satisfied when gynecologic needs are met in an empathetic and thorough fashion. A list of educational resources is appended.

Adolescent↗
PubMed2001

Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people.

The loss of teeth is known to influence the mastication of foods and nutritional status. Therefore, we hypothesize that poor dentition status can impair the systemic health of the aged. To clarify the influence of dentition status on deterioration in physical ability, mental impairment, and mortality, we conducted a six-year prospective cohort study of the institutionalized elderly living in 29 of the 30 institutions for the elderly in Kitakyushu, Japan. Bivariate analysis revealed that worse dentition status at baseline led to significantly worse physical and mental impairment, and higher mortality. In a multiple logistic regression analysis, the physical ability of edentulous subjects without dentures significantly deteriorated compared with that of dentate subjects with 20 or more teeth. The six-year mortality rate of the edentulous subjects without dentures was significantly higher than that of the subjects with 20 or more teeth. Poorer dentition status, especially edentulousness without dentures, may therefore be related to deterioration in the systemic health of the aged.

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PubMed1999

Is there a difference between family caregiving of institutionalized elders with or without dementia?

Based on the stress and coping model of Lazarus and Folkman, the aim of this comparative study was to determine whether the caregiving experience of the caregivers of an institutionalized demented relative is different from the one of the caregivers whose relative does not suffer from dementia. Five dimensions of the caregiving experience were considered: stressors, cognitive appraisal of the stressors, social support, coping strategies and well-being. The sample consisted of primary caregivers of a demented and a nondemented relative. Results revealed that the caregivers of a demented relative were exposed to more stressors than the caregivers of a nondemented relative. Functional impairment as well as depressive behaviors were appraised as more disturbing. According to MANCOVA analysis, formal and informal social support seems to play a protective role in the psychological distress of the caregivers of a demented relative. There was no difference between the two groups with regard to their coping strategies. Overall, the caregivers of a demented relative seemed to experience some dimensions of caregiving in a different way compared with their counterparts, and the nature of dementia in itself helps to explain this difference.

Activities of Daily Living↗
PubMed1991

Sources of stress for family caregivers of institutionalized dementia patients.

Although many caregivers place their relative in a nursing home in an attempt to reduce their own burden, caregiving stress often continues after institutionalization. This research examined sources of stress for 66 caregivers who cared for their impaired relative at home and later placed that individual in a nursing home. We hypothesized that although these caregivers no longer had primary responsibility for direct care, they would continue to experience distress because of the stressors associated with the nursing home. Results ran counter to our expectations. Although many caregivers reported stressors related to nursing home care, stressors stemming from the patient's Alzheimer's disease (AD) symptoms accounted for more variance in caregivers' levels of anxiety and depression, and in the quality of their interpersonal relations. Even though caregivers were assisted in their caregiving responsibilities by the nursing home staff, their relative's AD symptoms continued to prompt distress.

Alzheimer Disease↗
PubMed1994

A causal modeling approach to institutionalization.

A causal model of the institutionalization process is presented. Path analysis and logistic regression are performed on NHIS Longitudinal Study of Aging data. Based on initial analysis, the model is revised and re-evaluated. Convergent results support significance for four of five proposed predictors. Results are similar for men and women. Findings suggest unidentified factors are important to nursing home admission and that attention should be given to the process of decision-making that leads to admission.

Aged↗
PubMed1999

Sexuality among institutionalized elderly patients with dementia.

The subject of sexuality among elderly patients with dementia was examined, focusing on two main aspects: the sexual behaviour of institutionalized elderly people with dementia; and the reactions of other patients, staff and family members to this behaviour. The behaviour was found to be mostly heterosexual and ranged from love and caring to romance and outright eroticism. Reactions varied, being accepting of love and care but often objecting to erotic behaviour. Understanding of the sexual needs of elderly people should become an integral part of the training and continued education of health care staff, thus helping to resolve conflicts and clarify common misconceptions.

Aged↗
PubMed1993

Effects of therapeutic touch on anxiety in the institutionalized elderly.

The purpose of this study was to determine the effects of therapeutic touch, a specific healing technique, on state anxiety in 105 institutionalized elderly. A double-blind, three-group experimental design was used. State anxiety was measured using the Spielberger State-Trait Anxiety Inventory. The anxiety level of subjects who received therapeutic touch in the form of a back rub was found to be significantly lower than the anxiety level of subjects who received a back rub without therapeutic touch. Results suggest that this noninvasive intervention has potential for enhancing the quality of life for this population.

Aged↗