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PubMed2002

The use of a meditation programme for institutionalized juvenile delinquents.

The study applied intensive-seven consecutive days meditation programme in 101 late adolescent male delinquents in Upekkha Detention Centre. All of the boys completed the programme and answered the questionnaires. All of them felt that the meditation practice had been beneficial. 70 per cent of the subjects described feelings of contentment and calm, 53 per cent requested the programme to be repeated, 52 per cent of the subjects declared a clearer undestanding in the doctrine of Karma, 44 per cent referred to improved concentration and awareness, 36 per cent felt less impulsive, 22 per cent had flashbacks of their criminal behavior and their victims. In conclusion, the boys in Upekkha Detention Centre had the willing to join and complete the intensive meditation programme. Their self assessment reports showed a positive attitude to the programme. It is possible to develop a meditation programme as an adjunctive therapy for institutionalized juvenile delinquents.

Adolescent↗

PubMed1995

Therapeutic jurisprudence and the civil rights of institutionalized mentally disabled persons: hopeless oxymoron or path to redemption?

This article examines, from a therapeutic jurisprudence (TJ) perspective, the rights of institutionalized mentally disabled persons to determine whether TJ is compatible with positions advancing civil rights and liberties, and whether lawyers for such individuals should look more closely to TJ as a source of rights. It concludes (a) that despite harsh criticisms of mental disability law reform, most of the important decisions in the areas of involuntary civil commitment, right to treatment, and right to refuse treatment law have a strong TJ component and (b) that TJ analyses may be the appropriate tool to reinvigorate this area of mental disability law.

Civil Rights↗

PubMed1992

Oral care for the homebound and institutionalized.

Most patients who are homebound or in LTC facilities have multiple health problems that require the cooperation of many different types of providers. Dentists have a specific role in this process because they can improve the quality of life for the elderly by keeping them free of oral infection, restoring their dentition so they can enjoy eating, and restoring facial esthetics. It should be apparent that dental care for these patients is a complicated process. There are many considerations in prescribing the type of treatment needed by each patient. These include the patient's life span, medical history, drug history, mental status, mobility status, neuromuscular coordination, dental status, previous dental experience, dental expectations, and economic status. This information must be gathered by the dentist from the patient, the family, the nursing staff, and the patient's physician. Furthermore, the dentist also must assess the facilities and equipment available to carry out oral health care. Only after such considerations can a dental treatment plan evolve that is appropriate for the individual concerned. Dental care for one patient may be no treatment whatsoever, whereas a different patient in the same institution may require the most technologically sophisticated care that dentistry has to offer. Finally, the following circumstances should suggest that a homebound or institutionalized patient needs an urgent oral/dental evaluation: General Signs and Symptoms; Orofacial pain, Visible oral infection, Difficulty chewing food, Halitosis/dry burning mouth, Visible oral soft tissue lesions (white, red, or ulcerated). Tooth-related signs and symptoms; Visible dental decay, Loose or mobile teeth, Bleeding or sore gums. Denture-related Signs and Symptoms; Loose, ill-fitting, or worn dentures, Missing denture teeth, Home repairs attempted.

Aged↗

PubMed2003

[Selection of the more adequate prediction index to estimate the frame size a group of institutionalized and free living elderly in Venezuela. (Preliminary study)].

The objective of the study was to identify an easy to measure indicator of body frame size to allow refinement of anthropometric nutritional evaluation. Body dimensions and frame indices related to height, which might be potential frame size predictors in the elderly, were studied. In 307 subjects (163 women, 144 men) aged 60-99 years of whom 187 were institutionalized and 120 free-living outpatients, weight, height, mid-arm circumference; triceps, subscapular, midthigh and calf skinfolds; elbow, wrist, femur and biacromial widths, were measured. Body mass index, upper arm muscle area, upper arm fat area, fat percentage, sum of skinfolds and frame indices were calculated. Results were calculated in function of age, sex and life-style. Biacromial breadth, biacromial/height index, wrist breadth and wrist/height index gave variable correlations with indices of body mass and body fat. Femur breadth and femur/height index were significantly correlated with body fat indices. Elbow breadth, humerus/height index were not correlated to body fat indices, but were significantly correlated with weight, height and fat free mass. Elbow breadth and humerus/height index fulfilled most of the criteria of good predictors of body frame size in the group pf elderly studied.

Aged↗

PubMed1992

[Drugs and aged subjects institutionalized in geriatric units].

Our one-year retrospective study evaluated drug use in a population of 136 patients over 60 years old hospitalized in a geriatric ward (moderate--and long-term institutionalization). After having classified the reason for hospitalization, the length of stay and the number of pathologies per patient, the number of prescribed medications was quantified by means of a drug-day unit (D-D). The mean number was 3.36 D-D, which was independent of sex, age and reason for admission. The most frequently prescribed medications treated central nervous system, cardiovascular and metabolic disorders. These results were compared to those of CREDOC 1981 and CREDES 1987. In addition, 14 iatrogenic episodes were identified in this study; aminoglycosides and cardiovascular drugs were responsible for the majority of them, despite the precautions taken in light of the therapeutic indications. The iatrogenesis thus identified was not due to biological abnormalities found in the elderly. In our opinion, this evaluation of drug use is a good predictive element for understanding iatrogenicity on a larger scale and thereby to attempt to avoid it.

Aged↗

PubMed2004

[Experience with Risperidone in the treatment of institutionalized mentally retarded patients, with special reference to treatment of aggressive states].

Aggression has become a problem of our everyday life; every psychiatrist meets aggressive patients in his practice almost daily. Aggression represents a special problem in the case of institutionalized, mentally retarded (severe and moderate) patients, when it is associated with agitation, deficit of critical functions, impulsiveness, mood disorders. The nursing staff of these institutions is often overworked; the affective outbursts and aggressive behavior of mentally retarded patients may provoke a hostile attitude on the part of the nursing staff towards the patients. In the case of mentally retarded patients, unpredictable events may occur at any time. The structural background of mental retardation, the function of the affected cerebral structures, is not completely clarified. It was found in several studies that risperidone is effective in the treatment of agitation and aggressive behavior; the incidence of side effects is much lower than in the case of typical antipsychotics. We started the treatment with risperidone of 60 mentally retarded patients; we evaluated the therapeutic outcome after a three-month follow-up period using a rating scale made specially for this purpose. An attempt was made to compare the therapeutic results obtained in the risperidone group with the condition of patients receiving typical antipsychotics. It was found that, in the case of several items (aggression, agitation, deficit of critical functions, mood disorders, sleep disturbances, involvement in therapeutic activities), risperidone was significantly more effective than typical antipsychotics, and the incidence of extrapyramidal symptoms and other adverse events was much lower. It was hardly necessary to impose restraints in the risperidone group. In the care of mentally retarded patients, the use of risperidone has many long-term advantages, and hence it represents an effective alternative to typical antipsychotics.

Adult↗

PubMed2004

Malnutrition in the institutionalized elderly: the effects on wound healing.

Under-nutrition and protein-energy malnutrition are seen at alarmingly high rates in institutionalized elderly and in patients admitted to hospitals. A combination of immobility and loss of lean body mass - which comprises muscle and skin - and immune system challenges increases the risk of pressure ulcers by 74%. The development of pressure ulcers in the hospital affects 10% of admissions, with the elderly at the highest risk. Common causes of malnutrition in the elderly involve: decreased appetite, dependency on help for eating, impaired cognition and/or communication, poor positioning, frequent acute illnesses with gastrointestinal losses, medications that decrease appetite or increase nutrient losses, polypharmacy, decreased thirst response, decreased ability to concentrate urine, intentional fluid restriction because of fear of incontinence or choking if dysphagic, psychosocial factors such as isolation and depression, monotony of diet, and higher nutrient density requirements along with the demands of age, illness, and disease on the body. All have been found to delay healing and increase the risk of pressure ulcer development. In addition, what is ingested should contain nutrients to support health and healing. The financial impact of malnutrition is high and the consequences for patient morbidity and mortality are severe. Practical suggestions to improve the nutritional status of long-term care residents include liberalizing previous diet restrictions where safe and appropriate, addressing impairments to dentition and swallowing, addressing physical and/or cognitive deficits, encouraging family and friends to provide favorite foods, auditing/addressing specific food under-consumption, and providing prudent nutrient supplementation. Clinicians must be aware of the numerous factors in play with regard to nutrition and its impact on not only general well-being but also on wound care. Nutritional intervention in pressure ulcer management is truly "healing from the inside out."

Aged↗

PubMed2004

[Nutritional and antioxidant status of an institutionalized elderly group in Murcia (Spain)].

The aging of the population is giving rise to a large number of studies aimed at improving the quality of life, considering diet as a major contributing factor in this life stage. The objectives of the present study were to evaluate the nutritional status of a group of institutionalized elderly in Murcia, Spain, and to relate the diet to anthropometric and biochemical indices, paying special attention to total antioxidant status. The dietary evaluation showed excessive intakes of proteins and lipids, and deficiencies in those of carbohydrates, dietary fiber, zinc, iodine and vitamins A, E and D. The high proportion of overweight observed were not significantly correlated to the energy intakes. Although total plasma antioxidant status was low (0.62 mM eq Trolox and 0.98 mM eq Fe(II)) compared with reference values, estimated oxidative risk in this group of elderly was low according to plasma levels of vitamins C, A & E.

Aged↗

PubMed1992

Effects of yogurt and fermented-then-pasteurized milk on lactose absorption in an institutionalized elderly group.

In the present study we evaluated lactose malabsorption (LM) after ingestion of three dairy products in 53 healthy institutionalized elderly people. A preliminary screening with milk (250 ml, 11 g lactose) was carried out to select the LM subjects using the H2 breath test. The effect of consuming an equivalent amount of lactose contained in yogurt and fermented-then-pasteurized milk (FPM) was then assessed in LM subjects. Results indicated that 36% of the elderly population studied was considered as LM and that breath H2 excretion was significantly higher after ingestion of milk than after ingestion of yogurt. This beneficial effect was partially eliminated when FPM was tested. Moreover, breath H2 excretion was significantly higher (p less than 0.05) 3 hours after ingestion of FPM compared to the normal yogurt. These results demonstrate a high prevalence of LM in the elderly and confirm the positive effect of yogurt on lactose absorption, whereas pasteurized yogurt did not cause the same effect.

Aged↗

PubMed2005

[Nutritional status of institutionalized Venezuelan elderly].

With the aim of evaluating the nutritional status of institutionalized elders in different geriatric units of the metropolitan area of Caracas, 126 subjects with ages between 60 and 96 years old were evaluated. The Mini Nutritional Assessment was applied and were identified 48.4% individuals with nutritional risk, 5.6% malnourished and 46% without nutritional problems. Females presented higher prevalences of malnutrition and risk, while males presented an adequate nutritional state. By sex and age, females and males over 80 years presented a higher prevalence of malnutrition and risk when they were compared whit those younger. A low dayly liquid intake, a BMI equal or under of 23 kg/m2 and a limited physical performance were the items that presented the highest prevalence among the studied elders. In conclusion, the high prevalence of malnutrition risk in this population group, remarks the necessity to include into the global geriatric evaluation, a quick, simple and non-invasive instrument that allows to estimate the nutritional status of the elders.

Aged↗

PubMed2006

[Analysis and implementation of research findings on the decision making in institutionalization of the elderly: a family-centered perspective].

As the size of the population of the elderly increases, so does the incidence of chronic illness and disability. In addition, the rising prevalence of the nuclear family and rising unemployment among women, greatly reduce the resources available to families for caring. The institution placement rate among the elderly is increasing. The decision making process in relation to institutional placement, however, causes the utmost stress and suffering for the elderly and their families. The purpose of this paper is to review research articles concerning decision making in institutionalization, from the perspectives of type of decision, facilitating factors, the nature of the experience and the stress involved therein, the choice of institution, and the roles performed in the process by both the elderly person in question and by professionals, and then to propose recommendations for nursing research, nursing practice and health care policy. The researchers hope, by providing a family-centered perspective to nursing, to enable nurses to extend their concern and support to caregivers and the elderly facing decisions about institution placement.

Decision Making↗

PubMed1991

[A study of dental status and its contributing factors in mentally retarded persons institutionalized in welfare facilities].

Two hundred and forty-one mentally retarded persons, institutionalized in three private welfare facilities in Oita Prefecture, were assessed for dental status and tooth brushing ability. Information on their life style was also obtained by a questionnaire completed by their supervisors in the facilities. 1) Dental status of mentally retarded subjects was found to be inferior compared to the general Japanese population studied in the survey of dental disease in 1987 by the Ministry of Health and Welfare. Inferior dental status was characterized by a low score for filled teeth and a high score for missing teeth. 2) Both low tooth brushing ability and low intelligence quotient were associated with their poor dental status. 3) Discrepancy between supervisor assessment of tooth brushing ability and actual ability was observed. 4) Periodontitis was observed in young epileptics taking antiepileptic medication at a high rate. However there was no association between the taking of antiepileptic medication and missing teeth score. These results indicate a necessity for more active dental services including the teaching of tooth brushing and early treatment by dentists and supervisors.

Adolescent↗

PubMed1991

Primary family contacts and emotional health in the institutionalized elderly.

Research among nondemented elderly living independently in the community suggests that increased social support is associated with improved emotional and physical health. Relatively little research has examined associations between social supports and health among the institutionalized elderly. A sample of 70 nondemented, elderly nursing-home patients was studied to determine associations between qualitative and quantitative aspects of patients' relationships with their primary family contact and measures of emotional well-being, including depression, hopelessness, and life satisfaction. Significant correlations between quality of relationships and all domains of emotional well-being were found. None of the correlations between frequency of interaction and measures of emotional health were significant. A hierarchical regression analysis demonstrated that the correlation between quality of relationships and depression and life satisfaction was independent of functional status, mental status, age, type of relation, and frequency of visits. These results are consistent with studies of the noninstitutionalized elderly.

Aged↗

PubMed1991

Nutrition, health and psychosocial profile of institutionalized children.

A study was undertaken to assess the health, nutrition and psychosocial profile of Institutionalized children in four States--Uttar Pradesh, Andhra Pradesh, Karnataka and West Bengal. A sample of 3,822 children from 70 institutions in 6-18 years age group formed the subjects of the study. It was observed that the destitute children were mainly taken care of in three types of institutions, viz, Voluntary, Government Aided and Government run institutions. Calorie deficiency and deficiency of Vitamins and minerals characterized the diets of these children. In general, there was no deficit of protein in their diets. Growth wise, these children were retarded both in height and weight compared to standards. However, they fared better in comparison to their age and sex counterparts in the rural and urban poor. Psychosocial profile of these children indicated that the prevailing environment in the institutions is less conducive for intellectual stimulation but not so for the development of skills of self-help, locomotion, socialization and imagery.

Adolescent↗

PubMedDate not supplied

[The prevalence of smoking in psychiatric patients. The effect of "institutionalization"].

The prevalence and other parameters concerning tobacco smoking were assessed in 100 outpatients with psychiatric disorders of axis I and II, according to DSM-III R criteria, and compared with those of 85 male psychiatric inpatients with forensic problems, recruited in a psychiatric hospital. The use of tobacco smoking was increased in psychiatric outpatients vs. the general pupulation and was very heightened in schizophrenic, as reported in earlier investigations; in the forensic sample both schizophrenic and non schizophrenic patients showed a very high prevalence. Therefore, the factor "institutionalization" does not modify the prevalence of tobacco smoking in schizophrenic--whose "smoking disposition" appears independent of the different social environments--while increasing the use in non schizophrenic patients. The positive correlation between tobacco smoking and schizophrenia is largely supported by these data and demands further investigation of its pathophysiologic mechanisms.

Adult↗

PubMed1991

Riboflavin status in a group of institutionalized elderly.

We studied the riboflavin intake and biochemical status in a representative sample (20 males and 52 females) of institutionalized elderly people (aged 68-95) living in the Autonomic Community of Madrid. The riboflavin density of the diet was in general higher than the recommended amount, so the quality of the diet, related to riboflavin, can be considered satisfactory, and probably the caloric deficit is the major cause of the low intakes found. We found no correlation between the intake and biochemical status of riboflavin. The elderly with erythrocyte glutathione reductase greater than 1.2 are not those who have lower intakes. The cause of the deficit could be the different malabsorption problems and diseases that affect people as age increases.

Aged↗

PubMed1991

Rett syndrome symptomatology of institutionalized adults with mental retardation: comparison of males and females.

Institutionalized adults with mental retardation (N = 297) were surveyed to determine the prevalence of symptoms of Rett syndrome. No symptom of the syndrome occurred more frequently in males than females. When symptoms were analyzed in clusters (e.g., severe mental retardation, no prenatal complications, walked before 15 months, and wide-based gait), no single cluster of symptoms appeared to differentiate males from females. However, as individuals, only females were found to meet the necessary criteria for a diagnosis of Rett syndrome. Symptoms were seen with equal frequency in this population and no one or two symptoms differentiated patients with and without Rett syndrome.

Adolescent↗

PubMed1990

[Oral findings of institutionalized handicapped children].

In this study, we investigated the oral conditions of 77 handicapped children (57 boys and 20 girls) and backgrounds of living in an institution. The results were as follows. Among 73 children having permanent dentition, the percentage of subjects with one or more DMF teeth was 94.52%, while DMFT was 7.45. The percentage of teeth treated for dental caries was 57.35%. GI (Gingival Index) was 1.7, and OHI-S was 3.50. The other features observed were attrition of posterior teeth in 25 subjects and crowding in 39. According to the degree of mental retardation, severely retarded children had a lower percentage of teeth treated for dental caries than moderately and mildly retarded children. Additionally, the severely retarded handicapped children who were long-time institutionalized and taking antispastic drugs, had the higher incidence of gingivitis and poor oral hygiene. This study indicated the necessity of a scheduled and active practice in order to improve oral hygiene status and gingival condition, and raise the percentage of teeth treated for dental caries of severely retarded children in an institution.

Child↗