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PubMed1985

An analysis of a partial task training strategy for profoundly retarded institutionalized clients.

This study investigated the effects of a partial task training strategy on productivity and on-task behavior in three profoundly retarded institutionalized clients in a pre-skills workshop classroom. Partial task training consisted of the presentation of "mini-tasks," with reinforcement for completion of those tasks. Additionally, behavior monitors were used to provide the clients with further positive comments and prompts. The results indicated that this strategy was effective in decreasing high rates of off-task behavior and in substantially increasing the number of pieces completed during the session. However, the effect on other inappropriate behaviors was minimal. This strategy demonstrated that profoundly retarded clients could be taught to increase on-task behavior and productivity in pre-skills workshop classes.

Adolescent↗

PubMed1987

Identifying profiles of service requirements in a non-institutionalized elderly population.

Studies of service requirements for non-institutionalized elderly have tried, more or less successfully, to consider the effects of the elderly environment. Here, the environment of elderly is explicitly introduced in a secondary analysis of a data bank on service requirements of a sample of elderly. The environment of the elderly is described in terms of their housing environment: the resources available and the physical characteristics of the housing. A cluster analysis was done on these variables in order to identify the context in which the service requirements would have to be met. Twelve living arrangement groups were obtained. A cluster analysis of the service requirements was run on each of these living arrangement groups. The profile of services obtained was much the same for each of these groups. Four different profiles were identified. Half of the sampled elderly were classified in the first profile as not requiring any services beyond those already available to middle-aged adults in the community. The group of elderly people (9%) in need of all the services that can be prescribed in the study were also those living in the most congenial social and physical environment, which suggests that they had found a living arrangement which met their level of service needs. One third of the sampled elderly needed help with heavy housework only. Another 6% of the elderly needed help with many activities of daily living, but did not have access to help. The analysis of service requirements should always explicitly consider the resources available to the individual whose needs are assessed.

Activities of Daily Living↗

PubMed1991

The administration of folic acid to institutionalized epileptic adults with phenytoin-induced gingival hyperplasia. A double-blind, randomized, placebo-controlled, parallel study.

Twenty severely retarded institutionalized epileptic adults with phenytoin-induced gingival hyperplasia were divided into two groups and received a daily 3 mg capsule of either folic acid or lactose for 16 weeks in a randomized, double-blind, parallel study. Serum folate and phenytoin levels were recorded at baseline and on completion of the study. Twelve areas of the gingiva on each patient were graded at 4-week intervals for 16 weeks with respect to the three indexes: hyperplasia, gingival health, and plaque index. There were no significant differences between treatment groups for any of the three indexes over time. The poststudy serum folate levels were three times baseline levels for the active drug group (p less than 0.001) but unchanged in the placebo group. Phenytoin blood levels that began within the therapeutic window (10 to 20 micrograms/ml) tended to remain within the therapeutic window for both groups, with no reported seizure activity. A single daily oral 3 mg capsule of folic acid did not show efficacy as the sole therapeutic agent in the reduction of phenytoin-induced gingival hyperplasia.

Adult↗

PubMedDate not supplied

Urinary incontinence as a predictor of death and institutionalization in a general aged population.

The prognostic significance of urinary incontinence (UI) was evaluated using the Helsinki (Finland) Aging Study Database, in which a random sample of persons of three age cohorts (75, 80 and 85 years, n=649) was followed for 5 years. The prevalence rates of UI in the three age groups were 10.5%, 20.4% and 28.6%, respectively. UI was also frequent in healthy aged subjects (15.6%), but most common in hospitalized patients (35.3%), in those with severe depression (51.8%), previous stroke (37.6%) or dementia (48.8%). UI had age- and gender-adjusted risk ratios (95% C.I.) for mortality of 1.75 (1.33-2.30) and for long-term institutional care of 2.37 (1.30-3.84). However, after controlling for the presence of dementia, the risk ratios were no longer significant. Thus, UI predicts both death and long-term institutionalization in the general aged population. However, this observation is mainly explained by the close association of UI with dementia.

Journal Article↗

PubMed1988

The de-institutionalization of care of the elderly: some notes about implementation and outcome of a Swedish case-study.

During the 1980s the number of institutional beds in Sweden has decreased in relation to the number of elderly in the population. In some communities this development has been drastic. The present paper describes how the implementation of this process in one of these communities was based on action research design. Initially most people regarded the development as a success: more elderly people were able to stay in their homes and institutional places were used more effectively. The situation today is more complicated. Elderly patients finally ending up in institutions are in greater need of care than before. Over-occupation of beds is again common, making the situation more "heavy-going" for the staff. Staff outside the institutions are also experiencing a heavier workload. In view of this, the wisdom of further de-institutionalization is now questioned.

Aged↗

PubMed1985

The effects of exercise on the health, intelligence, and adaptive behavior of institutionalized severely and profoundly mentally retarded adults: a systematic replication.

Institutionalized severely and profoundly mentally retarded adults participated in a 7-month program of rigorous aerobic-type exercises. The effects of the treatment on the physical fitness, intelligence, and behavior of subjects were assessed. Fifty men and women were matched in pairs based on IQ, CA, and sex and assigned randomly to an experimental (E) or control (C) group. Those in the E group met 3 hours per day, 5 days per week and received a treatment that consisted of an exercise program that included jogging, running, dance-aerobics, and circuit training. The C group continued their normal institutional training programs. The treatment produced significant improvement in the cardiovascular efficiency of subjects; however, no changes in intelligence or adaptive behavior were obtained. Although standardized tests reflected little improvement in psychological or behavioral variables due to treatment, subjective reports suggest that exercise training may serve as a more practical habilitation program for severely and profoundly mentally retarded individuals than those typically employed in institutional settings.

Adolescent↗

PubMed1995

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample.

This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research-based diagnoses based on Diagnostic and Statistical Manual-revised 3rd edition (DSM-IIIR) criteria, and (2) evaluations of one's recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research-based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research-based anxiety.

Age Factors↗

PubMed1996

Critical pathways: a road to institutionalizing pain management.

Effective strategies to increase the visibility of pain and the accountability of health-care professionals for the treatment of pain are needed to improve the quality of pain management. Critical pathways are tools used to plan and document care for patients within a system of case management. Case management models of care focus on decreased cost, better coordination of services, and improved patient outcomes. This article describes how critical pathways are being used in one setting within a system of case management to help increase awareness of pain as a problem and to institutionalize pain management. As institutions seek to implement outcome-based practice systems, many are turning to the critical pathway to influence practice patterns. Critical pathways provide the vehicle to articulate and implement a standard for quality pain management and a mechanism to analyze persistent failures in achieving desired outcomes of care. Using pathways to track and monitor care promises to uncover clinical barriers to pain management and provide an impetus to increase clinician accountability for pain relief.

Critical Pathways↗

PubMed1989

Nutritional status of institutionalized children and adolescents with developmental disabilities.

The relationship was explored between anomalies associated with developmental disabilities and nutritional status of institutionalized children and adolescents who received comprehensive interdisciplinary services. Variables included dietary intake, serum laboratory values, anthropometric measurements, feeding skills assessment, and clinical assessment. Mean intakes of nutrients were greater than 67% of Recommended Daily Allowances. Laboratory values were within normal ranges with the exceptions of serum ferritin, which was borderline or below normal in 46% of the males and 55% of the females, and alkaline phosphatase, which was elevated in 70% of residents receiving anticonvulsants. Energy intake was highest in residents with adequate feeding skills, followed by nonfeeders and feeders requiring behavior management. Subjects had greater triceps skinfold and lower mid-arm muscle circumference and weight measurements as compared to reference data. Findings of this study suggest that these developmentally disabled children and adolescents who received comprehensive interdisciplinary nutritional services, in general, are adequately nourished and have nutrient intakes that meet the RDA requirements.

Activities of Daily Living↗

PubMed2005

A retrospective chart review of the clinical effects of atypical antipsychotic drugs on glycemic control in institutionalized patients with schizophrenia and comorbid diabetes mellitus.

BACKGROUND: The association between schizophrenia and onset of type 2 diabetes mellitus (DM) is well documented. It is unclear whether this association is due to inherent risk factors in individuals with schizophrenia or to treatment with antipsychotic drugs, particularly atypical antipsychotic agents. OBJECTIVES: The goals of this retrospective, observational study were the following: (1) to determine whether adequate glycemic control could be achieved in patients with schizophrenia and comorbid DM who were undergoing treatment with atypical antipsychotic drugs, (2) to identify inherent risk factors that may affect glycemic control in this patient population, and (3) to consider the possibility that combined medication and inherent risk factors may affect glycemic control. METHODS: This was a retrospective, observational chart review that evaluated institutionalized patients in a New Jersey mental institution with concurrent diagnoses of schizophrenia and type 1 or 2 DM who were being treated with atypical antipsychotic agents (ie, olanzapine, risperidone, clozapine, or quetiapine) and were referred by their hospital internists to a weekly, half-day, in-hospital DM clinic. All patients with initial and end-point data for the efficacy measure (ie, change in glycosylated hemoglobin [HbA(1c)]) were included in the analysis. Mixed-effects linear and least-squares models were used to test whether a specific comorbidity had an effect on the change in HbA(1c) adjusted for the duration of the observation. RESULTS: A total of 72 patients met entry criteria. Among the 38 patients with baseline and end-point data (20 treated with olanzapine and 18 treated with risperidone), mean (SD) HbA(1c) decreased from 8.21% (2.4%) to 7.62% (1.7%). The only baseline demographic characteristic or comorbidity that predicted significant worsening in the adjusted HbA(1c) change was hepatitis (P = 0.003). CONCLUSIONS: Using appropriate, aggressive antidiabetic therapy, glycemic control was achieved in this group of patients with schizophrenia and comorbid DM who were treated with atypical antipsychotic agents.

Adult↗

PubMed2003

Quality of care in institutionalized deliveries: the paradox of the Dominican Republic.

OBJECTIVES: To better understand the paradox in the Dominican Republic of a relatively high maternal mortality ratio despite nearly universal institutionalized deliveries with trained attendants, a rapid assessment using an adaptation of the strategic assessment method was conducted. METHODS: A multi-disciplinary team reviewed national statistics and hospital records, inventoried facilities, and observed peripartum client-provider interactions at 14 facilities. RESULTS: The major referral hospitals, where more than 40% of births in the country occur, were overcrowded and understaffed, with inexperienced residents overseeing care provided by medical students, interns and nurses. Uncomplicated labor and deliveries were overmedicalized, while complicated ones were not managed appropriately; emergencies were not dealt with in a timely fashion. In the peripheral hospitals physicians were seldom present and clients were either turned away or delivered by unprepared nursing staff. Providers in the busiest facilities suffered from compassion fatigue, and were demoralized and overworked. In all facilities, quality of care was lacking and the delivery and birthing process was dehumanized. CONCLUSIONS: Access and availability of institutional delivery alone is not enough to decrease MMR, it is also the quality of emergency obstetric care that saves lives.

Attitude of Health Personnel↗

PubMed1997

Serum concentration and dietary intake of Zn in healthy institutionalized elderly subjects.

We determined the serum concentrations and dietary intake of zinc, as indicators of Zn status, in 44 healthy institutionalized elderly subjects in Granada (Spain) (mean age 81.4 +/- 7.9 years). Determination of Zn in serum was carried out by electrothermal atomic absorption spectrophotometry. Serum samples had a mean Zn concentration of 10.49 +/- 3.5 mumol/1. No significant differences were found in the serum levels of Zn as regards the sex of the subjects. However, concerning Zn intake, determined by a 7-day weighted food record, a significant statistical difference (P < 0.001) was found between men and women, with mean values of 10.01 +/- 1.76 mg/day and 7.33 +/- 1.33 mg/day, respectively. Application of regression analysis to the serum concentration of Zn and other nutritional parameters shows a statistically significant correlation (P < 0.05) between serum levels of Zn and the body mass index. The lack of statistical correlation between the serum concentration of zinc and its intake indicates that this index cannot be used as an indicator of zinc status in the elderly.

Aged↗

PubMed1988

Nursing assistants' behavior toward the institutionalized elderly.

A study conducted at Grant Park Care Center, an intermediate care nursing facility in Washington, DC, explored nursing assistants' attitudes and behavior toward the institutionalized elderly. Stepwise regression analysis was performed to measure the relationship between nursing assistants' job performance and their attitudes toward their supervisors, in-service training, and the elderly. Study results suggest that education promoting appropriate behavior and positive supervisory role models can significantly affect nursing assistants' behavior toward the elderly.

Aged↗

PubMed1984

Speech development in young institutionalized retarded children under an early intervention procedure.

The author describes the speech development in 43 young institutionalized retarded children under a therapeutic-rehabilitative procedure which lasted two years. Retarded children not following the special rehabilitation program and normally developing children from the same institution were used as control groups. The development of speech in the rehabilitation group was significantly better than that of the retarded group, but not as good as that of the control group of normally developing children.

Child, Preschool↗

PubMedDate not supplied

Narratives of care providers concerning picking behavior among institutionalized dementia sufferers.

To illuminate the meaning of picking behavior in institutionalized people with dementia, the narratives of 15 care providers were interpreted using a method inspired by Ricoeur's phenomenologic hermeneutics. The care providers saw the behavior as a form of meaningful communication. The behavior was described as occurring in combination with wandering and in connection with restlessness and stress related to fatigue, difficulty communicating, and lack of occupation. The behavior also was seen as an attempt to engage in meaningful activities. Some care providers reported that the picking behavior caused them strain, whereas others reported a more positive reaction because the behavior made the ward more alive. Most care providers perceived the meaning of the picking behavior relative to the dementia sufferer's previous life and said they reacted by diverting, allowing, or understanding the picking.

Aged↗

PubMedDate not supplied

[Perceived health and functional capacity of a non-institutionalized elderly population in Barcelona].

In order to explore the perceived health and functional capacity in the elderly, a cross-sectional study was undertaken in a representative sample of the non-institutionalized population aged 65 and over, resident in Barcelona (N = 1,288), and included in the 2nd Health Interview Survey. Sociodemographic information was collected, as well as perceived morbidity, sensorial problems and functional capacity (measured by the activities of daily living [ADL]). Some 60.3% of the elderly reported having "good" or "very good" health, and 56% reported being able to do all ADL without difficulties. Women in general reported a worse perceived health and a higher chronic limitation in each age group (p = 0.001). Age was not significantly associated with perceived health, but was...associated with disability (ADL) (p = 0.001). Variables with a stronger association with "poor", "bad" o "very bad" perceived health were: comorbidity (OR = 3.69 IC 95% = 2.60-5.25), restricted activity (OR = 3.25 IC 95% = 1.86-5.66) and incapacity in any of the basic ADL (OR = 2.15 IC 95% = 1.38-3.36). The elderly who were dependent in any of the basic ADL were more frequently female, 75 or more years old, and in 10.5% of the cases did not receive any personal help. The present study gives a general description of the health status and functional capacity of the elderly and identifies a group of old people with unmet basic care needs.

Activities of Daily Living↗

PubMedDate not supplied

[Social support and perceived health status in non-institutionalized population over 60 years of age].

OBJECTIVES: The purpose of this study is to describe the degree of social support in a sample of non-institutionalized population aged 60 and over and to explore possible relations between social support and perceived health. METHODS: We analyse data coming from Barcelona 1992 Health Survey. Sociodemographic and perceived health variables are analysed together with several social support variables based on the presence and number of available people for instrumental and emotional support necessity and perceived aid need for personal care and daily needs. RESULTS: In the study period, 1156 subjects aged 60 and over were interviewed at home. 20% of the sample (28.9% were women) lived alone and 28.2% (41.7% were women) were widowed. 43% had an extensive social support and 51% had a good emotional support. The men with less emotional support had a worse perceived health (OR = 2.7, IC 95% = 1.3-5.5). Only aid need for daily works in women was associated with worse perceived health (OR = 6.3, IC 95% = 3.2-12.4). CONCLUSIONS: Instrumental and emotional support availability weren't associated with perceived health in women in spite of they lived alone in a greatest proportion. In men, only emotional support absence was associated with worse perceived health.

Aged↗

PubMed1997

Safety and immunogenicity of a respiratory syncytial virus subunit vaccine (PFP-2) in the institutionalized elderly.

The safety and immunogenicity of purified fusion protein (PFP-2) respiratory syncytial virus (RSV) vaccine was evaluated in an open label study in 37 frail institutionalized persons over age 65. Vaccination was well tolerated without significant side-effects. Thirty-six of 37 volunteers completed the study. Nineteen of 36 (53%) vaccinees had a greater than or equal to fourfold increase in IgG to F protein at 4 weeks and 17 (47%) had a greater than or equal to fourfold rise in neutralizing titers to either group A or B virus. Although response rate to PFP-2 vaccine in the frail elderly was somewhat diminished compared to results in the healthy elderly, the vaccine was well tolerated and relatively immunogenic.

Aged↗