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PubMed1998

Immune response to influenza vaccination in institutionalized elderly: effect on different T-cell subsets.

Humoral and cellular immunological responses to influenza vaccination were measured in volunteers in a long-term care facility. All participants were vaccinated with the commercially available 1994-95 trivalent influenza vaccine and blood samples were collected before and 6 and 12 weeks after vaccination. Cytokine and granzyme B in peripheral blood mononuclear cell (PBMC) cultures after virus stimulation, and serum antibody titres were measured for each of these time points. In general, the measures of the immunological response to vaccination were low and variably significant. The major finding was the difference with respect to post-vaccination measures for the two strains of influenza A contained in the vaccine. Geometric mean antibody titres were significantly higher for A/Texas/36/91 at all time points in the study when compared to A/Shangdong/09/93. There was a corresponding rise for interleukin-10 (IL-10) to the A/Texas/36/91 strain while no increase in IL-10 was observed in A/Shangdong/09/93-stimulated cultures after vaccination. In contrast, granzyme B rose after vaccination only in cultures stimulated with A/Shangdong/09/93. Interferon-gamma levels were also significantly higher in these PBMC cultures. There was a poor interleukin-2 (IL-2) response to both strains of influenza A. These data suggest that different strains or subtypes of influenza A may preferentially enhance T-helper type 1 versus type 2 responses through vaccination in institutionalized seniors.

Adult↗
PubMed2002

Behaviors mimicking seizures in institutionalized individuals with multiple disabilities and epilepsy: a video-EEG study.

We reviewed 824 video-EEG telemetry requests of institutionalized patients with epilepsy, searching for evaluations of "new seizure types" identified by staff (caregivers, teachers, therapists, LPNs, RNs). Of the 63 newly identified "seizure types," epilepsy was confirmed in 4 (6.3%); 59 represented nonepileptic events. Causes for diagnostic confusion in the profoundly retarded included stereotypic repeated blinking, swallowing, buccolingual movements, spontaneous grimacing, periods of apparent psychomotor arrest and increased muscle tone, dystonic posturing, and irascible personality emerging after reduction of sedatives. Three cases of "startle seizures" were due to dystonic posturing caused by the unexpected contact of body with water during bath. Episodes of decreased daytime alertness ("somnolence") were erroneously attributed to "absence seizures" in eight cases by staff supervising tasks requiring sustained attention (i.e., school, workshop). In less impaired patients, self-stimulation, self-abuse, and ataxia with falls were the more common diagnoses. Simulation of seizures, a somewhat uncommon finding in this population, was the diagnosis in 3 cases. All were high functioning and appeared to simulate seizures to avoid work. Our findings suggest that the de novo appearance of a "new seizure type" in these patients, particularly in cases with a well-established seizure pattern, is uncommon. Four patients in whom the "new event" was confirmed to be epileptic had preexisting secondarily generalized seizures. What the staff identified was the variable clinical progression of seizures probably due to medication changes. Different fragments of the seizure appear to have occurred at different times with variable intensity and duration. A single seizure type may have appeared to be a variety of attacks because of this fragmented presentation.

Journal Article↗
PubMed2004

Perceived enactment of autonomy and related sociodemographic factors among non-institutionalized elders.

The purpose of this study was to assess empirical data on the perceived enactment of autonomy (PEA), Chinese version, and to explore factors related to PEA among non-institutionalized elderly. A purposive sample of 165 subjects older than 65 years was recruited in Kaohsiung in southern Taiwan. Five subjects failed to answer their questionnaires completely; the total effective sample was thus 160. Questionnaires and interviews were used to collect data. The structured questionnaire consisted of two parts, assessing sociodemographic information and the PEA scale, Chinese version. Subjects had a high PEA score (mean, 3.38), with the greatest score in individuality (mean, 3.54), followed by self-direction (mean, 3.49) and freedom (mean, 3.16). Multiple regression analysis showed that the need for assistance in activities of daily living (beta = -0.62), overall health status (beta = 0.20), marital status (beta = 0.14), and age (beta = -0.13) significantly affected PEA in these elderly subjects and explained 61.9% of the total variance of PEA in this population. Based on these results, we provide substantive suggestions to practitioners and researchers. Possible future studies could expand the sample size using a random sampling method or examine factors related to PEA in order to learn more about PEA and apply it to clinical practice.

Aged↗
PubMed2005

Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease.

BACKGROUND: Disturbances in rest-activity rhythm are prominent and disabling symptoms in Alzheimer's disease (AD). Nighttime sleep is severely fragmented and daytime activity is disrupted by multiple napping episodes. In most institutional environments, light levels are very low and may not be sufficient to enable the circadian clock to entrain to the 24-hour day. The purpose of this randomized, placebo-controlled, clinical trial was to test the effectiveness of morning bright light therapy in reducing rest-activity (circadian) disruption in institutionalized patients with severe AD. METHOD: Subjects (n = 46, mean age 84 years) meeting the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke--the Alzheimer's Disease and Related Disorders Association) AD diagnostic criteria were recruited from two large, skilled nursing facilities in San Francisco, California. The experimental group received one hour (09:30-10:30) of bright light exposure (> or = 2500 lux in gaze direction) Monday through Friday for 10 weeks. The control group received usual indoor light (150-200 lux). Nighttime sleep efficiency, sleep time, wake time and number of awakenings and daytime wake time were assessed using actigraphy. Circadian rhythm parameters were also determined from the actigraphic data using cosinor analysis and nonparametric techniques. Repeated measures analysis of variance (ANOVA) was used to test the primary study hypotheses. RESULTS AND CONCLUSION: Although significant improvements were found in subjects with aberrant timing of their rest-activity rhythm, morning bright light exposure did not induce an overall improvement in measures of sleep or the rest-activity in all treated as compared to control subjects. The results indicate that only subjects with the most impaired rest-activity rhythm respond significantly and positively to a brief (one hour) light intervention.

Aged↗
PubMed1998

A study of factors facilitating and inhibiting the willingness of the institutionalized disabled elderly for rehabilitation: a United States-Japanese comparison.

The high prevalence of 'bedridden elderly' in Japan is at least three times higher than that of any other industrialized country. To decrease likelihood of being bedridden, it is important to cultivate and maintain the willingness of older disabled patients for rehabilitation, and to preserve functioning in activities of daily living (ADL). The purpose of this study was to identify the factors facilitating and inhibiting the willingness of institutionalized disabled older adults for rehabilitation with respect to physical, goal-attainment, psychological and cultural aspects. The convenience sample consisted of 71 disabled older adults (45 in Japan and 26 in the USA). 46 subjects (64.8%) were identified as 'willing for rehabilitation', whereas 25 (35.2%) were 'unwilling for rehabilitation'. The data were gathered using structured interviews to subjects and administering questionnaires to the nurses. The data were compared between the 'willing' and the 'unwilling', and between those from Japan and from the USA by cross-tabular and correlational analyses. The major findings in this study were as follows: (1) Factors found to facilitate willingness of older persons for rehabilitation included: high independence level in ADL, generalized endurance/stamina, lack of pain, mutual goal agreement between old people and care staff, and no presence of regressive behavior. (2) Factors found to inhibit willingness of older persons for rehabilitation included: lower independence in ADL, presence of pain, generalized little stamina, depression, presence of regressive behavior, and dementia, and expectation of another person's help all the time. Healthcare workers need to be aware of patients who are subject to factors inhibiting willingness, and to promote factors facilitating willingness, in order to prevent the elderly with disabilities from becoming bedridden. In addition, the implications of this study are for a multidimensional functional assessment to be part of the rehabilitation intake in order to better understand each individual and motivate his/her optimum level of functional ability.

Journal Article↗
PubMed1981

The paralanguage of caregiving: baby talk to the institutionalized aged.

A field study was conducted at a nursing home to (a) obtain descriptive information on the speech environment of the institutionalized elderly and (b) provide speech samples with which to conduct judgment studies on the paralinguistic features of caregiver communication. Three kinds of speech were differentiated: baby talk, speech to the elderly that was not in baby talk, and speech between caregivers, which was assumed to be normal adult speech. Over 22% of the sentences were reliably categorized as baby talk speech. Caregivers' ratings of the characteristics of the care receivers did not predict the amount of baby talk that was directed toward individual care receivers. In Judgment Study 1, content-filtered baby talk was identified as speech to children regardless of the actual status, adult or child, of the target. In Judgment Study 2, content-filtered speech samples were rated on four dimensions: comfort, pleasantness, irritation, and arousal. Baby talk was rated positive, adult speech received intermediate ratings, and non-baby-talk was rated negative. The findings suggest that baby talk is a speech register conveying affection, and it is proposed that non-baby-talk to the elderly is an "institutional" register denoting and promoting dependency.

Aged↗
PubMed1988

Application of operant procedures in a group of institutionalized aggressive geriatric patients.

This study used positive reinforcement schedules versus no reinforcement on a group of 6 highly aggressive, institutionalized elderly patients. Dependent measures included confirmed incidents of physical and verbal aggressive behavior monitored across an ABAB design with a 4-month phase-out period. Results indicated that aggressive behavior can be significantly decreased in a group setting and subsequently generalized to ward behavior. Ancillary aspects of the study included the role of tangible and back-up reinforcers and staff attitude and behavior. Implications for future research are discussed.

Aged↗
PubMed2006

On the failed institutionalization of German comparative psychology prior to 1940.

Despite an illustrious history marked by the work of Wolfgang Köhler and Mathilde Hertz, among others-the significance of which still resonates in different fields of animal behavior research-and the fact that interesting work in the field continues, comparative psychology has no official status within German psychology. A partial explanation for this lack of official representation might derive from unsuccessful attempts historically to secure institutional status. "Gifted" animals served as much of the impetus for the beginning of a scientific animal psychology in Germany and contributed to its institutionalization by providing the incentive for the establishment of organizations dealing with animal psychology. Although initially serving as a catalyst for an interdisciplinary exchange on animal psychology, the case of Clever Hans was also exploited to help psychology gain institutional status in the field, albeit without lasting success.

Animals↗
PubMed1983

Bacteriuria in elderly institutionalized men.

Over a two-year period we obtained monthly urine samples from all noncatheterized male residents on two geriatric wards to determine the occurrence and optimal management of bacteriuria in this population. Among 88 men the prevalence of bacteriuria was 33 per cent, and the incidence was 45 infections per 100 patients per year. Outcomes after single-dose therapy for asymptomatic bacteriuria with 43 courses of trimethoprim/sulfamethoxazole and 23 of tobramycin included 15 cures, 40 relapses, and 11 treatment failures. Thirty-six residents who had a relapse or in whom single-dose therapy failed were randomly assigned to receive therapy to eradicate bacteriuria or to receive no therapy. All 20 residents who received no therapy remained bacteriuric. The 16 residents who received therapy had fewer months of bacteriuria after randomization, but at the end of the study only one remained free of bacteriuria. Mortality and infectious morbidity after randomization were similar in the two groups. These data suggest that asymptomatic bacteriuria is common in elderly institutionalized men and that therapy is neither necessary nor effective.

Aged↗
PubMed2006

Factors associated with oral health-related quality of life in institutionalized elderly.

OBJECTIVE: The aim of this study was to investigate factors associated with the oral health-related quality of life (OHRQoL) of institutionalized elderly in Germany. MATERIAL AND METHODS: One-hundred-and-fifty-eight subjects from old people's homes were selected (mean 82.8 years). OHRQoL was measured using the Oral Health Impact Profile (OHIP). Denture characteristics (kind and age of denture, retention of removable denture, number of teeth in static occlusion) and general issues (age, gender, education level, and general pain status) were assessed. All factors were subjected to bivariate testing for their effects on the OHIP summary score (OHIP-SC) and to multivariate testing in subjects with removable dentures (n = 128); a linear regression model with backward elimination was used, with OHIP-SC as the dependent variable. RESULTS: In the context of other studies, a median OHIP-SC of 29 indicated highly impaired OHRQoL. According to the bivariate analysis, retention, age of denture, number of teeth in static occlusion, general pain status, and education all exhibited significant influence on OHIP-SC. In the final linear regression model, general pain status, education level, and retention of denture remained at a statistically significant level. The model explained 34% (R2 = 0.34) of the variance of the OHIP-SC. The kind of denture had no significant impact on OHIP-SC. CONCLUSIONS: In contrast to other groups, the kind of denture exhibited little impact on OHIP-SC for this highly specific collective. However, there were functional aspects of dentures which seemed to be important. Non-dental factors had a striking effect on OHRQoL.

Aged↗
PubMed1986

Construct validity of the Kendrick Battery with institutionalized aged.

In this study, we attempted to explore the construct validity of the Kendrick Battery by using an American sample and psychometric tests as indexes of diffuse organicity, depression, and normality. Institutionalized residents (N = 53) were tested twice (6-week interval). When organicity was defined by disorientation and memory deficits, then both the Object Learning test and the Digit Copying test were accurate in differentiating preestablished criterion groups. When organicity was defined more broadly, including sensorimotor function, the Digit Copying test alone was more accurate when depression was defined in terms of irritability, restlessness, and despair. These data suggest that although the Kendrick scales appeared to be sensitive to organicity and depression in this sample, their validity varied with the criteria for each when such were defined psychometrically.

Aged↗
PubMed1980

Resident and staff perceptions of latitude of choice in elderly institutionalized men.

Ninety-nine elderly institutionalized males, selected equally from three decades, completed measures of: their personal, perceived latitude of choice (LOC) in activities of daily living; self-concept; and life satisfaction. One hundred staff, of both sexes, estimated how the typical or "average" V.A. domiciliary resident would respond to the LOC measure. Mean resident LOC scores were found to be significantly related to life satisfaction but not to self-concept. This supports the thesis that latitude of choice, or personal autonomy, is related to well-being and that the LOC measure may be a useful tool in the development and evaluation of interventions aimed at improving resident well-being. Significant relationships between resident age and the importance of daily activities, self-concept and life satisfaction were also observed although there were no age differences in the resident data for the LOC, importance or choice measures. In comparing staff attributed and resident perceived latitude of choice, significant differences were found. Examination of response patterns to the specifically listed activities of daily living also revealed significant staff-resident differences. Therefore, any attempt to intervene in the environment to increase the personal autonomy or control of residents, and hence their well-being, must deal with such staff-resident differences and with staff misperceptions of what is and is not important to residents. Interventions should be targeted at specific activities viewed by a majority of residents as restricted and insofar as practical, interventions should be individually tailored.

Activities of Daily Living↗
PubMed1981

Determinants of person-environment congruence in institutionalized elderly men and women.

This study was designed to obtain information potentially of value in understanding an modifying the impact of the social environment of the perceived quality of like among institutionalized aged persons. It was hypothesized that Person-Environment (P-E) congruence, as assessed by the Environmental Perception, Preference and Importance Scale (EPPIS), would be related to (1) sex integration/segregation makeup of the health related facility (HRF) living units, and (2) quantity of social interaction between staff and residents. Analysis of sex by unit sex-type interaction for 60 residents' Person-Environment (P-E) congruence scores revealed that elderly females on sex-integrated units reported a higher level of P-E congruence than those residing on female-only units; males on sex-integrated units, in contrast, reported a poorer level of P-E congruence than males on sex -segregated units. Furthermore, behavioral observations of staff-resident verbal interactions confirmed the hypothesis that residents living on units with high staff-resident interaction perceived the environments more congruent with their preferences than residents on units low in verbal interaction. The observed relationships between the P-E congruence measure, resident-staff interaction, and unit sex-type were taken as further support for the relevance and value of the EPPIS measure as a tool for assessing and improving the institutional milieu.

Aged↗
PubMedDate not supplied

Reactions of the institutionalized elderly upon learning of the death of a peer.

An exploratory study of 25 institutionalized elderly people who witnessed the death of a co-resident is reported. Two topics are examined: thoughts and feelings of the survivors about their own death and the climate surrounding the death of a peer. Data obtained through a semistructured interview reveal that learning of a peer's death leads more than one third of the elderly residents to consider their own death. Witnessing a peer's death seems to have little positive or negative influence. On one hand, 84% of them state that they want to be informed of the impending death of a well-known peer; on the other hand, 80% reported that the staff does not say when a peer is dying. Half of the respondents perceive the staff as indifferent to the death of an elderly person.

Aged↗
PubMed2005

Effect of melatonin-rich night-time milk on sleep and activity in elderly institutionalized subjects.

Melatonin production decreases with advancing age, leading to insomnia and changes in circadian rhythmicity. Administration of melatonin in variable doses resulting in supraphysiological or physiological night-time blood levels of melatonin has been shown to improve sleep quality in the elderly. To study the effect of low doses of melatonin, which do not affect daytime blood melatonin concentrations, night-time milk containing 10-40 ng/l melatonin was used as a drink with meals. The effect of about 0.5 l night-time milk daily on sleep quality and circadian activity was studied in elderly institutionalized subjects in two long-term double-blind, placebo-controlled, crossover studies. Night-time milk was given for 8 weeks and normal day-time milk for 8 weeks with a 1-week washout period in between. In the first study, which was performed during spring with sleep quality evaluated subjectively by specially trained nurses, 70 demented patients showed only a seasonal effect on their sleep quality. In the second study performed around the winter solstice, 81 fairly healthy subjects living in rest-homes were divided into three groups, two for the crossover study as in the first investigation with a third group consuming only normal daytime milk as a control group to evaluate the effect of season. Caregivers graded the sleep quality and activity that was monitored separately for the morning before noon and for the evening after noon. In the second study, the effect of season was recognizable in the scores for sleep quality, which increased in all groups after the winter solstice. However, there were no changes in activity in the control group or in the group that consumed night-time milk during the first period of the crossover study, whereas both morning and evening activity increased significantly in the group that consumed night-time milk during the later period. Even ultra-low doses of melatonin may benefit the elderly by increasing their daytime activity.

Aged↗
PubMed2000

Circadian rhythms of agitation in institutionalized patients with Alzheimer's disease.

Agitation is a common problem in institutionalized patients with Alzheimer's disease (AD). "Sundowning," or agitation that occurs primarily in the evening, is estimated to occur in 10-25% of nursing home patients. The current study examined circadian patterns of agitation in 85 patients with AD living in nursing homes in the San Diego, California, area. Agitation was assessed using behavioral ratings collected every 15 minutes over 3 days, and activity and light exposure data were collected continuously using Actillume recorders. A five-parameter extension of the traditional cosine function was used to describe the circadian rhythms. The mean acrophase for agitation was 14:38, although there was considerable variability in the agitation rhythms displayed by the patients. Agitation rhythms were more robust than activity rhythms. Surprisingly, only 2 patients (2.4%) were "sundowners." In general, patients were exposed to very low levels of illumination, with higher illumination during the night being associated with less robust agitation rhythms with higher rhythm minima (i.e., some agitation present throughout the day and night). Seasonality was examined; however, there were no consistent seasonal patterns found. This is the largest study to date to examine agitation rhythms using behavioral observations over multiple 24 h periods. The results suggest that, although sundowning is uncommon, agitation appears to have a strong circadian component in most patients that is related to light exposure, sleep, and medication use. Further research into the understanding of agitation rhythms is needed to examine the potential effects of interventions targeting sleep and circadian rhythms.

Activity Cycles↗
PubMed2002

Angelman syndrome methylation screening of 15q11-q13 in institutionalized individuals with severe mental retardation.

Among several genetic diseases that comprise mental retardation, Angelman syndrome (AS) has been extensively recognized and investigated. In the general population, the syndrome occurs in about 1 in 20,000 live births and its prevalence in severely mentally retarded individuals is 1.4%. These figures, however, may be an underestimate, because of the variable phenotype of AS. The main objective of this work was to investigate AS patients among a group of mentally retarded subjects, using the methylation pattern of the SNRPN gene, as determined by Southern blotting molecular analysis. The molecular investigation of 75 institutionalized individuals with severe to profound mental retardation resulted in the detection of 1 case with an abnormal methylation pattern of the SNRPN gene, corresponding to AS. The patient's phenotype was classified as atypical, without outbursts of inappropriate laughter or a happy disposition; the patient would not have been diagnosed in the usual screens for AS, which only select patients who demonstrate the typical clinical findings characteristic of the disease.

Angelman Syndrome↗