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PubMed1989

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

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

Adolescent↗

PubMed1988

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

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

Activities of Daily Living↗

PubMed1995

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

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

Age Factors↗

PubMed1993

Time experience of selected institutionalized adult clients.

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

Adult↗

PubMed1995

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

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

Adult↗

PubMed1981

Institutionalization of programs in medical education.

Through the use of questionnaires and interview schedules during extended site visits, sixteen programs training residents in non-family medicine primary care were studied to determine what factors contributed to program success -- known as "institutionalization" -- or to program failure. The findings revealed that programs were initiated for either philosophic or pragmatic money reasons. For programs to begin, to continue, and to be institutionalized was due to several contributing key factors. These included the resolution of programmatic differences in regard to goals; development of a substantive quality program; presence of forceful and respected leadership; tangible support of the administration and key academic departments; commitment of the teaching staff; anticipation of potential conflicts; participation of the involved lay and professional community; and the availability of some continued funding. The study also revealed that one program was a complete failure and had to be aborted because none of the key factors were present. The study concluded that the best way for institutionalization to occur is to assure that sound and comprehensive planning takes place. With thorough and anticipatory planning, the conditions essential to program institutionalization can be met more easily.

Internship and Residency↗

PubMed1979

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

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

Aged↗

PubMed1993

Development of level of institutionalization scales for health promotion programs.

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

Community Health Services↗

PubMed1996

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

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

Aged↗

PubMed1995

Survival in institutionalized patients. Influence of dementia and loss of functional capacities.

BACKGROUND: Several studies have shown a negative correlation between dementia and survival. To our knowledge, the simultaneous effect of other factors has not been systematically studied in institutionalized patients. OBJECTIVE: To determine survival in demented inpatients compared with that in a matched population of nondemented patients institutionalized for other chronic debilitating diseases. DESIGN: The sample consisted of 213 patients with dementia and 157 patients without dementia. We studied the effect on survival of gender, age, loss of functional capacities, and cognitive functions with the method of Kaplan and Meier and with the model of Cox. RESULTS: Demented patients had significantly shorter survival when other factors were kept constant in the multivariate analysis. There was a strong correlation between survival and the degree of autonomy as measured by ability to walk, continence, and preserved activities of daily living. Survival was significantly shorter for men. No correlation was found with neuropsychological measures of severity of dementia or with age on admission. CONCLUSIONS: Survival of demented patients is shorter than that of patients institutionalized for other invalidating conditions. The lack of correlation between neuropsychological test results and survival indicates that in the population we studied, the severity of dementia did not predict length of survival. The data show that the combination of dementia and loss of functional capacities is the most important factor in predicting survival.

Activities of Daily Living↗

PubMed1983

Physical self-maintenance, mental status, and personality in institutionalized elderly adults.

Administered the projective Hand Test (HT) to 52 institutionalized elderly adults in order to establish its validity in measuring individual differences in relationships between mental status and physical self-maintenance ability. Results suggested substantial covariance among level of self-care, organic dysfunction, and personality, independent of length of institutionalization. Implications of these data for the functional assessment of institutionalized older adults are discussed.

Aged↗

PubMed1989

Arthritis in nursing home residents. A validation of its prevalence and examination of its impact on institutionalization and functional status.

We studied nursing home residents to validate the method used in national surveys for estimating the prevalence of arthritis, and to examine the impact of arthritis on institutionalization and on the physical function of residents. Five homes were studied using a 3-phase approach. Directors of nursing in each home classified residents (n = 629) with respect to the presence of arthritis and senile dementia. The presence of osteoarthritis or rheumatoid arthritis and their impacts on a resident's initial placement were separately assessed by a physician through a chart review of a stratified subsample. The physician also rated a resident's likelihood of returning to community living. Finally, the functional impact of arthritis was assessed by a physical therapist. The nurses' estimate of the prevalence of arthritis in this population was 23.33%, while the physician estimate was 23.03%. These results are consistent with the 24.6% prevalence found in a 1977 national survey. Arthritis itself was a major cause of nursing home placement in 15% of all residents without dementia. Among those without dementia who also had arthritis, arthritis was a major cause of institutionalization in 31%. None of the residents without dementia showed substantial potential for reintegration into the community. Controlling for age, residents with arthritis had more pain, were more likely to require assistance in functional tasks, and were more likely to use a wheelchair daily than were their fellow residents. Nevertheless, our results suggest that arthritis, despite its impact on function, in and of itself is not a major cause of nursing home placement or ongoing institutionalization.

Activities of Daily Living↗

PubMed1982

Sexual interest, attitudes, knowledge, and sexual history in relation to sexual behavior in the institutionalized aged.

Although the idea that sexuality is a lifelong need is gaining greater research support and greater acceptability to the general public, few consider the institutionalized aged as having sexual needs or being able to benefit from sexual intimacy. The research presented here indicates that sexual activity in the institutionalized aged is related to their attitudes and behavior toward sexuality and to their sexual interest level and prior frequency of sexual activity. Institutionalized aged persons evidence sexual needs and do engage in sexual behavior.

Aged↗

PubMed1990

A comparison of cognitive function in community-dwelling and institutionalized old people of normal intelligence.

Two carefully matched groups of normal old people living in institutions or in the community were administered a neuropsychological cognitive test battery. In general, the institutionalized group performed worse than the community group. Discriminant function analysis identified a subgroup of high-functioning institutionalized subjects whose performance more closely resembled that of the community group than the remainder of the institutionalized group. Differences between the various groups were not due to differences in IQ, age, health, or other controlled variables. The critical tests that differentiated the groups were sensitive to impaired function in frontal and medial-temporal lobe brain regions. The results suggest a complex interaction involving effects of age and environmental factors on brain function and cognition.

Aged↗

PubMed1975

A comparative computer content analysis of the verbal behavior of institutionalized and noninstitutionalized retarded children.

Previous studies have indicated structural language differences favoring the noninstitutionalized retarded when compared to matched institutionalized retarded children. In this study, a sociological and psychological deficit hypothesis for institutional retardates was explored by using a verbal content analysis system. Unstructured speech samples from 20 institutionalized and 20 noninstitutionalized retarded children were employed using the computerized General Inquirer System and the Harvard III Psychosociological Dictionary. Differences were found between the groups but all except two were negated or attenuated by additional extended manual analysis treatments. The findings of this study do not support a psychological or sociological deficit hypothesis for institutionalized educable retardates as measured by this content analysis system.

Adaptation, Psychological↗

PubMed1999

Motivation to perform activities of daily living in the institutionalized older adult: can a leopard change its spots?

The concept of motivation has great relevance for the older adult because of the multiple problems that can result in functional limitations. The ability to overcome and transcend these problems is related to the individuals' motivation to maintain and/or improve function. The purpose of this study, which used a naturalistic or constructivist inquiry, was to explore what motivates the institutionalized older adult to perform functional activities. Primary selection was used to obtain the sample which included 44 older adults, 37 (84%) females, and 7(16%) males. The average of participants was 88 +/- 6.4, and they were institutionalized for 2.8 +/- 2.8 years. Semi-structured interviews were done in the participants room. Data analysis involved content analysis. A total of 27 codes were initially identified, and these were categorized and developed into five major themes: Personality, Goals, Beliefs, Fear and Physical factors. The participants indicated that basic personality had a major on motivation, i.e. 'a leopard can't change his spots'. Further findings suggested that although personality may be central to the individuals' motivation to perform, goals, fear, beliefs and physiological sensations also influenced motivation and behavior. Appropriate interventions can be used to foster motivation to perform functional activities for institutionalized older adults.

Activities of Daily Living↗

PubMed1997

Dental care for institutionalized geriatric patients in Germany.

This investigation determined the level of dental care for institutionalized geriatric patients residing in nursing home facilities. A total of 364 patients from nine different geriatric care units within the city of Berlin were involved in this study. On average the patients were 84.9 years old. Women represented 87.3% of the patients. A standardized questionnaire and a clinical examination of the mouth were utilized to assess patient satisfaction with geriatric care, their general medical status and their oral health status. The results demonstrated that patients in geriatric care did not undergo routine dental check-ups. Oral hygiene was sufficient in only 12.6% of the patients, and prosthesis hygiene in 45% of the cases. Only 37.6 of the dentures exhibited sufficient retention and stability. In 80% of the patients dental treatment was necessary. Recommendations for improvement of dental care delivery to institutionalized geriatric patients are given. It has to be concluded that dental management of institutionalized geriatric patients is an essential yet presently underfulfilled service.

Aged↗

PubMed1993

Factors associated with decline in function, institutionalization and mortality of elderly people.

Movements between dependency states, institutionalization and death are investigated in a general practice cohort of people aged 75 years and over with follow-up at 5 and 7 years from initial interview. Initially, 1203 people were interviewed, 1124 living in the community and 79 in institutions. By 5 years, 42% (510) had died and by 7 years 58% (700) had died. Dependency was defined as requiring help or aids with at least one activity of daily living (ADL). Of those initially independent, 34% were still independent 7 years later. Women at each age were more likely to become dependent whilst men had higher mortality. Those rating their health as fair or poor were more likely to lose independence at both 5 and 7 years than those rating their health as good. These differences remained, even after adjustment for age, sex and baseline ADL status. With the assumption that once institutionalized a person did not return to live in the community (an assumption upheld by the present data), 7% (79/1124) of those initially resident in the community were institutionalized during the 7 years; the rates for men (6%) being slightly lower than for women (7.5%).

Activities of Daily Living↗