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PubMedDate not supplied

Linking young and old institutionalized people.

A proprietary nursing home for the elderly in the State of North Carolina succeeded in pairing itself for joint activities of residents with an institution for the young mentally retarded. The young and old residents of the two homes were thus enabled to help each other, and thereby to help themselves as well. For the nursing home residents, this program provided an opportunity to engage in respected volunteer work and to regain a meaningful role in the community. It is believed that indications drawn from this demonstration of interaction between a nursing home and a home for the mentally retarded can aid in farther planning of such arrangements and in identifying research needs and potentials. Although only relatively few of the mildly impaired elderly in the nursing home volunteered for the joint activity, the ripple effect of the project extended beyond the direct participants. Since residents of the two institutions alternated visits, nonparticipants had a chance to observe and even participate in the activities for short periods. Even those who chose not to participate at all shared in the enriched conversation that resulted from this experience. The project was obviously a source of satisfaction and pride to residents of the nursing home, and the activity was eagerly received by the mentally retarded youngsters. The program demonstrates that aged persons in nursing homes can be tapped as a resource for providing service to institutionalized mentally retarded children and that a mutually beneficial relationship between the two institutions can accompany such service. Many leads for worthwhile research emerge from this pilot project.

Adolescent↗

PubMed1977

Self-perception of intrinsic and extrinsic motivation: effects on institutionalized mentally retarded adolescents.

Self-perception theory predicts that the introduction of extrinsic rewards for behavior that was intrinsically rewarding may decrease rather than enhance overall motivation. This hypothesis was tested on a group of institutionalized mentally retarded adolescents (34 boys, 10 girls). Intrinsic (high and low task interest) and extrinsic (high- and low-incentive objects) motivation were both manipulated as independent variables, and the dependent variable was task persistence during a free-play period. Results indicated that for a high intrinsically interesting task, the task persistence was greater under the external reward of low- rather than high-incentive value conditions. The opposite trend was revealed for the low intrinsically interesting task. The results provided some evidence that the greater the amount of the reward for an interesting activity, the greater the degree to which the intrinsic interest is undermined.

Adolescent↗

PubMed1995

Nutritional state of beta-carotene and retinol in institutionalized elderly individuals of México City.

A study of the nutritional status of beta-carotene and retinol of 228 institutionalized elderly individuals, in four elderly homes of México City was carried out. Subjects varied between 61 and 101 years of age (151 were females and 77 were males). High pressure liquid chromatography was used to quantitate retinol and beta-carotene. Ninety eight percent of elderly individuals showed beta-carotene levels less than acceptable (at risk); 85.2% were deficient (high risk), and 12.9% were low (medium risk), only 1.85% had acceptable values (low risk). Ninety two percent of subjects had acceptable values (low risk) of retinol, while 6.0% and 2.0% were low (medium risk) and deficient (high risk) respectively. There were not significant differences among the four elderly homes. No significant correlation with age was found for any of the two vitamins. No sex related difference (p > 0.05) was observed in serum vitamin A and beta-carotene in either group.

Aged↗

PubMedDate not supplied

Follow-up study of biological parameters in elderly institutionalized patients more than one year after discontinuation of calcium-vitamin D supplementation.

Laboratory tests were done 15 to 19 months after completion of a six-month clinical trial of oral supplementation with 1 g elemental calcium and 800 IU vitamin D per day in elderly institutionalized patients. Serum 25-OH-vitamin D and intact parathyroid hormone levels returned to normal during the trial, indicating efficacy of the supplementation in correcting the vitamin D deficiency and secondary hyperparathyroidism present before the trial. Data were available before, during, immediately after and 15 to 19 months after the trial in 37 patients. Recurrence of the vitamin D deficiency was observed after discontinuation of the supplementation.

Administration, Oral↗

PubMed1997

Treatment of elderly institutionalized bipolar patients with clozapine.

In an open trial, clozapine was used to treat 3 elderly (mean age 72 +/- 2.5 years) institutionalized male patients with bipolar I disorder, most recent episode manic, severe with psychotic features. All patients were refractory or intolerant of treatment with lithium, valproate, benzodiazepines, and traditional neuroleptics both alone and in combination. Response to clozapine was determined using the Severity of Illness score on the Clinical Global Impression (CGI) scale (1 = normal, not at all ill, 7 = among the most extremely ill). Pre-clozapine severity of illness scores on the CGI averaged 6.33 +/- 0.6; post-clozapine CGI scores averaged 2.0 +/- 1.0 (t = 13.00, df = 2, p < .01). The therapeutic dosage of clozapine varied (range = 25-112.5 mg/day). There were no significant drops in granulocyte counts. Followup revealed sustained improvement over an average of 11 months. These dramatic results suggest that clozapine may be an effective alternative treatment for similar patients and that prospective trials are warranted.

Aged↗

PubMed1977

Learning concepts through modeling: using different instructional procedures with institutionalized mentally retarded adults.

A group of severely retarded institutionalized adults was exposed to three different types of instructional procedures (imaginal instruction, verbal instruction, no instruction) and three types of reinforcement procedures (no reinforcement, reinforcing correct responses, reinforcing all responses) in learning concepts through modeling. Concept acquisition was tested, using Leiter-type items, in direct imitation as well as in a generalization task. In both imitation and generalization conditions, imaginal instructions were more effective than verbal instructions, which in turn were more effective than no instructions. The study of modeling procedures, especially with regard to the use of imagery, is called for in order to investigate the processes involved in their effectiveness with a severely retarded population.

Concept Formation↗

PubMed1976

The mandate project: institutionalizing a system of patient care quality assurance.

In 1970, prior to present-day requirements for quality assurance programs, a project was undertaken to institute such a program voluntarily in ten hospitals. Five hospitals succeeded in fully implementing the program which was based on the "Bi-Cycle Process" and each documented improvements in desired patient care behaviors. Two hospitals partially implemented the process and demonstrated no significant changes in desired patient care behaviors. Two hospitals failed to provide the data upon which assessments could be made and one hospital never got beyond preliminary efforts at instituting the process. The project demonstrates that a voluntary quality assurance program is feasible and has important implications for PSROs and continuing medical education. It also provides evidence that attention to psychosocial factors is essential in the institutionalization of programs designed to produce desired changes in patient care behaviors.

Education, Medical, Continuing↗

PubMed1998

Measurement characteristics of the levels of institutionalization scales: examining reliability and validity.

The Level of Institutionalization (LoIn) scales were developed to assess the extent to which a health promotion program has become integrated into a health care organization. The instrument was designed specifically to measure the amount of routinization and niche saturation of four subsystems (production, maintenance, supportive, and managerial) believed to make up an organization. In this study, the LoIn scales were completed for diabetes programs in 102 general hospitals and 30 home health agencies in Maryland and Pennsylvania. Reliability estimates across the four subsystems for routines (alpha = .61) and for niche saturation (alpha = .44) were substandard. Average correlation among the four subsystems for routines was .67, and among the four subsystems for niche saturation was .38, indicating moderate to large amounts of shared variance among subsystems and challenging claims of discriminant validity. Given these large correlations and a poor fit when testing the eight-factor model, higher-order confirmatory factor analyses were carried out. Results supported the existence of two second-order factors. When collapsed into two factors, the reliabilities were adequate (routines alpha = .90; niche saturation alpha = .80). Criterion-related validity also was found between length of program existence and the routine factor.

Diabetes Mellitus↗

PubMed1998

MDS+ RAP items associated with pressure ulcer prevalence in newly institutionalized elderly: study I.

All federally funded facilities are required to use the Minimum Data Set Plus (MDS+) for functional assessment of their residents. Within the MDS+ there are 18 specific conditions addressed through Resident Assessment Protocols (RAPs). There is a RAP for pressure ulcers but the validity of the pressure ulcer RAP items has not been documented. The purpose of this study was to determine which pressure ulcer RAP items correlate with pressure ulcer prevalence in newly institutionalized elderly and whether inclusion of nutritional status information to the correlated RAP items increases association with pressure ulcer prevalence. Data were collected through a retrospective chart review of 990 residents over age 65 at 8 nursing homes. Five pressure ulcer RAP items were predictive of pressure ulcer prevalence 19.76% of the time. When nutritional status markers were added in a logistic regression, pressure ulcers were correctly predicted 32.3% of the time. In clinical practice, the pressure ulcer RAP needs to include nutritional status information to accurately reflect pressure ulcer risk.

Aged↗

PubMed2001

[Conduct problems in a sample of institutionalized minors with previous mistreatment].

PURPOSE: The present study tries to analyse the maltreatment effects and the expected relation, according to the reviewed literature, with behaviour problems in a sample of children in residential care in a protection centre in Seville county (Spain). METHOD: The sample was conformed by a group of maltreated subjects in a protection setting (n = 30) and two groups of equivalent comparison (n = 30 and n = 30). The first group was conformed by subjects living in a marginal area of Sevilla, similar to the origin setting of the study group, and the second group comes from a wealthy area of this city. The behaviour problems index CBC of Achenbach (1978; 1979; Achenbach & Edelbrock, 1983) was used. RESULTS: No significant differences between groups in the CBC total score was found. However, significant differences were found in the extemalising dimension and in the delinquency, somatic anxiety, somatic problems, and social withdrawal dimensions. Victims of corruption presented higher scores on the CBC total score, extemalising dimension, and delinquency. CONCLUSIONS: Young people, victims of child maltreatment and living in an institution, showed problems of withdrawal. Victims of corruption or emotional abuse presented more psychopathological problems.

Adolescent↗

PubMed1994

Institutionalizing children and adolescents in private psychiatric hospitals.

Admissions of children and adolescents to private psychiatric hospitals have been increasing more and more rapidly in recent years. However, the increasing use of inpatient treatment is not consistent with current theory and research about the mental health needs of children and adolescents; often inpatient treatment cannot be justified on the basis of the admitting diagnosis. Hospitalization has an array of negative effects and is less effective in terms of treatment outcome and cost when compared with community-based alternatives. High rates of admissions continue because of changes in the juvenile justice law, insurance practices, lack of legal protection for youths and children, inappropriate government policy, and the growth and practices of for-profit hospitals. Implications for social policy and social work practice are discussed.

Adolescent↗

PubMed1979