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PubMed1981

Effects of parental absence and institutionalization on the development of clinical symptoms in high-risk children.

Longitudinal data on 207 Danish subjects at high-risk for schizophrenia (they have schizophrenic mothers) were examined to assess the direct and indirect effects of parental absence and institutionalization on the development of schizophrenic symptomatology. Information on the amount of parental absence and institutional child care during the first through 10th year was collected in 1962. A psychiatric evaluation, consisting of a standardized interview and two questionnaires (PSE and CAPPS), was administered to the subjects in 1972. Factors were constructed relating to eight clinical symptoms from the interview and questionnaires. Path analyses were performed separately for males and females with maternal absence, paternal absence and institutionalization as the predictors and the clinical syndromes as the dependent variables. The analyses showed both direct effects of parental absence and indirect effects mediated by institutionalization. For males, the absence of a schizophrenic mother was related to decreased symptomatology, but only when it did not result in institutionalization. Institutionalization was related to increased symptoms in males but not females. These results are discussed in light of previous research, and explanations are offered for the differential effects by sex.

Adolescent↗

PubMedDate not supplied

Helping students survive institutionalized patients and burn-out in staff in chronic psychiatric care facilities.

In summary, we have discussed the problem of institutionalized patients and burn-out in staff as well as the effect they both have on nursing students during their mental health-psychiatric nursing rotation. The stages in which specific student behaviors occur during the psychiatric nursing rotation as a result of the students' perceptions, and the interventions faculty members can employ in decreasing the subjective aspects of these perceptions have also been presented. We conclude that nursing students will emerge from their experience with better understanding of institutionalization and burn-out, and better equipped to cope with reality shock if they are introduced to these concepts early in the lecture series and are sent to a variety of psychiatric care facilities for observational experience. The facilities selected should be those in which patients are coping with less chronic behavior problems than found in state hospitals and where observable behavioral changes in patients are measured in weeks or months, rather than years. Facilities such as outpatient clinics and crisis intervention centers where clients may be more stabilized, less overwhelming, and have more resources available to them would meet these criteria. Finally, we recommend that instructors be made more aware than they are of the institutionalization and burn-out process early in their teaching responsibilities; that faculty group discussions on institutionalization as maladaptive behavior be held; and that the faculty encourage an open atmosphere where students can discuss their reactions to institutionalization in patients and burn-out in staff freely.

Aged↗

PubMedDate not supplied

Institutionalized older adults in a health district in the United Arab Emirates: health status and utilization rate.

BACKGROUND: Little is known about the rate of institutionalization and health status of nursing home (NH) type patients living in the Middle East. This study was set in the Al-Ain Medical District, a geographically discrete region of the United Arab Emirates, a country with a developing economy located on the shores of the Arabian Gulf. NH-type patients were defined as people aged 60 years and older who were admitted to a hospital or a long-term institutionalized setting for at least 6 weeks and with no evidence of an expectation of discharge at the time of the evaluation. OBJECTIVE: To determine the clinical, functional, cognitive, and nutritional status of NH-type patients living in a defined community within a developing country. METHOD: Cross-sectional survey. RESULTS: All NH-type patients were identified, and all were included in this study (n = 47, 100% participation rate). All were located within three public institutions, none of which was a dedicated NH facility. The rate of institutionalization was 7.0-14.0 per 1,000 people aged 65 or older. The age distribution was 30% (60-74 years), 49% (75-84 years), and 21% (85+ years). The length of stay was 3.8 years. The female:male ratio was 1.6. All except 1 had a neurological disorder, and 89% had dementia. The cognitive deficits were severe with only 61% alert, 41% able to speak, 17% orientated in place, and 15% orientated in time. The functional status was also poor: 98% received assistance with all instrumental activities of daily living, 85% received assistance with five activities of daily living, and 94% were bed bound. The nutritional status was also impaired with a mean body weight of 45 +/- 14 kg and a mean albumin level of 3.1 +/- 0.6 g/dl. When compared with the USA data from the National Center for Health Statistics, the study population was younger, had a longer length of stay, a lower female:male ratio, a higher rate of neurological diseases and dementia, and were far more dependent and disoriented. The rate of institutionalization was one sixth to one third of that in the USA. CONCLUSION: From these data we concluded that this region has a distinctly different population of institutionalized older people who demonstrate greater impairments in all domains of health status.

Activities of Daily Living↗

PubMed2001

Critical incidents precipitating institutionalization of a relative with Alzheimer's.

Despite the stressors of caring for a relative with Alzheimer's disease (AD), families institutionalize their loved one only as a last resort. What constitutes this last resort? Predictors of and risks for institutionalization have been widely examined by researchers for two decades. To date, values underpinning the critical incident leading to institutionalization of a relative with AD have not been explored. The purpose of this secondary analysis of 20 interviews with family caregivers who had recently institutionalized their relative with AD was to examine underlying values that precipitated the move. Mitchell's definition, in 1983, of a critical incident was used as a guiding framework. Three major themes were identified: "I couldn't forgive myself if something happened," "It was ruining my life," and "I had no choice." The ability to identify underlying values precipitating critical events may help nurses plan interventions to assist increasing numbers of families faced with institutionalizing a relative with AD as our population ages.

Adult↗

PubMed2006

Psychosocial predictors of dementia caregiver desire to institutionalize: caregiver, care recipient, and family relationship factors.

Several factors influence dementia caregiver desire to institutionalize; however, little is known about differences in caregivers who desire institutionalization versus those who do not. The current study compares predictors of desire to institutionalize in dementia caregivers. Seventy-two caregivers completed the Desire to Institutionalize Scale (DIS) and several psychosocial measures, including burden, dementia knowledge, self-efficacy, depression, health, care recipient daily functioning and memory/behavior problems, family functioning, and social support. Based on DIS responses, caregivers were divided into No DI versus DI groups. DI caregivers had significantly higher burden, greater dementia knowledge, more family dysfunction, and decreased social support compared with No DI caregivers. Findings emphasize the importance of caregiver and family relationship variables in DIS, suggesting potentially modifiable targets for caregiver interventions. Dementia knowledge was associated with higher DIS, suggesting that educational programs alone may not be helpful to delay institutionalization.

Aged↗

PubMedDate not supplied

Sleep problems and institutionalization of the elderly.

This study examined the role of sleep problems in the decisions of families to institutionalize elderly relatives. Previous work on institutionalization of the elderly has given little attention to the contribution of nocturnal, sleep-related problems. Seventy-three primary caregivers of elders recently admitted to a nursing home or psychiatric hospital were asked to identify the problems the elder was having during the night and day and rate the degree to which these influenced their decision to institutionalize the elder. Seventy percent of the caregivers in each sample cited nocturnal problems in their decision to institutionalize, often because their own sleep was disrupted. The most frequent disruptive nocturnal events were micturition, pain, and complaints of sleeplessness. Sleep problems of the elderly contribute heavily to the decision to institutionalize an elder and thus to the social and economic cost of institutional care. They appear to do this largely by interfering with the sleep of caregivers. The nature, prevalence, and treatability of the sleeping problems of both elders and their caregivers need further study.

Activities of Daily Living↗

PubMed2003

Family involvement following institutionalization: modeling nursing home visits over time.

Gerontological research has emphasized family members' continued involvement in the lives of loved ones following institutionalization. However, many of these studies are cross-sectional in design and do not ascertain how family members' visits change over time. The present study utilized a growth curve analysis to examine preplacement and postplacement predictors of nursing home visits over a two-year period among a sample of 65 caregivers of dementia patients. Intraindividual patterns of change suggested considerable heterogeneity in family visits. Several variables were also significantly predictive (p < .05) of change in nursing home visits. Spousal caregivers were more likely to report increased visits. Care recipients with greater cognitive impairment following institutionalization experienced increased visits. Caregivers who perceived respect and support from their social network following institutionalization also reported increased visits over the two-year study period. Caregivers who engaged in socially restorative activities after institutionalization reported decreases in visits. The findings provide a more refined understanding of the long-term involvement process following institutionalization.

Aged↗

PubMed1993

Dementia day care and its effects on symptoms and institutionalization--a controlled Swedish study.

OBJECTIVE: To examine the effects of Day Care (DC) on demented patients. DESIGN: A prospective non-randomized concurrent-control study. PARTICIPANTS: 55 demented patients in DC and 44 controls. SETTING: Sundsvall, an industrial community in northern Sweden. MAIN OUTCOME MEASURE: Cognition, ADL-functions, behaviour and institutionalization. RESULTS: Measurements of cognition, ADL-functions, and behaviour showed no or only small differences between the groups. After one year, 24% of the patients in the DC-group were institutionalized, compared with 44% of the controls. In the control group, the exhaustion of spouse and supervision need were highly correlated to institutionalization (p < 0.001), while high physical nursing load was correlated to institutionalization in the DC-group (p < 0.01). CONCLUSION: DC postpones institutionalization, probably because of less exhaustion of spouses and decreased supervision need.

Activities of Daily Living↗

PubMed1998

Food habits and anthropometric measurements in a group of independent and institutionalized elderly people in Spain.

Because of an increase in the number of elderly and the problems of nutrition associated with them, we considered it of interest to study the eating habits of 352 elderly persons (134 males and 218 females) 65 to 95 years of age in an urban area in the north of Spain (Oviedo). The purpose of this study was specifically to describe the differences in the eating habits of elderly institutionalized persons and those resident at home and to detect the nutritional status of 161 subjects living in institutions and 191 living at home. The weight, height, body mass index (BMI), and triceps skinfold (PTP) of each were recorded. To determine the eating habits, a questionnaire measuring the frequency of food consumption was distributed to the subjects. The mean age of the institutionalized elderly was greater than those living independently. The mean values of BMI indicated overweight in all cases, with values around those of obesity in independent females (BMI = 29.97). The value of PTP was found to be within normal limits, but a greater percentage of institutionalized subjects showed PTP values of less than P10 (males, 10.2%; females, 11%). Food habits showed that the consumption of fish and margarine/oil was greater in institutionalized subjects of both sexes. Independent males consumed more vegetables; females consumed more milk and greens. Milk, vegetables, fruit, and fish were the food groups with consumption frequencies less than those recommended. A greater percentage of noncompliance was seen among the institutionalized elderly.

Aged↗

PubMedDate not supplied

The relation between length of institutionalization and sensory integration in children adopted from Eastern Europe.

OBJECTIVE: To examine the relation between length of institutionalization and sensory integration in children adopted from Eastern Europe. METHOD: The Sensory Integration and Praxis Tests (SIPT) and the Developmental and Sensory Processing Questionnaire were administered to 60 adopted children, 4 years to 8 years, 11 months of age. Thirty had longer institutionalization histories (mean: 34 months; LIH group) and the other 30 had shorter institutionalization histories (mean: 3 months; SIH group). RESULTS: The LIH group demonstrated significantly lower scores than the SIH group on the SIPT in vestibular-proprioceptive, visual, and praxis areas, and effect sizes ranged from .09 to 1.13. The LIH group also had significantly more frequent behaviors suggestive of sensory modulation dysfunction compared to the SIH group, particularly in touch and movement seeking, vision, and audition. Effect sizes ranged from 0 to 1.39. CONCLUSION: Longer lengths of institutionalization are associated with more atypical sensory discrimination, praxis, and sensory modulation scores in children adopted from Eastern European orphanages. The areas of sensory integration that appear to be more vulnerable to deprived conditions in early childhood are vestibular-proprioceptive, tactile, visual, auditory, and praxis. Adopted children with lengthy periods of institutionalization may benefit from occupational therapy for early sensory integrative and developmental screenings.

Adoption↗

PubMed1982

[Life course and institutionalization: the deceptive effect of the percentage].

At one moment in time the percentage of elderly people living in an old people's home (bejaardenoord) or nursing-home (verpleeghuis) is much higher in the Netherlands than in comparable western countries. About 11% of people 65 years of age and more are living in such institutions. However, in discussions about institutionalization, people are making the same fallacious statements based on the percentage at one moment in time as indicated in literature as "% fallacy" (Kastenbaum & Candy, 1973). In this article we have calculated that about 35% of all elderly people in the Netherlands will be institutionalized before before death. Although at one moment in time about 2% of the elderly are living in a Dutch nursing-home, the incidence is as high as in the old people's home. That is why almost the same number of elderly people will be institutionalized before death in both institutions. Three examples are given of the fallacious use of the percentage at one moment in time. An attempt is made to calculate the chance which persons have, at different ages, to be institutionalized in later life. We use the incidence-rate in 1977 and 1978 and the life expectancy inthe period 1970-1975. The results indicate high chances for elderly people at different ages to be institutionalized in later life in an old people's home.

Aged↗

PubMed1997

[Prevalence of serum anti-Helicobacter pylori IgG antibody in persons with severe motor and intellectual disabilities--comparison between institutionalized persons and persons living at home].

The seroprevalence of an anti-Helicobacter pylori antibody (ELISA) was investigated in institutionalized persons with severe motor and intellectual disabilities (SMID). The rate of seropositivity was significantly higher in persons with SMID under 29 years of age than in age-matched controls and in institutionalized patients with muscular dystrophy. No difference in seropositivity among SMID patients was found between those in our and other institutions. Therefore, it is speculated that Helicobacter pylori infection occurs soon after the institutionalization of SMID patients. Persons with SMID living at home, in their teens and twenties, had lower seropositivity than that of institutionalized patients but higher than controls. These data implicate the life style of persons with SMID and long-term institutionalization as one of important risk factors of Helicobacter pylori infection.

Adolescent↗

PubMedDate not supplied

Field dependence in the institutionalized elderly.

The institutional-inducement hypothesis of field dependence regression in the elderly was assessed by administering the Children's Embedded Figures Test (CEFT) to a group of elderly upon admission to a nursing home and to a group of community-living elderly. Both groups were retested four months later. The institutionalized group exhibited significantly lower CEFT scores on initial testing than the community-living group. In addition, the CEFT scores for the institutionalized group declined significantly from pretest to posttest. The results suggested that greater field dependence in the institutionalized elderly may be due to pre-institutional dependence regression that continues after institutionalization. Additional measures of mental status and activity levels were also lower in the institutionalized group upon admission supporting a pre-institutional generalized regression effect.

Aged↗

PubMed2002

A framework for institutionalizing quality assurance.

OBJECTIVE: To develop a framework to support the institutionalization of quality assurance (QA). DESIGN: The framework for institutionalizing QA consists of a model of eight essential elements and a 'roadmap' for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of preawareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously. CONCLUSION: The framework has been introduced in nearly a dozen countries in Latin America and Africa. The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA.

Decision Making, Organizational↗

PubMed2006

Implementation of discharge management for geriatric patients at risk of readmission or institutionalization.

OBJECTIVE: To evaluate whether implementation of discharge management by trained social workers or nurses reduces hospital readmissions and institutionalizations of geriatric patients in a real-world setting. DESIGN: Quasi-experimental design. SETTING: Six general hospitals in Belgium. PARTICIPANTS: A representative sample of 824 patients, 355 of whom were assigned to the experimental group receiving comprehensive discharge management and 469 to the control group receiving usual care. Inclusion criteria were patients admitted to a geriatric, rehabilitation, or internal medicine ward, not residing in a nursing home, and showing risk of readmission or institutionalization on admission in the hospital. INTERVENTION: In-hospital discharge planning according to a case management protocol allowing for adjustment to participating hospitals' case mix and patients' and families' specific needs. MAIN OUTCOME MEASURES: Hospital readmission within 15 and 90 days post discharge; institutionalization at discharge and within 15 and 90 days post discharge. RESULTS: Discharge management resulted in fewer institutionalizations (n = 53; 14.9%) compared with usual care (n = 130; 23.7%) (adjusted odds ratio = 0.47; CI 95% = 0.31-0.70). Readmission rates between the intervention and usual care group were not significantly different. CONCLUSIONS: This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.

Aged↗

PubMed2002

Grandparents in law: investigating the institutionalization of extended family roles.

Previous research on grandparents has focused on the individual and familial level and has characterized grandparent roles as ambiguous and contingent. Emphasizing instead structural phenomena, this theoretical paper argues that grandmother and grandfather roles are being institutionalized through state and federal legislation. This phenomenon provides an opportunity to investigate the process of institutionalization as it happens. Grandparenthood is evaluated as a potential site for institutionalization and law as a source of institutionalization is discussed. Preliminary evidence of the legal institutionalization of grandparenthood is presented and implications and directions for further research are suggested.

Adolescent↗

PubMed2003

The impact of institutionalization on child development.

During the past 10 years researchers studying children adopted from Romanian orphanages have had the opportunity to revisit developmental questions regarding the impact of early deprivation on child development. In the present paper the effects of deprivation are examined by reviewing both the early and more recent literature on studies of children who spent the first few years of life in institutions. Special attention is given to the Canadian study of Romanian adoptees in which the author has been involved. Findings across time and studies are consistent in showing the negative impact of institutionalization on all aspects of children's development (intellectual, physical, behavioral, and social emotional). Results of studies show, however, that institutionalization, although a risk factor for less optimal development, does not doom a child to psychopathology. However, the impact of institutionalization is greater when coupled with risk factors in the postinstitutional environment. Methodological and conceptual difficulties in research with institutionalized samples of children are discussed and future directions for research are considered.

Child↗

PubMed1980

Effects of the institutional label on peer assessments of institutionalized EMR persons.

The "group concept" of EMR persons was examined in a study in which a sample of institutionalized male and female subjects evaluated a target person either labeled as institutionalized or not labeled. Contrary to expectations, the institutionalized person was rated as favorably as the noninstitutionalized person on all of the adjective traits (e.g., "friendly"); however, all subjects showed a preference for the noninstitutionalized person on two social-distance items ("live near" and "work with"). In addition, when asked in a series of questions to compare an institutionalized and a noninstitutionalized target person, male subjects preferred the noninstitutionalized person. Results were discussed in terms of subjects' reactions to the institutional label.

Adolescent↗