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PubMed1983

Psychological, sociological and health behaviour aspects of a long term activation programme for institutionalized elderly people.

The present study deals with psychological, sociological and subjective health aspects of social isolation and understimulation in institutional elderly people. In a controlled study over a 6 month period, A programme was devised in collaboration with residents of a senior citizens apartment building and its staff. The aim of the programme was to increase social activation and to encourage among the elderly an enhanced control over their daily lives. It was agreed that the programme implemented should involve no extra costs, overtime work or external resources. Most psychological and sociological variables were stable over the 6 month period. However, social activity level increased 3-fold in the Experimental group compared with the Control group. The E-group also started to attend activities outside the actual programme, and in general spent more time out of doors. Seasonal variations were found in feelings of depression, visits to the country/summer houses, as well as visits by children and neighbours. There were no changes in psychosomatic or psychological complaints indices. However, feelings of restlessness decreased significantly in the E-group over the 6 month period compared with the C-group. There was also a non significant decrease over time in complaints of heart palpitations in the E-group.

Affective Symptoms↗
PubMed1992

The roles staff play in the social networks of elderly institutionalized people.

This paper concerns different ways in which nursing home residents interpret their relationships with institution staff. The research on which it is based involved an anthropological social network analysis. Analysis revealed different patterns of resident-staff interaction that are described in relation to four types of personal networks. Their meaning is interpreted in terms of the tensions between residents' common needs for attachment and autonomy and their limited means to achieve satisfaction.

Aged↗
PubMed1989

A survey of self-restraint, self-injury, and other maladaptive behaviors in an institutionalized retarded population.

Psychologists of a state school for mentally retarded persons were surveyed to assess the prevalence of self-restraint, self-injurious behavior (SIB), and other maladaptive behaviors for clients in their facility. Results indicated that almost all clients reliably identified as engaging in self-restraint also engaged in self-injurious behavior while other maladaptive behaviors for self-restraining clients occurred much less frequently. The occurrence of SIB in the school's population was substantially lower than in the self-restraining population. Results are discussed in terms of future research investigating a functional relationship between self-restraint and SIB. Clinical implications for the use of self-restraint as an intervention for SIB also are discussed.

Adolescent↗
PubMed1991

DSM-III diagnoses compared with factor structure of the psychopathology instrument for mentally retarded adults (PIMRA), in an institutionalized, mostly severely retarded population.

The Psychopathology Instrument for Mentally Retarded Adults (PIMRA) was used to diagnose 163 mentally retarded adults in an institution according to DSM-III axis 1 categories. The relevant 49 items of the PIMRA were subsequently factor analysed. The factors were compared with the diagnoses to examine similarities or differences. The nine factors extracted contained 49.3% of the variance in the data, and were able to categorize correctly 69.3% of the cases with regards to diagnosis through a discriminant analysis. This is statistically different from chance expectations (p less than 0.001) and gives an inter-method agreement of 87.86% and a kappa of 0.62. Some of the factors were recognized as important aspects of traditional psychiatric categories. This makes these diagnostic categories more credible as valid diagnoses for persons from a population like the one studied.

Adolescent↗
PubMed2004

Hip fractures and Alzheimer's disease in elderly institutionalized Canadians.

PURPOSE: To examine the associations among Alzheimer's disease, hip fractures, and falls in elderly Canadians > or = 65 years of age (n=1513) who participated in the National Population Health Survey for Health Institutions between 1994 and 1995. METHODS: The survey was designed to provide health-related information for residents of Canadian health institutions. Logistic regression analysis was used to assess the association between hip fractures and Alzheimer's Disease (AD). Covariates assessed included osteoporosis, age, sex, medications, and comorbid conditions. We did an additional analysis confined to participants who fell, in an attempt to tease out the contribution of falling to the relation between AD and hip fractures. RESULTS: The adjusted odds ratio relating Alzheimer's disease to hip fracture was 2.18 (95% CI: 1.26-3.79). Among those who reported falling, the adjusted odds ratio relating Alzheimer's disease to hip fracture was 1.78 (95% CI: 1.01-3.14). CONCLUSIONS: The most important finding in this study is the independent relation between Alzheimer's disease and hip fractures.

Accidental Falls↗
PubMed2005

[Longitudinal changes in body composition and basal metabolic rate in institutionalized or domiciled obese adolescents].

UNLABELLED: The prevalence of obesity in children has increased dramatically during the past decades, and requires efficient care. OBJECTIVES: To determine changes in anthropometric parameters and basal metabolic rate (BMR) in obese adolescents during and after 2 types of weight-reduction programs. SUBJECTS AND METHODS: Twenty-six adolescents (group I, Z-score of BMI = 4.72) followed a 9-month-weight reduction program including a moderate energy restriction and regular physical activities in a specialized institution. In addition, 39 adolescents (group E, Z-score of BMI = 2.83) followed at home a 9-month-weight reduction program including medical and dietetic advices. Body composition (by impedancemetry) and BMR (by indirect calorimetry) were assessed before the beginning (M0), 4 months after (M4) and at the end (M9) of the programs, then 4 months (M13) and 16 month (M25) after the end of the weight-reduction programs. RESULTS: Twenty-two adolescents in group I and 20 adolescents in group E completed the study. At M0, age, body weight (BW), fat-free mass (FFM) and BMR of subjects of group I were higher (1.0 year, 36 %, 30 % and 23 %, respectively, P < 0.001), than those of group E. Pubertal stage and percentage of fat mass (FM) were not significantly different between the 2 groups. At M9, adolescents of group I showed significant reductions in BW and FM (-19 and -37 %, respectively, P < 0.001), but not significant differences in FFM. In addition, BMR decreased significantly between M0 and M4, both in absolute value (-6.7%, P < 0.001) and after adjustment for FFM (-5.8%, P < 0.001), and the difference was maintained until M9. Between M9 and M13, BW and Z-score of BMI were maintained in 12 adolescents, but increased (+9.7% and 14.8%, respectively, P < 0.001) in 10 adolescents. However, BMR did not change significantly in all adolescents. Between M13 and M25, BW, FM, FFM and BMR increased significantly (+13%, +34%, +6% et +5%, respectively, P < 0.001). During the 25 month period, adolescents of group E showed significant increases in BW, FFM and BMR (+8%, +14% and +10%, respectively, P < 0.001), and maintained their Z-score and FM. CONCLUSION: The reduction in BMR during the weight-reduction program at the institution could contribute to body weight regain in the post-obese adolescents if they do not maintain the lifestyle habits taught during the weight-reduction period. In other respects, Z-score was stabilized in 51% of domiciled obese adolescents.

Adipose Tissue↗
PubMed2004

Antibiotic resistance in the institutionalized elderly.

Geriatric patients frequently are cared for in long term care facilities (LTCFs), which are now a major component of our health care delivery system. Nearly half of the 2.2 million people who turned 65 years old in 1990 will enter an LTCF at least once before they die. Infections are one of the principal causes of morbidity and mortality in LTCFs. Because LTCFs are a less costly alternative to hospitalization, clinicians are treating many serious infections in the nursing home. As a result of antibiotic use, LTCFs will increasingly be recognized as sources of organisms resistant to multiple antibiotics. b-Lactams are a valuable class of potent antimicrobials with broad-spectrum activity against Gram-negative and Gram-positive organisms. The safety and efficacy of this class of antibiotics make them easy choices for empiric treatment of infections in the elderly. Unfortunately, excessive use of these antibiotics has created serious threats to our therapeutic armamentarium: the emergence of methicillin-resistant Staphylococcus aureus and of Gram-negative pathogens resistant to third-generation cephalosporins such as cefotaxime, ceftazidime, and ceftriaxone. Of these third-generation cephalosporins, resistance to ceftazidime is most frequently recognized. The major mechanism responsible for ceftazidime resistance in Gram-negative bacteria is the production of b-lactamases. This article summarizes the diversity of b-lactamases, highlights the important enzymes that confer ceftazidime resistance in LTCFs, and details some methods used to identify and characterize these enzymes. A clear challenge is to apply these techniques to epidemiologic and molecular studies conducted in LTCFs.

Aged↗
PubMed1997

Institutionalization following diabetes-related lower extremity amputation.

PURPOSE: We are unaware of any report in the medical literature that has discussed risk factors for both mortality and discharge disposition following lower extremity amputation (LEA). Our aim was to report risk factors associated with in-hospital mortality and the need for institutional care in diabetics with LEAs. PATIENTS AND METHODS: We abstracted data for every hospitalization for a LEA from January 1 to December 31, 1993 in six metropolitan statistical areas in South Texas. Amputation level was categorized as foot, leg, or thigh. Discharge status categories were: home, nursing home, rehabilitation facility, and death. We used the Kaplan scale of cogent comorbidities to determine the relationship of 12 disease categories and their association with discharge status. RESULTS: There were 1,043 LEAs in South Texas in 1993. Although only 2.3% of the population was admitted from an institutional care facility, over 25% were discharged to one. Of the total population, 18.5% were discharged to a nursing home and 7.0% to a rehabilitation facility, and 5.1% died within the period of hospitalization. We performed a univariate analysis. Factors with a P <0.25 were included in a stepwise logistic regression analysis with an alpha of 0.05. High level (leg or thigh) amputation, peripheral vascular disease, male gender, and absence of advanced locomotor impairment were associated with discharge to a rehabilitation facility. For discharge to a nursing home, significant associations were found with: female gender, advanced age (>65 years), single marital status, high level amputation, and advanced cerebrovascular disease and locomotor impairment. Death following LEA was strongly associated with female gender, high level amputation, advanced renal disease, anemia, and congestive heart failure. CONCLUSION: A significant number of patients either die or require long-term care following a diabetes-related LEA, thus further adding to the burden of this sequela. Several clinical parameters are significantly associated with discharge status after this procedure. More prospective clinical research is needed to verify the associations and to clarify their application in practice.

Aged↗
PubMed1996

The institutionalized elderly: dry to the bone!

The fluid intake of 57 elderly male and female patients, drawn from psychogeriatric, long-term care and geriatric admission units, was monitored. The fluid intake was determined by direct observation and recording of fluids consumed by each subject over three 24-hour periods. In all cases, regardless of the unit, level of dependency, cognitive or continence status, elderly patients received considerably less fluid than the recommended daily intake of 2000-2500 ml. In the case of patients who were cognitively impaired, dependent and incontinent, fluid intake was less than patients who did not have these impediments. Forty-seven nurses, working on the three units, completed a self-administered questionnaire on the fluid needs of elderly patients. Generally, nurses' knowledge was inadequate in a number of areas such as the signs and complications of dehydration and the fluid requirements of the elderly. A study of this size does not permit general conclusions to be drawn. Nonetheless, if the results are indicative of current practice, nurses do not have a good knowledge of the fluid needs of the elderly, and the low level of fluid intake constitutes a form of neglect.

Aged↗
PubMed2001

Granzyme B: a marker of risk for influenza in institutionalized older adults.

Risk for influenza increases with age while cellular immune responses decline. This was a prospective study to determine the relationship between cytokine and granzyme B levels in peripheral blood mononuclear cells stimulated with live influenza virus, and subsequent influenza illness. Granzyme B levels were lower in the group who later developed symptomatic laboratory-confirmed influenza (n=10) compared to the group who did not (n=90) (ANOVA, P=0.024). In contrast, none of the cytokine levels were related to the development of influenza. Thus, granzyme B is a potential marker of influenza risk in older adults.

Aged↗
PubMed2004

A practical approach to understanding risk of institutionalization in two Canadian cities: the Regina Risk Indicator Tool.

Appropriate utilization of long-term care resources is critical to sustainability. This article reports on the evaluation of the Regina Risk Indicator Tool conducted by the Calgary Health Region in 2000, including an overview of the tool evaluation and a summary of RRIT development within the Regina Health District. The RRIT has provided value to Calgary and Regina in matching client needs with appropriate community and facility-based services.

Alberta↗