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PubMed1990

Optometric care of the homebound and institutionalized older adult.

The older adult population is one of the fastest growing segments of the United States population. The number of older adults requiring services in nontraditional settings is expanding rapidly. This paper explores the background, realities, and methods of delivery of optometric services in two nontraditional settings: the home and the long-term care nursing facility.

Aged↗
PubMed1993

Trivalent cold recombinant influenza live vaccine in institutionalized children with bronchial asthma and patients with psychomotor retardation.

Twenty asthmatic children and 48 patients with severe psychomotor retardation were inoculated intranasally with trivalent cold-adapted recombinant (CR) influenza vaccine containing CR-125 (H1N1), CR-159 (H3N2) and CRB-117 (B). The vaccinees were mostly seropositive. Severe adverse reactions or asthmatic attacks were not observed, but 7 (15%) of 48 vaccinees with severe psychomotor retardation developed mild to moderate fever. Significant antibody responses in hemagglutination-inhibition tests were demonstrated in 33 (49%) vaccinees to CR-125, 20 (29%) to CR-159 and 8 (12%) to CRB-117. Two nosocomial outbreaks of influenza were observed in the subsequent winter. During an outbreak with H3N2 in one ward of severe psychomotor retardation patients, 2 (11%) of 18 vaccinees became infected compared with 10 (48%) of 21 placebo controls in the same ward (P < 0.05). In the other outbreak, with influenza B virus, 2 (14%) of 14 vaccinees and 13 (52%) of 25 controls in the ward for asthmatic children were infected (P < 0.05). The results indicate that trivalent CR vaccine is safe and effective against nosocomial outbreaks of influenza.

Adolescent↗
PubMed1997

Natural history of scoliosis in the institutionalized adult cerebral palsy population.

STUDY DESIGN: Fifty-six residents with cerebral palsy and significant scoliosis or kyphosis at the Hazelwood Center in Louisville, Kentucky were studied periodically using radiographs to assess the degree of scoliosis, kyphosis, and pelvic obliquity and by clinical evaluation to assess functional status and skin condition. OBJECTIVES: This study followed the natural history of untreated scoliosis to determine whether a decline in functional status is related to curve progression and whether the development of decubiti is associated with the degree of pelvic obliquity. Identifying the factors that affect functional decline may help develop treatment plans to minimize it. SUMMARY OF BACKGROUND DATA: Significant structural deformities of the spine often accompany cerebral palsy. Despite the relatively large number of cases, little is known about the natural history of untreated scoliosis in the adult cerebral palsy population. Theoretically, curve progression will lead to pain, loss of ambulation or sitting balance, or even cardiopulmonary compromise, but few studies have been done to verify this. METHODS: Single-factor analysis of variance was used to compare the curve progression rate within groups based on the structure of the curve, and the two-sample student t test was used to compare the average initial curve, the average final curve, the progression rate, and the amount of progression between groups based on functional decline. The two sample t test also was used to correlate the average pelvic obliquity and the size of the final curve with the presence or absence of decubiti. RESULTS: Functionally, 10 patients (18%) declined during the course of the study. In these 10 patients, the average initial curve was 41.1 degrees, the average final curve was 80.6 degrees, and the average progression rate was 4.4 degrees per year. For the stable patients, the average initial curve was 33.9 degrees, the average final curve was 56.5 degrees, and the average progression rate was 3.0 degrees per year. The differences between the final curve and the absolute amount of progression were statistically significant (P = 0.018 and P = 0.03, respectively). Three patients developed decubiti. Their curve averaged 106 degrees, and their pelvic obliquity measured 45 degrees, both of which were significantly higher than those of the patients without decubiti. CONCLUSIONS: The results of the present study demonstrate that in the adult patient with cerebral palsy and scoliosis, a definite correlation exists between deformity size and functional decline and decubiti. Progression rate also seems to be a factor in functional decline. Additional studies are needed to determine whether surgical intervention will halt or reverse the decline.

Adolescent↗
PubMed2005

Does the addition of functional status indicators to case-mix adjustment indices improve prediction of hospitalization, institutionalization, and death in the elderly?

BACKGROUND: Case-mix adjustment is widely used in health services research to ensure that groups being compared are equivalent on variables predicting outcome. There has been considerable development and testing of comorbidity indices derived from diagnostic codes recorded in administrative databases, but increasingly, the benefit of clinical information and patient reported ratings of health and functional status is being recognized. One type of information that is highly valued but has so far not been captured by administrative health databases is functional status indicators (FSI). OBJECTIVE: The purpose of this study was to estimate the extent to which prediction of health outcomes can be improved on by including information on functional status indicators (FSI). RESEARCH DESIGN: The data for the current study was obtained from a clustered randomized trial evaluating computerized decision support for managing drug therapy in the elderly, conducted from 1997 to 1998. A total of 107 primary care physicians participated in this trial and 6465 of their patients (51%) completed a generic health status measure-the SF-12-before the intervention. C statistics and R were used to compare the predictive value of sociodemographic factors, 2 comorbidity indices, and 11 FSI predictor variables derived from the SF-12 and coded (possible for 8) using the International Classification of Functioning (ICF). RESULTS: Using stepwise logistic regression, FSI, particularly limitation in stair climbing or doing moderate activities like housework, were found to be strong and independent predictors of all outcomes, even after controlling for sociodemographics and comorbidity. CONCLUSION: This study indicates that FSI provided as robust a prediction of health events as did complex comorbidity indices. Additionally, the ICF coding system provides a mechanism whereby information on FSI could be incorporated into administrative databases through the use of electronic health records that include a health or functional status measure.

Activities of Daily Living↗
PubMed1987

Developing self-care skills and reducing institutionalized behaviour in a long-stay psychiatric population: the role of the nurse in behaviour modification.

This paper examines the potential for behaviour modification in the rehabilitation of chronic, long-stay psychiatric patients and the impact such procedures may have on the work role of ward-based nursing staff. Through the use of five case histories the effectiveness of behavioural analysis and modification in encouraging self-help skills and constructive activity is identified. In addition to a critical examination of the clinical and organizational factors involved in patient improvement, it is argued that behaviour modification develops the therapeutic potential of nurses. The development of the patient-teaching dimension of the nursing role not only fosters greater clinical responsibility, but also promotes both professional independence and institutional power. This is not to imply that the use of behavioural methods cannot be combined with customary nursing practices, for in many ways they provide nurses with an appropriate technology to achieve established therapeutic goals. In conclusion, it is noted that clinical success is not sufficient to ensure the acceptance of ward-based behavioural programmes. The critical issues concern conventional hospital and staff practices and institutional rigidity, not the commitment of nursing staff or patient improvement.

Aged↗
PubMed1987

Mandibular dysfunction in an institutionalized and predominantly elderly population.

Oral health problems were identified among 653 residents of 40 long-term care institutions in Vancouver, using a personal interview and a dental examination. Information on jaw function was analysed as part of this investigation to identify associations between the clinical signs of mandibular dysfunction and the complaints of the subjects, their occlusal instability, and the quality of their dentures. The sample population were predominantly female and over 75 years of age, and 42% had some natural teeth. Complaints of jaw dysfunction, usually sore muscles, were heard from 13% of the 488 subjects interviewed. The examination was performed on all of the subjects and revealed that 43% had unstable occlusal contacts, 37% were using loose or unstable dentures, and 20% had one or more clinical signs of jaw dysfunction. Joint noise was the most frequent sign detected and it was heard in a greater percentage of the women than men, while deviation of the mandible during mouth opening was observed with great frequency in the younger age groups. There was no apparent association found between the clinical signs of jaw dysfunction and the complaints of the subjects or the condition of their teeth or dentures. The study demonstrated that complaints and clinical signs of jaw dysfunction, with the exception of joint noises, were uncommon in this population.

Adult↗
PubMed1998

A genetic diagnostic survey in a population of 202 mentally retarded institutionalized patients in the south of Brazil.

The Associação dos Pais e Amigos dos Excepcionais (APAE) is an institution for mentally retarded patients located at Caxias do Sul in the south of Brazil. A genetic diagnostic survey of 202 individuals from this institution is presented. The patients had a male:female ratio of 1.3:1 and their ages varied from 1 month to 47 years with a mean of 5.5 years. Using personal and family data, careful clinical examination and laboratory investigation, the authors established a definitive diagnosis in 132 patients (65.34%). A constitutional disorder was present in 111 patients (54.95%). Down's syndrome patients represented 32.15%, while 1.98% had other chromosomal anomalies. In 25 patients (12.37%) a disorder of Mendelian inheritance was diagnosed. In 8 patients (3.96%) a multiple congenital anomalies/mental retardation (MCA/MR) syndrome was recorded. Eight patients (3.96%) had a central nervous system (CNS) malformation. An acquired condition was observed in 21 patients (10.39%), including pre- or post-natal infections. In the remaining 70 patients (34.65%) a conclusive diagnosis was not possible.

Adolescent↗
PubMed1980

A study of institutionalized mentally retarded patients in Manitoba. I: Classification and preventability.

This preliminary report concerns the types, and the possibility of prevention, of mental retardation found among 406 patients less than 20 years of age and with IQs less than or equal to 50 who had been admitted to institutions for the retarded in Manitoba prior to 1977. The retardation appeared to be of genetic origin in 27.8 per cent of cases, and acquired in a further 30.3 per cent. 31 per cent of the genetic and 55 per cent of the acquired, or 25.4 per cent of the total group, are considered to have been avoidable, given the full application of current techniques and knowledge.

Adolescent↗
PubMed1979

Institutionalized older adults and their future orientation.

This study hypothesized: 1) that as the duration of institutional living increases, the future orientation of active older adults contracts; and 2) that this constriction in future temporal orientation means less opportunity for interaction in the institutional environment. To test the first hypothesis, 100 active female residents in six institutions for the aged were evaluated regarding future orientation, by means of Cottle's Experiential Inventory. The opportunity for interaction was measured by Pincus's Psychosocial Dimensions in the Institutional Environment. The findings indicated that, irrespective of age, the residents became less future-oriented or their orientation became less recent, as the length of institutional residence increased. The second hypothesis was not supported; in fact, the reverse was true.

Aged↗
PubMed1983

Sleep disturbances in the institutionalized aged.

One hundred eighty nursing home residents, not psychotic or demented, average age 82 years, were administered a 30-minute structured interview to identify and characterize their sleeping patterns, health status, medications, psychosocial environment, and living conditions. In addition, both the residents and the night nurses rated quality of sleep on a five-point scale. Residents and nurses on all shifts also rated appetite and exercise on five-point scales. Residents were classified as having a sleep disturbance if they met at least one of the following criteria and reported poor sleep quality: onset of sleep latency greater than 30 minutes, three or more nighttime awakenings, and less than six hours sleep per night. Forty-five per cent of the residents met at least one clinical research criterion. Residents with sleep disturbance rated their sleep quality significantly lower than their peers not meeting research criteria. However, the nurses' ratings did not discriminate problem sleepers, and they correlated poorly with the residents' ratings. These subjective patient evaluations are discussed in relation to nursing evaluations, prescription of hypnotic medications, and other variables.

Aged↗
PubMed1986

Folate deficiency among institutionalized elderly. Public health impact.

All patients 65 years and older who had been living in an institution for at least six months had a measurement of red blood cell folate (RBCF), serum folate (SF), vitamin B12, hemoglobin, and mean corpuscular volume. Twenty-two percent of the 97 studied subjects were found deficient in RBCF, although only 6% had anemia. Length of stay at the institution was significantly associated with deficiency in RBCF and this association was uncon-founded by age. The proportion of RBCF deficiency among the studied subjects attributable to length of stay is 80%. The prophylactic administration of folate among long-term nursing home type of patients should be considered.

Age Factors↗
PubMed1987

Sundown syndrome in institutionalized elderly.

To describe sundown syndrome and determine factors related to its occurrence, 59 demented and 30 nondemented nursing home residents aged 60 years and above were observed in the morning and the evening over two consecutive days using a Confusion Inventory. Physiologic, psychosocial, and environmental data were also recorded. In addition, Pfeiffer's Short Portable Mental Status Questionnaire, the Philadelphia Geriatric Center Morale Scale, Face-Hand Test, and sensory screening were completed. Among the 89 subjects, 11 were found to be sundowners, a prevalence rate of one in eight in the facility. No clear pattern of behaviors evolved but sundowners were found to increase restless and verbal behavior as evening approached. Sundowners were more likely to be demented, with greater mental impairment and organic involvement than nonsundowners. Among physiologic factors, odor of urine, being awakened frequently on the evening shift, and fewer medical diagnoses were significantly associated with sundowning. Significant psychosocial factors were current room residence of less than one month, more recent admission to the facility, and higher evening levels of confusion. No environmental factors were related.

Aged↗