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Results for “Institutionalization”

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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.

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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↗

PubMed2004

Delirium symptoms and low dietary intake in older inpatients are independent predictors of institutionalization: a 1-year prospective population-based study.

OBJECTIVE: To assess the effects of delirium on the institutionalization rate, taking into account geriatric syndromes and nutritional status. METHODS: This population-based study took place in an acute care unit and included participants older than 75 years, arriving from home and later discharged. Confusion Assessment Method (CAM) symptoms were recorded by the nurses within 24 hours after admission and every 3 days. Delirium was defined using the CAM algorithm, and subsyndromal delirium responded to symptoms not fulfilling the CAM algorithm. These delirium categories were either present at admission (prevalent) or occurred during the hospital stay (incident). Participants were classified as having a low dietary intake when energy intake was at any time lower than 600 kcal/d. Age, sex, known cognitive impairment, weight, functional dependency, and laboratory testing as well as diagnoses were also recorded. Step-by-step backward logistic regression was used to identify predictors of institutionalization. RESULTS: Among 427 patients, 310 (72.6%) were discharged and were compared with 117 (27.4%) participants admitted to an institution. Female sex (odds ratio [OR]: OR 2.15, 95% confidence interval [CI]: CI 1.22-3.78), prevalent delirium (OR 3.19, 95% CI 1.33-7.64), subsyndromal delirium (OR 2.72, 95% CI 1.48-5.01), incident subsyndromal delirium (OR 4.27, 95% CI 2.17-8.39), low dietary intake (OR 2.50, 95% CI 1.35-4.63), and a fall (OR 2.16, 95% CI 1.22-3.84) or a diagnosis of stroke (OR 2.03, 95% CI 1.04-3.94) were independent predictors of institutionalization. CONCLUSIONS: Symptoms of delirium and severe nutritional impairment led patients to geriatric institutions. Therefore, these institutions need to implement policies that address both of these issues.

Aged↗

PubMed1978

Psychotropic drug use among institutionalized and noninstitutionalized Medicaid aged in California.

Previous research has shown that prescription drug use is higher for the aged than for the general population. The present study uses the California Medicaid data base to compare the amount and pattern of prescription drug use among the aged to that of the general population and then compares, within the aged population, drug use by the institutionalized and noninstitutionalized. It was found that prescription drug use was higher for the aged as compared to the general population; among the aged, however, prescription drug expenditures were almost three times as high for the institutionalized as compared to the noninstitutionalized. The bulk of the difference in prescription drug expenditure among the aged subgroup was found to be due to a much higher level of psychotropic drug use among the institutionalized. Data from a sample of aged in a day health program raises questions about the appropriateness of this level of psychotropic drug use.

Aged↗

PubMed1983

Paired-associate learning in institutionalized and noninstitutionalized old people: an analysis of interference and context effects.

Groups of old people were impaired, relative to young adults, on a test of negative transfer involving lists of paired-associate words. Susceptibility to interference effects were greater in old people living in institutions than in old people living in their own homes. The effects of varying contextual cues on performance on this task were also assessed. All participants, regardless of age, benefitted from manipulations that were intrinsic to the task (e.g., relatedness of paired associates), but only the institutionalized aged responded to extrinsic contextual manipulations (e.g., environmental changes). In general, the performance of institutionalized old people resembled that of brain-damaged amnesic patients tested under similar conditions; old people living at home generally behaved more like normal, young people. The results were discussed in terms of specific age differences in cognitive function, declining brain function, and possible selective effects of institutionalization.

Adult↗

PubMed1991

Factors affecting decisions to institutionalize demented elderly.

This study followed 321 community-based patients with documented dementias, 22% of whom were institutionalized after 1 year. Multivariate analyses indicated that none of the patient characteristics, such as level of cognitive, psychiatric, or neurological impairment, predicted institutionalization. Social psychological characteristics, type and number of caregivers, and subjective caregiver distress did predict which patients were ultimately institutionalized. Implications for treatment planning are discussed.

Aged↗

PubMed1993

Factors determining the decision to institutionalize dementing individuals: a prospective study.

This longitudinal study of 196 caregiver/care receiver dyads was undertaken to determine the variables predictive of caregiver decision to institutionalize a dependent with dementia. Seven variables (use of services, enjoyment of caregiving, caregiver burden and health, caregiver rating and reaction to care receiver behavior and memory problems, and presence of troublesome behaviors) predicted the decision to institutionalize. Six variables (caregiver health and burden, use of services, care receiver cognitive function and troublesome behaviors, and caregiver reaction to behaviors) predicted actual institutionalization at 18 months.

Aged↗

PubMed2002

Effects of a community-based early intervention program on the subjective well-being, institutionalization, and mortality of low-income elders.

PURPOSE: This study examined the effects of an early interventive social service program on the subjective well-being, permanent institutionalization, and mortality risk of low-income community-dwelling elders. DESIGN AND METHODS: From a waiting list for community-based services, 105 "moderately at-risk" community-dwelling elders were recruited. Forty of these persons were randomly assigned to receive the intervention, and the remainder did not receive the intervention. Participants were interviewed every 3 months for 18 months. Primary outcome measures were depression, satisfaction with social relationships, environmental mastery, life satisfaction, permanent institutionalization, and mortality. RESULTS: No significant differences in sociodemographic or health characteristics were found between the intervention and control groups at baseline. Those elders who received the intervention had significantly higher subjective well-being and were less likely to be institutionalized or die than those in the comparison group across the 18-month period. IMPLICATIONS: The results make a strong case for the importance of community-based programs to the well-being of elders. Practitioners and policy makers should continue the search for community-based programs that are cost-effective and improve the quality of life for elders.

Aged↗

PubMed2005

The effects of duration of caregiving on institutionalization.

PURPOSE: Our objective in this analysis was to determine how the duration of caregiving interacts with key care demands (i.e., severity of problem behaviors) to influence the institutionalization of individuals suffering from dementia. METHODS: We utilized multiregional data from 4,761 caregivers of individuals with dementia over a 3-year period. We conducted multinomial logistic and Cox proportional hazards analyses to determine the moderating effects of duration on behavior problems when institutionalization was predicted. Baseline covariates included the context of care, primary objective stressors, primary subjective stressors, resources, and global outcomes. RESULTS: The Duration of care x Behavior problems interaction term was not significant in the multinomial regression or Cox hazards models. However, main effects models demonstrated that more recent caregivers were more likely to institutionalize individuals with dementia than respondents in different stages of the caregiving career. IMPLICATIONS: The results emphasize the need to (a) broaden scientific conceptualizations to consider duration of care as integral; (b) refine targeting when interventions are administered early in the dementia caregiving process; and (c) understand patterns of attrition when caregiver adaptation is modeled over time.

Dementia↗

PubMed1988

The prevalence and transmission of hepatitis B virus infection in urban, rural and institutionalized black children of Natal/KwaZulu, South Africa.

The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.

Adolescent↗

PubMed2005

Factors associated with institutionalization of children orphaned by AIDS in a population-based survey in Porto Alegre, Brazil.

BACKGROUND: There are increasing numbers of children orphaned by AIDS, especially in countries without universal free AIDS treatment. As institutionalization is associated with bad health and developmental outcomes, we have identified the factors associated with the institutionalization of AIDS orphans in a population-based survey in a city in southern Brazil. METHODS: Using AIDS mortality and healthcare registries from 1998 to 2001, a cross-sectional study was conducted among the caregivers of children aged 0-14 years who were the survivors of parents dying of AIDS in Porto Alegre. Data were collected by a household survey using a structured questionnaire. RESULTS: Out of 1131 orphans identified, 75.4% of their caregivers participated. Among participants, 70% had lost their father and 50% their mother, and 21% had lost both parents. At the time of the survey, 41% of the children lived with the mother, 25% lived with grandparents and 5% lived in institutions. In multivariate analysis, HIV positivity multiplied the child's chances of living in an institution by a factor of 4.6, losing its mother by 5.9, losing both parents by 3.7, and having a non-white mother by 4.0. CONCLUSION: This study provides population-based data on what has become of the children of individuals dying of AIDS. Improving the quality of life and averting the institutionalization of AIDS orphans requires interventions to promote the survival of mothers living with AIDS, as well as specific interventions for child family placement. Reducing the stigma of HIV infection in children and racial discrimination present challenges in Brazil.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Predictors of mortality and institutionalization in Alzheimer disease patients 1 year after discharge from an Alzheimer dementia unit.

Several factors have been reported to predict death and institutionalization in demented patients, even if the results of the studies are often conflicting. We conducted a study on a group of 86 consecutive noninstitutionalized probable Alzheimer disease (AD) patients, to evaluate clinical and social factors predicting mortality and institutionalization 1 year after discharge from the Alzheimer Dementia Unit at 'Sacro Cuore Fatebenefratelli' Hospital, Brescia, Italy. The 1-year mortality rate was 13.9% and the 1-year rate of admission to a nursing home was 34%. Our data indicate that the number of lost functions on the Activity of Daily Living scale is the most important predictor of short-term mortality, independently of the degree of cognitive impairment, the duration of the dementia, the age of the patients and the number of chronic diseases. Our data also demonstrate that, in a short period of observation, behavioral disturbances (and in particular insomnia) and availability of social services play a major role in the decision to institutionalize AD patients.

Age Factors↗

PubMed1994

Severity of dementia and institutionalization in the elderly: prevalence data from an urban area in Sweden.

This study investigated the severity of dementia in relation to disease type and sociodemographic variables. The dementia cases were detected with a two-phase study design in a population aged over 74 years in Stockholm. The prevalence of questionable, mild, moderate, and severe dementia was 1.0, 3.1, 5.5, and 2.3 per 100, respectively. Women aged over 84 had the highest prevalence of severe dementia. More severe cases and a higher institutionalization rate were present for vascular dementia than for Alzheimer's disease. Fifty-five percent of the demented subjects but only 3% of the nondemented were institutionalized. The institutionalized demented subjects were affected mostly by moderate-severe dementia (88.6%), while the noninstitutionalized were affected more often by a questionable-mild form (68.3%).

Aged↗

PubMed1990

Race/sex comparisons of elderly living arrangements. Factors influencing the institutionalized of the unmarried.

This article describes recent trends in the total institutionalization rates among unmarried Black and White populations, by sex. In addition, an analysis is provided that evaluates the individual attributes associated with the probability of institutionalization for these same groups in 1980. To accomplish these goals, U.S. Census data from the 1960, 1970, and 1980 Public Use Samples are employed. The evidence suggests convergence over time in age-standardized rates across both race and sex groups. Also, there is considerable consistency among the groups in the factors that predict the likelihood of being in a formal long-term care situation. Although the Black population continues to access formal institutions less frequently than does the White population, the findings suggest that forecasters and planners need to take into account the increasing rate of elderly Black institutionalization along with the individual characteristics that influence these rates.

Black or African American↗

PubMed1999

Cognitive deficits and psychopathology in institutionalized versus community-dwelling elderly schizophrenia patients.

We evaluated psychiatric symptoms and neurocognitive functioning among 25 institutionalized and 25 outpatient DSM-IV-diagnosed schizophrenia patients, as well as 25 middle-aged and elderly normal comparison subjects. All subjects were assessed with the Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, modified Simpson-Angus Extrapyramidal Symptom Scale, the Abnormal Involuntary Movement Scale, and the Mattis Dementia Rating Scale (DRS). The two patient groups had similar levels of depressive symptoms, but the institutionalized patients had more severe positive and negative symptoms and were on higher doses of neuroleptic medication. The institutionalized patients had significantly more cognitive impairment on the DRS than outpatients and normal comparison subjects, particularly on the subscales of initiation/perseveration, conceptualization, and memory. Results are discussed in terms of the possible neuropathology associated with cognitive impairment in chronic schizophrenia.

Aged↗