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At least 19 recordsLinked to original sources
PubMed1996

Social support and knowledge level of the older adult homebound person with diabetes.

The purpose of this study was to continue research related to the identification of social support systems for an older adult homebound population of people who have diabetes compared to a control group of elder home care clients without diabetes, their knowledge level, and the significance of home health care intervention in these support networks. A sample of 11 older adult homebound people with diabetes and 11 older adult home care controls without diabetes from two home care agencies in Connecticut were used for this pilot study. A large sample was projected, but home-visiting scheduling difficulties arose. Eighty-two percent of both groups had adequate support systems. There was some difficulty with interpretation of the Homebound Diabetes Knowledge Level Questionnaire and further refinement is needed, especially in relationship to non-insulin-dependent diabetes mellitus client responses. Results from chart review, utilizing the Diabetes Clinical Indicator Tool, yielded a 59%-66% rate of the criteria met in the four categories outlined. It is evident that social support makes a significant contribution to the physical and psychological well-being of the home care elder, but further study is needed to examine the relationship between an individual's personal and professional network of support in this setting.

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PubMedDate not supplied

Nutritional parameters in homebound persons of greatly advanced age.

There exists a deficiency of accurate information regarding standard nutritional parameters in people of greatly advanced age. In order to begin obtaining appropriate data, we assessed nutritional status in 45 elderly homebound individuals with a mean age of 84 yr, using anthropometric methods, skin testing, and blood analysis. We compared our data with those from the HANES survey, a reasonable approach to the testing of new possible standards for nutritional assessment. Our results suggest that standard measures in common use are inappropriate for people of greatly advanced age.

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PubMed1995

Vitamin D deficiency in homebound elderly persons.

OBJECTIVE: To assess the vitamin D status in homebound, community-dwelling elderly persons; sunlight-deprived elderly nursing home residents; and healthy, ambulatory elderly persons. DESIGN: A cohort analytic study. PARTICIPANTS: Of 244 subjects at least 65 years old, 116 subjects (85 women and 31 men) had been confined indoors for at least 6 months, either in private dwellings in the community (the Hopkins Elder Housecall Program) or in a teaching nursing home (The Johns Hopkins Geriatrics Center). The 128 control subjects, a healthy ambulatory group, came from the Baltimore Longitudinal Study on Aging. All subjects were free of diseases or medications that might interfere with their vitamin D status. MAIN OUTCOME MEASURES: Serum levels of 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-[OH]2D) were measured in all subjects. In a subgroup of 80 subjects, serum levels of intact parathyroid hormone (PTH), ionized calcium, and osteocalcin and intake of vitamin D (through 3-day food records) were assessed. A randomly selected cohort of sunlight-deprived subjects also had serum levels of vitamin D binding protein measured. RESULTS: In sunlight-deprived subjects overall, the mean 25-OHD level was 30 nmol/L (12 ng/mL) (range, < 10 to 77 nmol/L [< 4 to 31 ng/mL]) and the mean 1,25-(OH)2D level was 52 pmol/L (20 pg/mL) (range, 18 to 122 pmol/L [7 to 47 pg/mL]). In the sunlight-deprived subjects, 54% of community dwellers and 38% of nursing home residents had serum levels of 25-OHD below 25 nmol/L (10 ng/mL) (normal range, 25 to 137 nmol/L [10 to 55 ng/mL]). A significant inverse relationship existed between 25-OHD (ie, Log [25-OHD]) and PTH when they were analyzed together (r = -0.42; R2 = 0.18; P < .001) and for each cohort separately. All other parameters measured, except ionized calcium, differed significantly from the Baltimore Longitudinal Study Group means. The mean (SD) daily intakes of vitamin D (121 [132] IU) and calcium (583 [322] mg) were below the recommended dietary allowance only in the community-dwelling homebound population. The mean vitamin D binding protein level in the sunlight-deprived subgroup was in the normal range. CONCLUSIONS: Despite a relatively high degree of vitamin supplementation in the United States, homebound elderly persons are likely to suffer from vitamin D deficiency.

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PubMed1990

The impact of community care on provision of informal care to homebound elderly persons.

This study examined the impact of community care on informal care provided by family and friends to homebound elderly persons. Secondary analyses were conducted on data collected from clients at baseline, 9 months (N = 225), and 48 months (N = 76) after acceptance to community care and home-delivered meals programs. Analyses revealed a significant increase in the amount of formal services provided to both groups of clients at 9 months and to community care clients at 48 months. The increase was attributed to the large proportion of "new" or "supplementary" services provided by agencies. No significant decrease in the amount of service provided by informal caregivers was found. In addition, regression analyses demonstrated only a weak impact of formal service on informal care. Analysis of patterns of service provision for each client demonstrated that formal care supplemented rather than substituted for informal care significantly more often in both the 9- and 48-month samples. We conclude that formal care in general supplemented the efforts of informal caregivers, and that informal caregiving remained stable over time.

Activities of Daily Living↗
PubMed1996

The future of clinical communication in an electronic environment.

Computer technologies, particularly electronic computer networks, can enhance nurses' abilities to initiate, facilitate, and sustain interpersonal contact with patients. Computer networks are electronic links between remote sites and as such provide a pathway for communication between nurses and patients. In an innovative project known as the ComputerLink, a team of nurses used an electronic network to provide information, communication, and decision support to homebound persons and their caregivers. This experiment allowed exploration of the unspoken language of nursing and provides direction for considering how nursing therapeutics can capitalize on the benefits of the electronic network.

Communication↗
PubMedDate not supplied

A comparison of two mobile treatment programs for the homebound and nursing home patient.

Two mobile treatment programs using portable equipment transported in vans to serve homebound persons in Denver and Chicago are compared for types of patients treated, use by local dentists, types of services provided, fees generated, and costs involved in operation during the 2-year period (1985-86). Both programs treated a similar, largely nursing home-based white female population that was predominantly older. Volunteer dentist participation varied greatly, with more than twice the number of dentists using the service in Chicago. Both programs accomplished essentially the same number of visits for the biennium studied, with 1,324 for Chicago and 1,320 for Denver. The Denver program was more efficient, generating more visits each time a dentist used the program. The services provided in total were about the same for both programs, with Denver generating 4,887 procedures and Chicago 4,602 for the biennium, but Denver had a more favorable ratio of diagnostic to treatment services. The costs of both programs were close, averaging about $60,000 per year. Denver was able to generate far more in equivalent fees than Chicago for the biennium, but Chicago dentists donated a greater percentage of services (67) than did Denver dentists (62).

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PubMed1987

Dietary characteristics and nutrient intake in an urban homebound population.

The food and nutrient intake of 53 homebound older persons (mean age = 82 years) who receive home medical care in metropolitan Boston was examined, using the 24-hour recall and food frequency methodologies. Demographic data were collected in personal interviews, and systematic analyses were conducted of subjects' medical records. Mean intake of energy, folic acid, and calcium was below the RDAs for both men and women, and intake of thiamin was below the RDA for men. Nutrient intake failed to meet the RDAs for nine leader nutrients in 40% to 80% of the sample. Fewer than 20% of the subjects were able to name the Basic Food Groups or any of their food components. The subjects' age, income, gender, marital and health status, living situation, and educational level did not predict nutrient intake. Poor dietary intake among older, homebound persons, coupled with diverse medical problems, places them at major risk of nutrition problems. The nutrition needs and problems of the homebound elderly should be considered in the delivery of home health care services.

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PubMedDate not supplied

Sociodemographics of homebound people in Kentucky.

In this report, selected results are presented from the 1987 Kentucky Oral Health Survey, which acquired statewide data on the oral health status and practices of the noninstitutionalized population of Kentucky. In the 1987 epidemiological survey, information about persons who were homebound was also gathered through telephone and in-person interviews. The results of that survey provided a relatively accurate estimate of the number of persons homebound in the state of Kentucky. Although the majority of this population was older than age 60, almost 21% were between the ages of 35 and 59. Household income for persons who are homebound and the amount of money spent on dental care is significantly less than in households not reporting the presence of a person who is homebound. These findings provide baseline data for dentists and health planners interested in serving this population. Also, this data is pertinent to the formation of health policies to create accessible, affordable care for this growing segment of the population.

Adult↗
PubMed1996

Characteristics of urinary incontinence in homebound older adults.

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults. DESIGN: A descriptive study of 90 cognitively intact incontinent homebound older persons referred to a clinical trial to examine the effectiveness of behavioral therapies in the treatment of urinary incontinence (UI) in homebound patients. SETTING AND PARTICIPANTS: Incontinent patients more than 60 years of age who met the Health Care Financing Administration's definition of homebound were referred to a clinical trial by home care nurses from a Medicare-approved home care agency in a large metropolitan country in Pennsylvania. MEASURES: Structured continence and medical history, basic and instrumental activities of daily living, Folstein MMSE, Geriatric Depression Scale, mobility-toileting skills, bladder diaries, and physical examination. RESULTS: Four hundred eighty-four persons were referred to the clinical trial, and 90 cognitively intact persons were found eligible to participate in this study (80 women and 10 men). Subjects had a mean age of 75.8 years, reported a mean of 8.4 medical problems, and most, 80%, had functional limitations in ambulation. Subjects recorded a mean of 3.8 urinary accidents/day-1.4 large and 2.4 small accidents/ day-in baseline bladder diaries. The majority, 73.3%, had more than 10 accidents per week, and most patients reported mixed urge, stress (57.1%), or pure urge (37.7%) UI. Half (54.4%) reported that UI further restricted their activities, and 52.2% reported that this problem was extremely disturbing. However, 90.5% believed that UI could be treated. CONCLUSIONS: Urinary incontinence tends to be severe among cognitively intact homebound older adults in both frequency and volume of accidents. Although subjects were homebound with many health and functional disabilities, they perceived UI as a very disturbing problem that further restricted their activities. Participants in this study were optimistic about the potential benefits of treatment.

Activities of Daily Living↗
PubMed1988

Nutrition in the elderly.

Nutritional modulation is one approach to successful aging. In animals, dietary restriction increases life span. Alterations in the macronutrient and micronutrient constituent of the diet can modulate gene expression. Anorexia is common in elderly persons. The results of studies in animals suggest that aging is associated with a decrease in the opioid feeding drive and an increase in the satiating effect of cholecystokinin. Unrecognized depression is a common, treatable cause of anorexia and weight loss in elderly persons. Protein synthesis decreases in elderly persons; nevertheless, nitrogen balance can be maintained in patients with fairly low intakes of protein. Carbohydrate intolerance is common and may be modulated by nutritional intervention and physical activity. The role of cholesterol in the development of heart disease in very old persons is controversial. Homebound and institutionalized elderly persons often do not expose their skin to sunlight; because the skin of older persons has a decreased ability to form vitamin D, the vitamin D status in these persons is precarious and they are at risk for osteopenia. Vitamins are often abused by elderly persons. Drug administration alters the vitamin requirements of persons. Borderline zinc state has been associated with deteriorating immune function, especially in persons who have diabetes mellitus or who abuse alcohol. Zinc administration appears to protect against the deteriorating vision associated with age-related macular degeneration. Selenium deficiency seems to be associated with an increased prevalence of cancer.

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PubMed1993

Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons.

We studied alcohol use and abuse in 103 frail, homebound elderly individuals cared for in a long-term home health care program from July 1991 to February 1992. Their average age was 80.63 years. Eighty-four percent were abstinent at the time of the study, including 25 (25%) past heavy drinkers. Two persons were current heavy drinkers and 14 continued to drink socially. Previous alcohol use or abuse was associated with a history of smoking, cardiovascular morbidity, social isolation, and anxiety or agitation. Current social drinking was associated with sedative-hypnotic use as well as smoking. Twenty-three of 25 past heavy drinkers remained sober on our programs without the use of formal alcohol treatment. Abstinence is known to increase with age, appears to be fostered by the homebound setting, is feasible for homebound elderly persons and is often accepted.

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PubMed1994

Impact of joint impairment on longitudinal disability in elderly persons.

Recent longitudinal data indicating that arthritis is a major contributor to disability in elderly persons are based on self-reported diagnostic information. This longitudinal study included baseline physical examinations of joints of 541 persons over age 60. Previous results from a cross-sectional multivariate model of disability in this sample found that joint impairment (and, its absence, arthritis pain) explained a significant proportion of variance in overall disability. We have retested this model using generalized estimation equations (GEE) analysis to estimate the effect of joint impairment and arthritis pain on baseline and Year 2 disability. Findings indicate that baseline joint impairment contributes substantially to longitudinal disability. If direct measures of baseline joint impairment are unavailable, concurrent self-reported arthritis pain also predicts longitudinal disability well. These findings indicate that longitudinal studies should monitor arthritis pain and that symptomatic arthritis is a risk factor for future disability.

Activities of Daily Living↗
PubMed1997

Incidence of functional decline and improvement in a community-dwelling, very elderly population.

With the aging of the population, functional decline is one of the major challenges to health care systems. The objective of this study was to estimate the incidence of functional decline and improvement in a community-dwelling population of people aged 75 years and above. A representative sample of elderly people living at home in the city of Sherbrooke (Québec, Canada) was assessed yearly on three occasions (1991-1993) by a nurse. Disabilities were measured by the Functional Autonomy Measurement System, a 29-item rating scale developed according to the World Health Organization classification of disabilities. From the 655 subjects who agreed to participate, a total of 572 subjects completed the study, including 68 who subsequently died. The probability of declining was 20.1% for the first year and 12.4% for the second year. The incidence of functional decline among previously stable subjects was 11.9% (95% confidence interval (CI) 8.9-15.9). Age was strongly related to decline (relative risk (RR) = 1.15/year, 95% CI 1.09-1.21), but there was no significant sex effect (RRmale = 0.88, 95% CI 0.55-1.39). The incidence of improvement among previously disabled subjects was estimated at 7.5% (95% CI 5.1-10.9) for the first year and 17.9% (95% CI 14.0-23.0) for the second year. Neither age (RR = 1.07, 95% CI 0.99-1.15) nor sex (RRmale = 1.70, 95% CI 0.90-3.18) was significantly associated with the probability of improving. This study stresses the importance of precise measurement of disabilities and the complex and dynamic process of functional transitions.

Activities of Daily Living↗