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At least 19 recordsLinked to original sources
PubMed2005

Making choices: how older people living in independent living units decide to enter the acute care system.

Older people living in independent living units make choices about where they live and the degree of support required to maximize their health and well-being. This can include when to enter the acute care system. Using a multimethod, multistage qualitative approach, this study aims to explore and describe the decision-making process of older people living in independent living units to enter the acute care system. Based on the findings, recommendations are provided which can ensure that older people do not enter acute care facilities until they need to, or if they do need to, they can access the care they require and leave with the best possible chance of not re-entering unnecessarily. The findings highlight that it is not enough to focus on the older person at the point of entry into the acute care system so the recommendations aim to assist in the development of best-practice initiatives for older people living in independent living units.

Acute Disease↗
PubMed2003

The promise of the internet for disability: a study of on-line services and web site accessibility at Centers for Independent Living.

The Internet provides individuals with disabilities numerous tools to live independently. In the convenience of the home, a person can access an abundance of information, an electronic community, updates on the latest disability advocacy news, education through distance-learning classes, and on-line shopping for books, clothes, assistive technology, and a host of other consumer goods. Centers for Independent Living (CILs) are consumer-run, non-profit grassroots disability service organizations at the forefront of the disability rights movement. Providing services to individuals across the range of disabilities, CILs have begun to use the Internet as a complement to their traditional service delivery methods. This article examines the emerging trend of independent living services on the web. The investigation examines 200 CIL Internet sites across the United States during the period of April to August 2001. Information is collected and analyzed about how CILs are using the Internet to provide their services and programs. In addition, the article examines the technological accessibility of their web sites. Implications of the findings for CILs, consumers with disabilities, and disability policy are examined.

Activities of Daily Living↗
PubMed1984

Independent living outcomes in spinal cord injury: multivariate analyses.

This paper presents results of a study designed to isolate those medical, personal, and environmental factors that best predict a spinal cord injured (SCI) person's ability to live independently following discharge from medical rehabilitation. A formal research model is used to identify the most promising dependent and independent variables. The principal data source is an extensive data file of 111 persons with SCI who were discharged from 10 medical rehabilitation centers across the nation. The two main independent living (IL) outcome variables are (1) a person's ability to live in a less restrictive environment, and (2) a person's ability to live productively--not only in terms of gainful employment but also in terms of other contributions to community and family life. Using multiple regression analysis, the paper reports that approximately 63% of the variance in IL outcome can be explained. The most important predictors of IL outcome are marital status, education, transportation barriers, economic disincentives, and the severity of a person's disability as measured by the Barthel index. All predictors are statistically significant. The paper concludes with implications for medical rehabilitation practice and disability policy.

Activities of Daily Living↗
PubMed1996

[The relative importance of independent living for the social functioning of the elderly].

This article confronts the belief that, among elderly persons, living (in)dependently is equivalent to functioning (in)dependently. It has been examined to what degree the living situation of elderly persons (either living independently or in a residential home) affects the degree of social functioning (as indicated by the size of the personal network, participation in voluntary organizations, outdoor mobility and loneliness), when the differences in need for care and background characteristics are taken into account. Respondents were 2523 older persons between 68 and 90 years of age, who took part in the main survey of the NESTOR-programme "Living arrangements and social networks of elderly'. Using a LISREL-model the direct effects of the living situation on the four aspects of social functioning are examined. The results indicate that, controlled for the need for care and the background characteristics, older persons living in a residential home have smaller networks, participate less in voluntary organizations, and have a lower outdoor mobility compared to independently living older adults, but are not more or less lonely. The relatively low degree of social functioning of older persons living in a residential home can also be explained by factors as the need for care, age and partner status. The general conclusion is that living independently contributes to the maintenance of social functioning outside the home, whereas the social life of older adults in residential homes remains to a large degree "indoors'.

Activities of Daily Living↗
PubMed2001

Embedding health-promoting changes into the daily lives of independent-living older adults: long-term follow-up of occupational therapy intervention.

The Well Elderly Study was a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to a 9-month program in preventive occupational therapy (OT). All participants completing the trial were followed for an additional 6 months without further intervention and then reevaluated using the same battery of instruments. Long-term benefit attributable to preventive OT was found for the quality of interaction scale of the Functional Status Questionnaire and for six of eight scales on the RAND SF-36: physical functioning, role functioning, vitality, social functioning, role emotional, and general mental health (p<.05). Approximately 90% of the therapeutic gain observed following OT treatment was retained in follow-up. The finding of a sustained effect for preventive OT is of great public health relevance given the looming health care cost crisis associated with our nation's expanding elderly population.

Activities of Daily Living↗
PubMedDate not supplied

Patients with oropharyngeal cancer: a comparison of adults living independently and patients living in long-term care facilities.

The low survival rate of persons with oropharyngeal cancer (OPC) is directly related to the size of the primary tumor, lymph node involvement and to the smoking history. The association between medical independence and the survival rate of oral cancer is unclear. The purpose of this study was to assess the survival rate of institutionalized patients with oral cancer compared to those living independently. Information regarding gender, age, tobacco habits, disease characteristics, and survival status were recorded and statistically analyzed from 30 patients with oral cancer who were institutionalized compared to 543 patients with oral cancer who were non-institutionalized. Patients living in long-term care facilities (LTC) were significantly older than the independent patients (67% were 70 years or older versus 28% of independent patients) (p = 0.0001). No differences in smoking habits were noted between the two groups but more patients who were institutionalized stopped smoking at the time of diagnosis (p = 0.47). More patients who were institutionalized were diagnosed with positive lymph node involvement (p = 0.09). Significantly higher all-cause and disease-free 5-year survival rates were noted in the patients living independently, compared to the adults who were institutionalized (32% and 60% compared to 7% and 26% respectively; p < 0.05). The disease-specific 5-year survival was directly related to age (p = 0.001), size of the tumor (p = 0.001), and lymph node involvement (p < 0.001). Significant longer survival rates were observed for patients living independently. The more advanced disease seen in the patients who were institutionalized may be due to a delay in diagnosis, which may be associated with fewer symptoms, limited report of symptoms, a lack of attention or a misdiagnosis of the oral lesion.

Activities of Daily Living↗
PubMed2002

Independent living after fractures in the elderly.

Although fractures are an important source of disability among the growing elderly populations of industrialized societies, patient-centered multidimensional outcome information is scarce. The purpose of this study was to quantify the natural history of recovery from fractures of the upper and lower extremities. From the 1994/95 WHO MONICA survey in Augsburg, Germany, we selected all persons aged 58-78 years who had experienced a fracture during the preceeding 10 years, along with a control population twice as large. The Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered to these subjects in 1998. Patients' recollection of fracture type and location were validated against medical records. The most recent fracture was in the upper extremity in 45 cases, lower extremity in 55 cases and elsewhere in 46 cases. Extremity fractures resulted in persistent and measurable impairment of the activities of daily living or general quality of life in patients 65 years or older, especially if the femur was involved. More than 40% of the interindividual variation of functional disability in the study group could be explained by age, sex, history of a fracture within 12 years and perceived difficulties walking. Existing generic and specific musculoskeletal outcome measurement instruments thus allow the assessment of functional recovery and health status after fractures in an elderly population. Geriatric assessment following fractures at higher age may improve ability to live independently. Difficulty walking deserves special attention, as it is associated with more general functional disability among the elderly.

Activities of Daily Living↗
PubMed1979

The environment as a support system for independent living.

In extended interviews and visits with 150 physically disabled young adults living independently in Berkeley, CA, the author studied the environment as they experienced it and evaluated its accommodation to their special needs. The environment in this study is considered in physical and psychosocial terms, that is, as a support system for the multifaceted needs of the whole person. The framework for organizing the data was Mayer Spivak's construct of "archetypal place" in which he defines 13 fundamental places in terms of the behaviors they support: shelter, sleep, mate, groom, feed, excrete, store, territory, play, route, meet, compete, and work. For purposes of the present work, shelter and mate are discussed--shelter, because of the clarity of its relationship between existence and physical form, and mate because of its more abstract relevance to physical form.

Activities of Daily Living↗
PubMed2001

When your patient can no longer live independently: a guide to supporting the patient and family.

This article uses a case study format to illustrate the Expanded Family Life Cycle Theory of Carter and McGoldrick (1999). This theory provides nurses and other health care providers with tools for assessing and planning care for older adults facing stressful life transitions. The individual and family are assessed as a unit embedded within their community. This multicontextual framework is applied to an elderly woman's transition from independent living to supervised living in a facility and illustrates the ease of use for practicing nurses. Suggestions are also offered to assist health care providers in supporting older adults and their families in making this significant transition.

Adaptation, Psychological↗
PubMed1979

Transportation: a key to independent living.

Accessible transportation is essential if people with disabilities, particularly persons who are severely disabled, are to live independently in the community. The development of transportation services has moved from a focus upon special and separate "dial-a-ride" programs to an emphasis upon making fixed-route, main-stream systems accessible. The current state of the art, supported in large part by federal regulations, features a combination of mainstream accessibility and supplemental special services. Future progress in transportation for disabled people depends largely upon resolution of complex, politically explosive cost-benefit arguments on the federal and local levels, and on community acceptance of disabled persons as people deserving a spectrum of transportation services.

Government Agencies↗
PubMed1983

Independent living: a successful concept.

The Independent Living Program at the Little Rock Veterans Administration Medical Center is providing an invaluable service to disabled veterans. Since activation 2 1/2 years ago, it was proven to be a strong, viable program which fills a previous gap in the discharge plans of the medically stable but physically disabled veteran. Without a successful transition into the community, many are susceptible to failure, which then results in hospital readmission or nursing home placement. These veterans, having suffered a severe disability, cannot be expected to return to the mainstream of life solely on the basis of having received medical treatment and therapy. The utilization of available resources and expertise of professionals, combined with the constructive input and determination of the veteran will significantly enhance the potential of a smooth transition into the community. The veteran's satisfaction and pleasure of living independently, despite his disability, is immeasurable. Independent living should be the ultimate goal for health care providers of the disabled.

Activities of Daily Living↗
PubMed1998

Redesigning services to meet client needs: the Gage Transition to Independent Living.

The Gage Transition to Independent Living, offered by Toronto's West Park Hospital, helps physically disabled adults acquire the skills necessary for living independently in the community. Although the program's goal has remained constant, its structure has changed considerably. In response to client feedback and community trends, the program has replaced its original institutional framework with a community-based one. This article traces how those involved changed the program to meet client needs, and describes what they learned in the process.

Activities of Daily Living↗
PubMed2003

[The health status and health care use of elderly living in sheltered residences. A comparison with independently living elderly].

A sheltered residence for older persons is a living arrangement in between independent living and a residential institution. There is little knowledge about the health of elderly living in these residences. We studied the physical, functional and psychosocial health of 401 persons living in a sheltered residence for elderly in Zwolle through a standardised interview. We compared the health of these elderly to the health of independently living elderly in the same region studied in the Longitudinal Aging Study Amsterdam and adjusted for sex, age and married state. We found an impaired functional health and more chronic illnesses among elderly living in a sheltered residence. In addition, more medication was used (OR = 2.4). The studied elderly felt more often depressed (OR = 1.9) or lonely (OR = 1.7). Their mental state was more frequently impaired (OR = 1.7), they visited health professionals more often and received more help for personal care (OR = 2.0) and housekeeping (OR = 1.6). We conclude that people living in sheltered residences form a distinct group of elderly, characterised by impaired physical, functional and psychosocial health. Planners of future care must be aware of this vulnerable group.

Aged↗
PubMedDate not supplied

Predicting the stroke patient's ability to live independently.

The objective of this paper is to identify those variables that best predict a stroke patient's ability to live independently following his/her discharge from medical rehabilitation. The paper draws heavily on a formal research model grounded in independent living (IL) theory. Independent living is defined and operationalized as (1) the patient's ability to live in a nonrestrictive environment and (2) the patient's ability to live productively--not only in terms of gainful employment but also in terms of other contributions to community and family life. The main data source for the study is an extensive computer file of 84 stroke patients discharged from 8 medical rehabilitation centers. The multivariate statistical analysis indicates that 56 to 80 percent of the variance in a patient's ability to live independently can be explained or predicted mainly by the patient's marital status, age, Barthel score, communication impairments, and the ability to get into a motor vehicle. The paper concludes by discussing the implications of the findings for medical rehabilitation and public policy.

Analysis of Variance↗
PubMed1994

The use of occupational therapists in independent living programs.

OBJECTIVES: Occupational therapy literature describes various independent living programs developed by occupational therapists and at times documents their effectiveness, yet none of the literature reviewed examined the involvement of occupational therapists in independent living programs. METHOD: Directors of independent living programs in the United States were surveyed to ascertain their use of occupational therapists, to discover which disciplines were providing traditional occupational therapy services (e.g., daily living skills, assistive device provision, etc.) in these programs, and to identify which types of independent living programs were more likely to use occupational therapy services. RESULTS: Less than half of the 96 responding independent living programs (46%) reported using occupational therapy services, and those programs that did provide occupational therapy services did so at a minimal rate. The programs that employed occupational therapists offered traditional occupational therapy services more often than those with no occupational therapists, but frequently, occupational therapists were not the providers of these traditional occupational therapy services. Chi-square analyses indicated that an independent living program's use of occupational therapy services was significantly affected by the type of facility (p = 0.05), the primary funding source (p = 0.04), and the program's practices regarding the hiring of professionals without disabilities (p = 0.04). CONCLUSION: Possible reasons why occupational therapists are not employed more by independent living centers are discussed and recommendations for change are provided.

Activities of Daily Living↗
PubMed1993

Problems in relation to independent living: a retrospective study of physically disabled school-leavers.

Problems in relation to independent living were studied in a cohort of 80 physically disabled young people on average five years after leaving school. 38 per cent were living, or planned to live, independently. This group was more likely to be of average intellectual ability and to have a physical impairment other than cerebral palsy. Of the 35 per cent who felt that their physical disabilities were such that they would be unable to manage without care from parents in the family home, at least 80 per cent needed daily help with personal hygiene, dressing and travel. 90 per cent of the parents interviewed felt that their son or daughter should not live independently. Counselling of the young person and parent from an earlier stage to allow forward planning is recommended, and will be easier if there is a choice of accommodation and style of living available.

Activities of Daily Living↗
PubMed1979

Federal legislative history of independent living programs.

In some respects, passage by the US Congress of the 1978 Amendments to the Rehabilitation Act (PL95-602) marked the beginning of federal involvement in the independent-living movement. For the 1st time a program was created whose primary goal is to help disabled persons to live independently; previous programs have been designed to help such persons become employable. This paper briefly examines the roots of PL95-602 and identifies how this new law represents a major new direction in the rehabilitation movement. The purposes and goals of the advocates of independent living have changed in the past decade and the new law reflects those changes.

Humans↗