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ABSTRACT Objectives To determine depressive syndrome in community-dwelling elderly caregivers; and to test the association between such syndrome and both visual complaints (VC) and aspects of care. Methods This is a cross-sectional study conducted with 332 elderly caregivers. Geriatric Depression Scale (GDS-15) was used to screen for depressive symptoms (cutoff > 5 points). Logistic regression was performed to identify associations between depression and both VC and aspects related to care. Results Median age of the caregivers was 68 years. The majority was female (75.9%) and took care of a spouse (84.3%). The prevalence of depressive syndrome was 22.6%. The syndrome was associated with VC when it affected activities of daily living (OR = 2.4; 95% CI: 1.37-4.27) and caring for an individual with cognitive impairment (OR = 1.85; 95% CI: 1.05-3.26). Conclusions While measured aspects of care did not exert an influence on the incidence of depressive symptoms, VC associated to functional limitation and caring for elderly individuals with cognitive impairment was associated with such symptoms in the elderly caregivers.
RESUMO Objetivos Determinar a síndrome depressiva em idosos cuidadores da comunidade e testar a associação entre tal síndrome, queixas visuais e aspectos dos cuidados. Métodos Este é um estudo transversal realizado com 332 idosos cuidadores. A Escala de Depressão Geriátrica (GDS-15) foi utilizada para triagem da síndrome depressiva (corte > 5 pontos). Regressão logística foi realizada para identificar associações entre depressão, queixas visuais e aspectos relacionados ao cuidado. Resultados A mediana de idade dos cuidadores foi de 68 anos. A maioria era do sexo feminino (75,9%) e estava cuidando do seu cônjuge (84,3%). A prevalência da síndrome depressiva foi de 22,6%. A síndrome foi associada com queixas visuais quando estas prejudicavam o desempenho nas atividades da vida diária do cuidador (OR = 2,4; IC 95%: 1,37-4,27). Além disso, cuidar de um indivíduo com comprometimento cognitivo também esteve associado à depressão nos cuidadores (OR = 1,85; IC 95%: 1,05-3,26). Conclusões Os aspectos do cuidado não exerceram influência sobre a incidência de síndrome depressiva, no entanto a queixa visual associada à limitação funcional e o ato de cuidar de idosos com comprometimento cognitivo estiveram associados ao humor deprimido em idosos cuidadores da comunidade.
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The manual handling of people (MHP) is known to be associated with high incidence of musculoskeletal disorders for aged care staff. Environment-related MHP interventions, such as appropriate seated heights to aid sit-to-stand transfers, can reduce staff injury while improving the patient's mobility. Promoting patient mobility within the manual handling interaction is an endorsed MHP risk control intervention strategy. This article provides a narrative review of the types of MHP environmental controls that can improve mobility, as well as the extent to which these environmental controls are considered in MHP risk management and assessment tools. Although a range of possible environmental interventions exist, current tools only consider these in a limited manner. Development of an assessment tool that more comprehensively covers environmental strategies in MHP risk management could help reduce staff injury and improve resident mobility through auditing existing practices and guiding the design of new and refurbished aged care facilities.
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Humans , Activities of Daily Living , Incidence , Risk Management , Self-Help DevicesABSTRACT
Abstract Introduction: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. Objective: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. Method: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination - Revised; Mini Mental State Examination), burden (Zarit Burden Interview) and frailty (Fried's frailty phenotype) were assessed. All ethical principles were observed. Results: Older caregivers were mostly women (76.7%); mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test). Caregivers presenting a high burden level and some frailty degree (pre-frail or frail) simultaneously were more likely to have a reduced global cognition performance. Conclusion: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers.
Resumo Introdução: Idosos cuidadores que moram em comunidades rurais podem estar expostos a uma tripla condição de vulnerabilidade, por exemplo, condições relacionadas a ser cuidador de outro, condições inerentes ao seu próprio envelhecimento e ao seu contexto de moradia. Objetivo: Analisar a associação entre sobrecarga, fragilidade e desempenho cognitivo em idosos cuidadores que moram em comunidades rurais. Método: Tratou-se de uma pesquisa transversal com 85 idosos cuidadores que cuidavam de idosos dependentes na comunidade. A cognição global (Exame Cognitivo de Addenbrooke - Revisado; Mini Exame do Estado Mental), a sobrecarga (Entrevista de Sobrecarga de Zarit) e a fragilidade (Fenótipo de Fragilidade de Fried) foram mensuradas. Todos os princípios éticos foram respeitados. Resultados: Os idosos cuidadores foram predominantemente mulheres (76.7%) com média de idade de 69 anos. A proporção de indício de alteração cognitiva foi de 15.3%, sobrecarga severa de 8.2%, fragilidade de 9.4% e pré-fragilidade de 52.9% nos idosos cuidadores. Cuidadores severamente sobrecarregados ou frágeis apresentaram pior desempenho cognitivo comparado àqueles levemente sobrecarregados e não frágeis, respectivamente (teste ANOVA). Apresentar simultaneamente sobrecarga elevada e algum grau de fragilidade (pré-frágil ou frágil) esteve associado à redução do desempenho cognitivo global. Conclusão: Um significante número de idosos cuidadores teve indício de alteração cognitiva. Estratégias e recursos para reduzir o sentimento de sobrecarga e a fragilidade física podem melhorar o desempenho mental e o bem estar, levando assim a uma melhora da qualidade de vida do idoso que cuida, bem como a qualidade do cuidado prestado por ele.
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Humans , Male , Female , Aged , Aged, 80 and over , Rural Population , Frail Elderly/psychology , Caregivers/psychology , Cost of Illness , Cognition , Vulnerable Populations/psychology , Cross-Sectional Studies , Regression Analysis , Risk Factors , Cognitive Dysfunction/epidemiology , Neuropsychological TestsABSTRACT
Abstract: Basal cell carcinoma and Squamous cell carcinoma, referred to as non-melanoma skin cancer, are the most common malignancies in humans. Their incidence is increasing worldwide every year. In Brazil, even with the advent of educational campaigns on photoprotection and laws that banned tanning beds, they are the most frequent neoplasias, representing a public health problem recognized by the Ministry of health.
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Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Skin Neoplasms/epidemiology , Carcinoma, Basal Cell/epidemiology , Carcinoma, Squamous Cell/epidemiology , Ambulatory Care Facilities/statistics & numerical data , Hospitals, Public/statistics & numerical data , Brazil/epidemiology , Comorbidity , Sex Distribution , Age DistributionABSTRACT
Increasing aged care requisite has become a serious challenge all over the world. Compared with developed countries, aged care in China still has some limitations, i.e., lack of qualified professionals, aged care system needs to be improved, and lack of aged long term care insurance. This article discussed these points and put forward the corresponding countermeasures.
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@#BACKGROUND: Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95％CI): 0.09 (0.04, 0.22);P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95％CI): 0.22 (0.07, 0.66);P=0.007]. CONCLUSION: The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.
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In 2014, influenza activity was high in New South Wales (NSW), Australia, and 21 443 people were hospitalized with a diagnosis of influenza-associated pneumonia. This translates to a rate of 252.4 cases per 100 000 population. More than 18 000 cases of laboratory-confirmed influenza were reported in NSW. The majority were influenza A, dominated by A/H3N2 subtype. There were also 111 influenza outbreaks in aged care facilities (ACFs) reported in NSW in 2014, the highest number on record. Elderly residents in ACFs experience high rates of morbidity and mortality during influenza outbreaks. They are at increased risk of developing complications due to underlying diseases. These residents also have an increased risk of infection because of the institutional environment they share with many other residents and staff. Furthermore, impaired oral intake, limited dexterity and altered consciousness may limit treatment options when they are infected.
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BACKGROUND: There was a record number (n = 111) of influenza outbreaks in aged care facilities in New South Wales, Australia during 2014. To determine the impact of antiviral prophylaxis recommendations in practice, influenza outbreak data were compared for facilities in which antiviral prophylaxis and treatment were recommended and for those in which antivirals were recommended for treatment only. METHODS: Routinely collected outbreak data were extracted from the Notifiable Conditions Information Management System for two Local Health Districts where antiviral prophylaxis was routinely recommended and one Local Health District where antivirals were recommended for treatment but not routinely for prophylaxis. Data collected on residents included counts of influenza-like illness, confirmed influenza, hospitalizations and related deaths. Dates of onset, notification, influenza confirmation and antiviral recommendations were also collected for analysis. The Mann–Whitney U test was used to assess the significance of differences between group medians for key parameters. RESULTS: A total of 41 outbreaks (12 in the prophylaxis group and 29 in the treatment-only group) were included in the analysis. There was no significant difference in overall outbreak duration; outbreak duration after notification; or attack, hospitalization or case fatality rates between the two groups. The prophylaxis group had significantly higher cases with influenza-like illness (P = 0.03) and cases recommended antiviral treatment per facility (P = 0.01). DISCUSSION: This study found no significant difference in key outbreak parameters between the two groups. However, further high quality evidence is needed to guide the use of antivirals in responding to influenza outbreaks in aged care facilities.
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Objective To check the maneuverability of the nursing safety management indicators for skilled nursing facilities.Methods A hospital based skilled nursing facility in Chongqing was chosen as the main study target while a Red Cross nursing hospital in Shanghai which operated earlier was also included as a comparison object.Combination of files reference,on-the-scene observation,manager interviews,sampling survey and institution's self-assessment,scores of indicators were calculated,and the total scores for both institutions were calculated as well.Results The institution from Chongqing marked 81 points while the other one got 86 points.Conclusions The indicator system had good maneuverability and the weight of indexes was consistent with the practical requirement of safety management.This indicator system could provide reference for standardize skilled nursing facilities' management,but still needed further revision and consummation.
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Aims: To review and analyse Australian general practitioner’s workforce data for the 2000 to 2010 period by comparing this to Australian population trends and to make informed recommendations about GP workforce planning. Study Design: Descriptive analysis of the available Australian government data on GP workforce and the Australian population between 2000 and 2010. Place and Duration of Study: Griffith University, Australia, between April and November 2011. Methodology: Australian GP workforce data for the 2000 to 2010 period was obtained from the Australian Department of Health and Ageing (DoHA) website and population data was obtained from the Australian Bureau of Statistics website. A descriptive analysis of workforce trends using variables of interests such as overseas trained GPs, gender, age, professional services during the 11 year period was compared to population trends data. A new GP Workforce Index ratio (GPWIR = No. of GPs <35yrs ÷ No. of GPs 35yrs to 64yrs of age) was derived from the data and calculated for each year of the study period. Results: The ratio of female to male GPs has increased by 35% and the percentage of overseas graduates has increased by nearly 35% in the 11 year period, an indication that the 0.12% number of GPs as a percentage of Australian population between 2000 and 2010 was only sustained by increasing the intake of foreign trained graduates. Vocationally registered GPs have increased by 20% in same period. The GP workforce index ratio (GPWIR) decreased from 0.223 in 2000 to 0.118 in 2007; this was followed by a slight increase from 0.120 in 2008 to 0.128 in 2010. Conclusion: The impact that an increase in the number of female GPs graduating from medical schools may have on the overall number of GP services available to the Australian population requires further study, since it was noted in the literature that female GPs are more likely to work part-time than male GPs. The GPWIR may be a useful indicator for evaluating the proportion of the <35yrs old GPs as a proportion of overall GP workforce. Lower GPWIR may be associated with GP workforce shortage. GPWIR increased in the last 3 years of the study corresponding with an improvement in GP supply. In this study, the GPWIR proved to be more effective in predicting overall National GP workforce shortage trend than the DoHA GP per Population ratio of 0.71:1000 (Primarily used for regional and rural workforce shortage prediction). The Department of Health and Ageing may need to keep supporting rural and remote migration of GPs and also maintain an increase in the number of students entering medical schools.
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ObjectiveTo understand the quality of life and influencing factors of elderly person in agedcare at home.MethodsThe elderly person in aged-care at home in 3 towns and a street of Shanghai Minhang District were enrolled by stratified cluster sampling.To investigate quality of life for elderly person by adopting SF-36 form.Meanwhile,to find out the principal influencing factors on quality of life by adopting both single-factor and multiple-factor analysis.ResultsThe score of life quality of senior citizen in local was as following:43.63 ± 30.04 (Physical Function),55.57 ± 48.96 (Role Physical),81.75 ± 20.49 (Bodily Pain),42.07 ± 18.84 ( General Health),58.57 ± 18.96 (Vitality),66.94 ± 26.79 ( Social Function),73.33 ± 43.33 ( Role Emotional),70.92 ± 19.02 ( Mental Health),61.60 ± 21.06 ( Weighted average).There were two aspects of the factors that influencing elderly persons'the quality of life:disease-related (coronary heart disease,cerebrovascular accident) and non-disease-related ( whether to go out for a walk every day,loneliness,living space,gender and on the current life satisfaction etc).ConclusionQuality of life of elderly person in aged-care at home is relatively low,special in the general health and physical function dimensions.The controllable factors are diseases,whether to go out for a walk every day,loneliness,on the current life satisfaction etc.