Before the COVID-Vaccine-Vulnerable Elderly in Homecare.

BACKGROUND: At the beginning of 2020, the COVID-19 virus was spreading all over the world. Frail elderly were at risk for illness and death. Isolation seemed to be the best solution. The aim of this paper was to describe how the lockdown affected elderly homecare patients. METHODS: We used an international self-reported screening instrument built on well-documented risk factors adapted to COVID-19. We considered ethical, legal, and practical concerns. The research included telephone interviews with 30 homecare patients. RESULTS: Seventy percent lived alone. Seventy-three percent of the sample suffered from major comorbidity. Cardiovascular disorder was the most frequent diagnosis. Nineteen (63.3%) needed help for personal care. Several of the participants were lonely and depressed. The homecare teams struggled to give proper care. The health authorities encouraged the population to reduce their outside physical activities to a minimum. The restrictions due to COVID-19 affected daily life and several respondents expressed uncertainties about the future. CONCLUSIONS: It is important to describe the patients' experiences in a homecare setting at the initiation of lockdowns due to COVID-19. The isolation protected them from the virus, but they struggled with loneliness and the lack of physical contact with their loved ones. In the future, we need to understand and address the unmet needs of elderly homecare patients in lockdown.

Recent visual decline-a health hazard with consequences for social life: a study of home care clients in 12 countries.

Information about recent visual decline (RVD) and its consequences is limited. The aim was to investigate this in an observational, prospective study. Participants were recipients of community home services, >/=65 years, from Ontario (Canada, n = 101618), Finland (the-RAI-database, STAKES, n = 1103), and 10 other European countries (the-Aged-in-HOmeCarestudy (AdHOC), n = 3793). The instrument RAI-HC version 2.0 was used in all sites. RVD was assessed by the item "Worsening of vision compared to status 90 days ago" and was present in 6-49% in various sites, more common among persons living alone, and in females. In the AdHOC sample, RVD was independently associated with declining social activity and limited outdoors activities due to fear of falling. The combination of stable vision impairment (SVI) and RVD was independently associated with IADL loss. RVD is common and has greater impact than SVI on social life and function. Caregivers should be particularly aware of RVD, its consequences, and help patients to seek assessments, treatment, and rehabilitation.

Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fractures.

AIMS AND OBJECTIVES: To examine the prevalence of hearing and vision impairments in 65+ year-old patients with hip fractures. BACKGROUND: Many older people believe sensory problems are inevitable and thus avoid medical assessment and assistance. Furthermore, health professionals often overlook sensory problems, though it is known that sensory impairments can increase the risk of falling and sustaining hip fractures. DESIGN: A prospective, observational study. METHODS: We admitted 544 consecutive patients to an orthogeriatric ward from October 2004-July 2006; 332 were screened for study inclusion with the Resident Assessment Instrument for Acute Care (InterRAI-AC) and a questionnaire (KAS-Screen). We conducted patient interviews, objective assessments, explored hospital records and interviewed the family and staff. Impairments were defined as problems with seeing, reading regular print or hearing normal speech. RESULTS: Sixteen per cent of the patients had no sensory impairments, 15.4% had vision impairments, 38.6% had hearing impairments and 30.1% had combined sensory impairments. Among the impaired, 80.6% were female, the mean age was 84.3 years (SD 6.8), 79.9% were living alone, 48.0% had cognitive impairments, 89.6% had impaired activities of daily living, 70.6% had impaired instrument activities in daily living, 51.0% had bladder incontinence and 26..8% were underweight. Comorbidity and polypharmacy were common. Delirium was detected in 17.9% on day three after surgery. Results showed the prevalence of combined sensory impairments was: 32.8% none; 52.2% moderate/severe; and 15.1% severe. CONCLUSION: Patients with hip fractures frequently have hearing, vision and combined impairments. RELEVANCE TO CLINICAL PRACTICE: We recommend routine screening for sensory impairments in patients with hip fractures. Most sensory problems can be treated or relieved with environmental adjustments. Patients should be encouraged to seek treatment and training for adapting to sensory deficiencies. This approach may reduce the number of falls and improve the ability to sustain independent living.

Vision and hearing impairments and their associations with falling and loss of instrumental activities in daily living in acute hospitalized older persons in five Nordic hospitals.

BACKGROUND: Many older people believe sensory problems are inevitably, a part of growing old, and avoid assessment and help. Such problems are often also overlooked by health professionals. The aim of this study was to find the prevalence of hearing and vision impairment and their associations with loss of instrumental activities in daily living (IADL) and risk of falling in patients aged 75 years or older, admitted to a medical ward in an acute hospital in each of the five Nordic countries. METHOD: The Minimum Data Set for Acute Care was used for data collection in 770 patients. Premorbid data, admission data and history of falls over 3 months were obtained on admission by interview and observation. Hearing impairment was present if the patient required a quiet setting to be able to hear normal speech. Vision impairment was defined as unable to read regular print in a newspaper. RESULTS: Bivariate and logistic regression analyses were performed. Forty-eight per cent of the patients had a hearing impairment, 32.3% had vision impairment and 20.1% had both. Hearing impairment was associated with falling but not in the logistic regression model. Hearing and vision impairment were associated with loss of IADL but only combined impairment was independently. CONCLUSION: Hearing and vision impairments were frequent among older patients in the medical wards. Falling was associated with hearing loss and IADL loss with hearing, vision and combined impairments. Sensory loss was also associated with fear of falling. It is recommended routinely to screen sensory functions in older patients in a medical setting. Intervention studies are needed to determine whether improvements in hearing and vision can prevent falls and further loss of function in this patient population.