From service quality in organisations to self-determination at home.

BACKGROUND: In our proposed model, family members' perceptions of service quality in organisations improve communication about self-determination. In turn, family perceptions of communication openness have a positive relationship with self-determination attitudes of family members. Finally, these attitudes predict self-determination behaviours of individuals with intellectual disability, as reported by family members. METHOD: We tested this model with a sample of 625 family members (196 using 'day care services' and 429 using 'occupational services'). RESULTS: Multi-sample structural equation modelling (SEM) supported the model. Communication and attitudes fully mediated the link from service quality to self-determination behaviours. CONCLUSIONS: Improving family members' perceptions of service quality and opening channels of communication between professionals and family members are useful strategies to facilitate parents' positive attitudes and increase the frequency of self-determination behaviours at home.

[Health and utilization of health services in the elderly, according to the level of living arrangements]. / Salud y utilización de servicios en anciano, según el nivel de convivencia.

OBJECTIVE: To assess the association between living arrangements (living alone, with company or in a nursing home) and the health status and the use of health and social services among the population over seventy with the purpose to help establishing health policies for the elderly. METHODS: A cross sectional survey was performed, interviewing a random sample of 110 institutionalised and 290 community elderly of Castelldefels. Subjects and carers answered the following questionnaires: health status self-perception (SF-36), level of autonomy (test de Barthel), anxiety and depression levels (HAD), cognitive deficit (Short Portable Mental Status Questionnaire), availability and use of housing facilities an social and health resources. RESULTS: 77.2% of the institutionalised, and 92% of those coming from the community answered the questionnaire. 60 lived alone, 208 accompanied and 85 in nursing homes. The 67% were women and those living alone (77 +/- 4.8 years), or with company (78.3 +/- 6.4 years) where younger than the institutionalised ones (83.1 +/- 6.9 years) (p < 0.01). Housing facilities was similar in the three groups, although those living in the community had a higher level of use. The proportion of handicapped grew progressively from those living alone, with company or in institutions (13.3%; 19.6%. 86.7%; p < 0.01), as well as the cognitive deficit (7.8%; 15.3%; 20.8%, p < 0.01). Every group had similar health status, only those living with the family experienced higher scores in the emotional role or social function (SF-36). Non institutionalised population received support from relatives, friends and primary care services. Those institutionalised received health care in a more intensive and selective way, and benefited from formal cares. CONCLUSIONS: Nursing homes host the population with highest level of cognitive deficit and dependence. The need of increasing formal care in the community, in special to people living alone, and of reorienting health services towards elderly care has been identified.