scholarly journals Characteristics and Prognoses of Long-Term Home Care Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 614-615
Author(s):  
Takashi Yamanaka ◽  
Maiko Mizuki ◽  
Kiwami Kidana ◽  
Ryonosuke Yamaga
Keyword(s):  
Cognitive Impairment ◽  
Home Care ◽  
Hospital Admissions ◽  
Neurological Diseases ◽  
Home Visits ◽  
Japanese Version ◽  
The United States ◽  
Assessment System ◽  
Demographic Aging

Abstract With demographic aging, many older adults require home medical care. Although home-based primary care is promoted in the United States and Japan, there is insufficient evidence about it. We aimed to study the characteristics and prognoses of long-term home care patients. We prospectively registered 151 patients, estimated to receive physician home visits for more than six months, in a clinic in Chiba, Japan, in 2020. The mean (±SD) age was 83.9±10.0 years and ranged from 31 to 102 years. Most patients were men (60.3%) and aged 65 years or above (95.3%). We investigated clinical information, the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J), Dementia Assessment Sheet in Community-based Integrated Care System 21 items (DASC-21), EuroQOL 5 dimensions 5-level (EQ-5D-5L) every six months, and the incidence of hospital admission, death, and patient transportation by ambulance. The most frequent diagnoses were dementia (31.1%), bone and articular diseases (17.2%), cerebrovascular diseases (11.9%), organ failure (9.3%), and neurological diseases (9.3%). Most patients (78.2%) showed more than 30 points on the DASC-21, suggesting cognitive impairment. Worse wellbeing, drowsiness, tiredness, anxiety, depression, and pain were the most prevalent symptoms. EQ-5D-5L index values were distributed around–0-0.2 and 0.4-0.7. During the first three months of physician home visits, 21.9% of patients had hospital admissions, 12.5% of them died, and 11.7% required hospital transportation by an ambulance. In this study, most long-term home care patients suffered from cognitive impairment. In addition to receiving care for daily life, these patients require intensive medical management.

scholarly journals Targeting the Blood-Brain Barrier to Prevent Sepsis-Associated Cognitive Impairment

2019 ◽  
Vol 11 ◽  
pp. 117957351984065 ◽  
Author(s):  
Divine C Nwafor ◽  
Allison L Brichacek ◽  
Afroz S Mohammad ◽  
Jessica Griffith ◽  
Brandon P Lucke-Wold ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Blood Brain Barrier ◽  
Immune Cell ◽  
The United States ◽  
Brain Barrier ◽  
Blood Brain ◽  
Systemic Inflammatory Disease ◽  
Sepsis Survivors ◽  
The Brain

Sepsis is a systemic inflammatory disease resulting from an infection. This disorder affects 750 000 people annually in the United States and has a 62% rehospitalization rate. Septic symptoms range from typical flu-like symptoms (eg, headache, fever) to a multifactorial syndrome known as sepsis-associated encephalopathy (SAE). Patients with SAE exhibit an acute altered mental status and often have higher mortality and morbidity. In addition, many sepsis survivors are also burdened with long-term cognitive impairment. The mechanisms through which sepsis initiates SAE and promotes long-term cognitive impairment in septic survivors are poorly understood. Due to its unique role as an interface between the brain and the periphery, numerous studies support a regulatory role for the blood-brain barrier (BBB) in the progression of acute and chronic brain dysfunction. In this review, we discuss the current body of literature which supports the BBB as a nexus which integrates signals from the brain and the periphery in sepsis. We highlight key insights on the mechanisms that contribute to the BBB’s role in sepsis which include neuroinflammation, increased barrier permeability, immune cell infiltration, mitochondrial dysfunction, and a potential barrier role for tissue non-specific alkaline phosphatase (TNAP). Finally, we address current drug treatments (eg, antimicrobials and intravenous immunoglobulins) for sepsis and their potential outcomes on brain function. A comprehensive understanding of these mechanisms may enable clinicians to target specific aspects of BBB function as a therapeutic tool to limit long-term cognitive impairment in sepsis survivors.

scholarly journals No Decision About Me Without Me: International Views on Providing Care Against Someone’s Will

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 664-664
Author(s):  
Michel Bleijlevens ◽  
Jan Hamers ◽  
Elizabeth Capezuti
Keyword(s):  
Cognitive Impairment ◽  
The Netherlands ◽  
Home Care ◽  
Psychotropic Medication ◽  
Long Term Care ◽  
Physical Restraint ◽  
Care Recipient ◽  
Term Care ◽  
Systems Research

Abstract People with cognitive impairment may experience the care provided by their caregiver(s) as unnecessary or undesirable, which is expressed by behaviors such as resisting the efforts of a caregiver or preventing the caregiver to perform or assist with ADL such as bathing, dressing and toileting. This can lead to stress, agitation and aggression for both the care recipient and the caregiver, and places the caregiver in a complex dilemma. Should the caregiver force hygiene or respect the person’s autonomy to refuse care? It is difficult for caregivers to find a balance between quality of care and safety, while accepting the person’s autonomy. Caregivers in long-term care often feel the necessity to provide care against the will of people with a cognitive impairment, including physical restraints, psychotropic medication, and non-consensual care. This symposium provides an international perspective with presenters from Belgium, Switzerland, Germany, and the Netherlands. The first presenter explores the use and factors associated with physical restraint, psychotropic medication, and non-consensual care in people with dementia receiving home care in the Netherlands and Belgium. Second, a presenter from Switzerland focuses on the prevalence of restraint use in nursing homes. The third presenter introduces an Advance Care Planning intervention from Germany that aims to ensure that personal wishes in home care are followed. The last presenter assesses the feasibility of an approach to prevent and reduce care against a person’s will in the Netherlands. To conclude, our discussant will integrate these insights and draw conclusion for policy, practice and further research. Systems Research in Long-Term Care Interest Group Sponsored Symposium

scholarly journals Home Care Services for Seniors: A Typology of Instruments and Administrative Burdens in Industrialized Countries

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 243-243
Author(s):  
Patrik Marier ◽  
Daniel Dickson ◽  
Kyuho Lee
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Local Level ◽  
The United States ◽  
Industrialized Countries ◽  
Social Dimensions ◽  
Term Care ◽  
The Social ◽  
Depth Analysis

Abstract This contribution has two key objectives. First, inspired by earlier studies in comparative welfare state and in (social) gerontology, we develop a conceptualization of autonomy that is rooted in its social dimensions. This concept is then deployed to assess its policy considerations within the field of home care, both with regards to access and generosity in 21 industrialized countries. Second, this contribution performs a comparative assessment of the key factors resulting in a prioritization of the social dimensions of home care and social services in long term care. This study involves an-depth analysis of policy instruments deployed by public authorities to enhance the (social) autonomy of older adults, complemented with interviews with policy makers in diverse home care policy settings (Canada, France, South Korea, Sweden, and the United States). As such, this study features an evaluation of the presence of social elements in the definition and supply of care needs across 21 countries. It leads to the construct of a social dimensions of autonomy index based upon these instruments and the budgetary prioritization of home care within long term care policies. Among core findings, one discovers broader access and more generous funding when home care responsibilities are firmly embedded at the local level.

scholarly journals Traumatic Brain Injury in Sports: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Christopher S. Sahler ◽  
Brian D. Greenwald
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Head Trauma ◽  
Brain Injuries ◽  
Cognitive Impairments ◽  
The United States ◽  
Neurological Dysfunction

Traumatic brain injury (TBI) is a clinical diagnosis of neurological dysfunction following head trauma, typically presenting with acute symptoms of some degree of cognitive impairment. There are an estimated 1.7 to 3.8 million TBIs each year in the United States, approximately 10 percent of which are due to sports and recreational activities. Most brain injuries are self-limited with symptom resolution within one week, however, a growing amount of data is now establishing significant sequelae from even minor impacts such as headaches, prolonged cognitive impairments, or even death. Appropriate diagnosis and treatment according to standardized guidelines are crucial when treating athletes who may be subjected to future head trauma, possibly increasing their likelihood of long-term impairments.

scholarly journals Risk of Venous Thromboembolism in Patients Nursed at Home or in Long-Term Care Residential Facilities

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Guido Arpaia ◽  
Federico Ambrogi ◽  
Maristella Penza ◽  
Aladar Bruno Ianes ◽  
Alessandra Serras ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Home Care ◽  
Residential Care ◽  
Long Term Care ◽  
Residential Facilities ◽  
Term Care ◽  
Reduced Mobility ◽  
At Home

Background. This study investigated the prevalence of and impact of risk factors for deep venous thrombosis (DVT) in patients with chronic diseases, bedridden or with greatly limited mobility, cared for at home or in long-term residential facilities.Methods. We enrolled 221 chronically ill patients, all over 18 years old, markedly or totally immobile, at home or in long-term care facilities. They were screened at the bedside by simplified compression ultrasound.Results. The prevalence of asymptomatic proximal DVT was 18% (95% CI 13–24%); there were no cases of symptomatic DVT or pulmonary embolism. The best model with at most four risk factors included: previous VTE, time of onset of reduced mobility, long-term residential care as opposed to home care and causes of reduced mobility. The risk of DVT for patients with reduced mobility due to cognitive impairment was about half that of patients with cognitive impairment/dementia.Conclusions. This is a first estimate of the prevalence of DVT among bedridden or low-mobility patients. Some of the risk factors that came to light, such as home care as opposed to long-term residential care and cognitive deficit as causes of reduced mobility, are not among those usually observed in acutely ill patients.

scholarly journals Long-term home care programmes may reduce hospital admissions in COPD with chronic hypercapnia

1996 ◽  
Vol 9 (8) ◽  
pp. 1605-1610 ◽  
Author(s):  
E. Clini ◽  
M. Vitacca ◽  
K. Foglio ◽  
P. Simoni ◽  
N. Ambrosino
Keyword(s):  
Home Care ◽  
Hospital Admissions

scholarly journals Aging, Pensions and Long-term Care: What, Why, Who, How? Comment on "Financing Long-term Care: Lessons From Japan"

2019 ◽  
Author(s):  
Kieke Okma ◽  
Michael K. Gusmano
Keyword(s):  
Home Care ◽  
Frail Elderly ◽  
Long Term Care ◽  
Assessment System ◽  
Control Measures ◽  
Nursing Home Care ◽  
International Studies ◽  
Term Care ◽  
The Government

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four "What, Why, Who, and How" questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life.

scholarly journals INTRODUCING ARTIFICIAL COMPANIONS TO USERS WITH DEMENTIA IN UNREGULATED MARKETS: OPPORTUNITIES VS. ETHICAL ISSUES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S378-S378
Author(s):  
Elena Portacolone ◽  
Jodi halpern ◽  
Jay Luxenberg ◽  
Krista Harrison ◽  
Kenneth Covinsky
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Abilities ◽  
Ethical Issues ◽  
The United States ◽  
Human Beings ◽  
Term Care ◽  
Cultural Lag ◽  
Commercial Introduction

Abstract Because of the high costs of providing long-term care, artificial companions are increasingly considered an opportunity to provide support to older adults with cognitive impairment while saving costs. Artificial companion can comfort and inform, thus inducing a sense of being in a relationship. Sensors and algorithms usually allow these applications to exude a life-like feel. The explosion of these technologies has created a “cultural lag” between their rapid commercial introduction and the slower evolution of regulations. An outcome of this cultural lag is a tension between the potential of artificial companions to support users and a series of unresolved ethical issues related to the fact that users might lack the capacity to fully understand the implications of using these technologies. Specific challenges of deception, surveillance, consent and social isolation are raised by the introduction of these technologies in users with cognitive impairment. The case study of a sophisticated artificial companion commercially available in the United States lends the opportunity to examine the tension between the potential of this technologies vs. unresolved ethical issues. This companion is an avatar on an electronic tablet that is displayed as a dog or a cat. Whereas artificial intelligence guides most artificial companions, this application is a hybrid of robots and human beings because it also relies on technicians “behind” the on-screen avatar, who via surveillance, interact with users. We conclude with a call to develop regulations promoting artificial companions as “human-driven technologies,” i.e. technologies focused on truly empowering users according to their cognitive abilities.

scholarly journals Article Commentary: The interRAI Pediatric Home Care (PEDS HC) Assessment: Evaluating the Long-term Community-Based Service and Support Needs of Children Facing Special Healthcare Challenges

2015 ◽  
Vol 8 ◽  
pp. HSI.S30775 ◽  
Author(s):  
Charles D. Phillips ◽  
Catherine Hawes
Keyword(s):  
Home Care ◽  
The United States ◽  
Case Managers ◽  
Support Needs ◽  
Assessment Instruments ◽  
Community Based ◽  
Wide Range ◽  
Services And Supports ◽  
Age Range

The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity–-explaining significant proportions of the variance in parents’ perceptions of needs, case managers’ service authorizations, and Medicaid program expenditures for long-term community-based services and supports. In addition, PEDS HC items have been used to construct scales that summarize the strengths and needs of children facing special healthcare challenges. Versions of the PEDS HC are now being used in Medicaid programs in three states in the United States.

scholarly journals Living Alone in Late Life

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 479-479
Author(s):  
Jacqueline Torres
Keyword(s):  
United States ◽  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Unmet Needs ◽  
The United States ◽  
Living Alone ◽  
The Us ◽  
Services And Supports

Abstract Approximately one third of older adults in the United States (US) and 13% of older adults in Mexico live alone. In both countries, the prevalence of living alone is higher for women and increases with advanced age; in the US, an estimated 4.3 million older adults continue to live alone with cognitive impairment or dementia. We will present research from the US and Mexico on the receipt of long-term services and supports and unmet needs for care among older adults living alone, including with cognitive impairment, as well as factors that may modify these outcomes. For the US, we will describe recent findings about the health, health care, and caregiving outcomes of older adults living alone vs. living with others during the COVID-19 pandemic.

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