scholarly journals To Clarify The Duration and Characteristics of the Continuation of Home Care for Older People With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 765-765
Author(s):  
Reiko Kanaya ◽  
Asuka Oyama ◽  
Hiroshi Toki ◽  
Ryohei Yamamoto ◽  
Miyae Yamakawa
Keyword(s):  
Multivariate Analysis ◽  
Home Care ◽  
Older People ◽  
Nursing Care ◽  
Drug Prescription ◽  
Cox Proportional Hazards Model ◽  
Nursing Home Admission ◽  
Rank Test ◽  
People With Dementia ◽  
At Home

Abstract As populations age worldwide, older people with dementia are increasing. Caregivers are also aging, necessitating arrangements like social services. How to prolong the home care desired by older people remains unclear. Using data from the Osaka National Health Insurance Database from 2012 to 2017 on insured persons’ registers, medical notes, and care benefits, this study included 9591 people aged ≤74 years with first dementia drug prescription between April 2013 and December 2017. Using the prescription as baseline and hospitalization or nursing home admission as outcomes, home care duration and characteristics of medical and nursing care services during the year before baseline were evaluated. Survival was compared by Kaplan–Meier curves and the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. During follow-up, the outcomes were observed in 1473 patients : 317 admission , 1145 hospitalized and 11 both. Mean duration of home care in patients with the outcomes was 11.5 months, which differed significantly from patients without these outcomes. When patients were grouped by hospitalization in year before first prescription, the survival curves differed significantly. In multivariate analysis, sex, renin-angiotensin system agonists, hyperlipidemia drugs, hospitalization history in past year, care level, and diabetes drugs were significantly associated with the outcomes. Taken together, hospitalization history, female sex, and diabetes were associated with home care disruption. Those undergoing cardiovascular disease treatment continued to live at home. For people with dementia, it is important to intervene by focusing on past medical and nursing care to continue life at home.

Models of home care services for persons with dementia: a narrative review

2015 ◽  
Vol 27 (10) ◽  
pp. 1593-1600 ◽  
Author(s):  
Lee-Fay Low ◽  
Jennifer Fletcher
Keyword(s):  
Case Management ◽  
Home Care ◽  
Integrated Care ◽  
Community Dwelling ◽  
Narrative Review ◽  
Nursing Home Admission ◽  
Community Based ◽  
People With Dementia ◽  
The Impact ◽  
Community Based Services

ABSTRACTBackground:Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care.Methods:We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs.Results:Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study.Conclusions:There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

scholarly journals In-home monitoring evaluation by home-dwelling older adults, caregivers and healthcare providers

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Pais ◽  
P Buluschek ◽  
T Nef ◽  
N Schütz ◽  
H Saner ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Older People ◽  
Healthcare Providers ◽  
Home Monitoring ◽  
Daily Activities ◽  
Healthcare Needs ◽  
Monitoring Technologies ◽  
The Impact ◽  
At Home

Abstract Background In Europe, population ageing is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, most older people prefer to age in their own homes. New development of in-home monitoring can play a role in staying independent, active and healthy. Our objective was to evaluate a new in-home monitoring system among home-dwelling older adults (OA), their family caregivers (FC), and their healthcare providers (HCP) for the support of home care. Methods The system continuously monitored OA’s daily activities (e.g., mobility, sleep habits, fridge visits, door events) at home by ambient sensor system (DomoCare®) and health-related events by wearable sensors (Fitbit®, ECG). In case of deviations in daily activities (e.g., changes in mobility), alerts were transmitted to HCP via email. Using specific questionnaires, the opinion of 13 OA, 13 FC, and 20 HCP were collected at the end of 12-month of follow-up focusing on their user experience and the impact of in-home monitoring on home care services. Results These preliminary results underlined that the majority of OA, FC, and HCP consider that in-home sensors can help staying at home, improving home care, reducing family stress, and preventing domestic accidents. The opinion tended to be more favourable toward ambient sensors (80%) than toward Fitbit® (67%) and ECG (64%). On average, OA (80%) and FC (73%) tended to be more enthusiast than HCP (63%). Some barriers reported by HCP were a fear of weakening of the relationship with OA and an excessive surveillance. Conclusions Overall, the opinion of OA, FC and HCP were positive related to in-home sensors, with HCP being more mixed about their use in clinical practice. Key messages In-home monitoring technologies seem to be generally well accepted. In-home monitoring technologies could be help facilitating home care of older people.

scholarly journals Hospital at Home care for older patients with cognitive impairment: a protocol for a randomised controlled feasibility trial

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020332 ◽  
Author(s):  
Maaike A Pouw ◽  
Agneta H Calf ◽  
Barbara C van Munster ◽  
Jan C ter Maaten ◽  
Nynke Smidt ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Home Care ◽  
Older Patients ◽  
Hospital Care ◽  
Feasibility Trial ◽  
Nursing Home Admission ◽  
Advantages And Disadvantages ◽  
Hospital At Home ◽  
Randomised Controlled ◽  
At Home

IntroductionAn acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient’s own environment.Methods and analysisThis randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospital care. The intervention consists of hospital level care provided at patients’ homes, including visits from healthcare professionals, diagnostics (laboratory tests, blood cultures) and treatment. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment.Ethics and disseminationInstitutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences, as well as peer-reviewed journal articles. The study findings will contribute to knowledge on the implementation of Hospital at Home care for older patients with cognitive disorders. The results will be used to inform and support strategies to deliver eligible care to older patients with cognitive impairment.Trial registration numberNTR6581; Pre-results.

Observational cohort study of 1st line bevacizumab combined with chemotherapy in metastatic colorectal cancer (HGCSG0802): Sub-group analysis by the GERCOR index.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 743-743
Author(s):  
Osamu Muto ◽  
Satoshi Yuki ◽  
Tetsuhito Muranaka ◽  
Takashi Kato ◽  
Takashi Meguro ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
High Risk ◽  
Performance Status ◽  
Group Analysis ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Prognostic Impact ◽  
First Line ◽  
Significant Difference ◽  
Line Chemotherapy

743 Background: The GERCOR index based on performance status and serum LDH was reported to be useful to predict survival for patients with previously untreated mCRC. However, the validity of the GERCOR index has not been reported in patients treated with bevacizumab (Bev)-based first line chemotherapy. Methods: 115 patients with mCRC treated with Bev contained first line chemotherapy were registered from 15 centers in Japan. Univariate and multivariate analysis for overall survival (OS) were performed using patient characteristics. Survival analyses were performed with the Kaplan-Meier method, log-rank test and the Cox proportional hazards model. The analysis was also designed to determine whether the GERCOR index could be extended to progression-free survival (PFS). Results: All data were available for prognostic categorization in 108 patients. Patients with the GERCOR index of low, intermediate and high risk were 45, 57, and 6, respectively. The pts characteristics between low risk (L) and intermediate/high risk (I/H) were generally balanced except for prior colorectomy (75.6% in L, 54.0% in I/H; p = 0.027), based cytotoxic agent (oxaliplatin) (80.0% in L, 93.7% in I/H; p = 0.039), liver metastasis (53.3% in L, 79.4% in I/H; p = 0.006) and median number of metastatic organ (1 in L, 2 in I/H; p = 0.024). The distribution and median OS / PFS for the GERCOR index were as follows: L (n = 45; 29.9/10.0 months), I/H (n = 63; 17.0/8.5 months). For OS, there was significant difference between L and I/H (p = 0.003). For PFS, there was not significant difference between L and I/H (p = 0.522). In the Cox multivariate analysis, GI did not show an independent prognostic impact (L vs I/H ; HR 1.499, p = 0.120) and predictive impact (L vs I/H ; HR 0.922, p = 0.733). Conclusions: In this analysis, the GERCOR index might be neither the predictive nor prognostic factor in the bevacizumab combined first line chemotherapy for patients with mCRC.

scholarly journals Meeting the needs of older people living at home with dementia who have problems with continence

2017 ◽  
Vol 18 (4) ◽  
pp. 246-253 ◽  
Author(s):  
Vari M. Drennan ◽  
Jill Manthorpe ◽  
Steve Ilifffe
Keyword(s):  
Older People ◽  
Social Care ◽  
Clinical Care ◽  
Care Practice ◽  
Service Improvement ◽  
Content Type ◽  
People With Dementia ◽  
Care Relationships ◽  
The Impact ◽  
At Home

Purpose The purpose of this paper is to discuss the question of how to meet the needs of older people living at home with dementia who have problems with continence. The paper is focused on social care practice in community settings. Design/methodology/approach This paper is practice focused and draws on the authors’ research and experiences in clinical care, workforce development and service improvement. Findings This paper summarises research on incontinence and its negative effects on quality of life and care relationships. It describes the impact of incontinence in terms of social embarrassment, restricted social activity, extra work (such as laundry) and costs, but also distress. It links research with care practice, with a focus on people with dementia who may be at particular risk of both continence problems and of assumptions that nothing can be done to assist them. Social implications This paper provides questions that could be addressed in commissioning and provision of services and argues that they need to be informed by care practitioners’ experiences. It provides details of sources of support that are available at national and local levels. Originality/value This paper draws together research on continence and social care practice to provide a series of self-assessment questions for local services. It focuses on social care workers who are at the frontline of practice including personal assistants and carers.

Enabling the person with moderate dementia to remain at home

2020 ◽  
Vol 14 (7) ◽  
pp. 324-329
Author(s):  
Linda Nazarko
Keyword(s):  
Public Health ◽  
Older People ◽  
End Of Life ◽  
People With Dementia ◽  
Moderate Dementia ◽  
Care At Home ◽  
The Uk ◽  
At Home

Most older people would prefer to remain at home and receive care at home until the end of life. In the UK, around 16% of older people die at home ( Hall et al, 2011:3 , Figure 1:1) and around 10% of people with dementia die at home ( Public Health England (PHE), 2019 ). In Europe, including the UK, the population is ageing and it is important that older people are enabled to remain at home whenever possible ( Hall et al, 2011 ). As dementia progresses, this can become more difficult, but can be managed if the appropriate support is provided. This article explores ways to support people with moderate dementia to remain at home.

scholarly journals Costs of formal and informal care at home for people with dementia: ‘Expert panel’ opinions from staff and informal carers

Dementia ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 210-227 ◽  
Author(s):  
Clarissa M Giebel ◽  
Susan Davies ◽  
Paul Clarkson ◽  
Caroline Sutcliffe ◽  
David Challis ◽  
...  
Keyword(s):  
Home Care ◽  
Care Home ◽  
Nursing Home Admission ◽  
Term Care ◽  
Data Set ◽  
Home Support ◽  
People With Dementia ◽  
Individual Needs ◽  
Informal Carers ◽  
The Individual

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.

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