A Profile of Older Adults With a History of Stroke Receiving Home Care in Ontario, Canada

The demand for home care services is increasing, yet the literature describing the clinical characteristics of community-dwelling individuals with a history of stroke who receive home care is limited. In this retrospective, cross-sectional, population-level study, data were sourced from home care recipients aged 65+ who had a routine assessment using the Resident Assessment Instrument for Home Care (RAI-HC) in Ontario between January 2007 and December 2011. The RAI-HC contains several health status indicators and validated health index scales. The association of a history of stroke on health status was assessed through a series of logistic regression models, adjusted for age, sex, and number of comorbidities. Sex differences were also explored. A change in odds of ≥25% was considered to indicate a clinically important finding. From the home care data ( N = 319,694), 56,909 individuals had a stroke diagnosis, with approximately 86% diagnosed with ≥3 chronic conditions. A stroke diagnosis was associated with a higher risk of limitations or impairments with communication, locomotion, continence, activities of daily living, and cognitive performance. A clinically meaningful difference was not observed for symptoms of depression. Few sex differences were observed. In an effort to support the development of effective home and community-based care programs, research is needed to understand differences in community-dwelling versus institutional populations. Community-dwelling individuals with a history of stroke show higher levels of impairment and limitations compared with those without, suggesting areas where home care resources could be improved to help manage the chronic effects of stroke.

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Eating alone at each meal and associated health status by cohabitation situation among Japanese community-dwelling elderly: a cross-sectional analysis of the KAGUYA study

10.21203/rs.3.rs-49187/v1 ◽

2020 ◽

Author(s):

Osamu Kushida ◽

Jong-Seong Moon ◽

Daisuke Matsumoto ◽

Naomi Yamasaki ◽

Katsuhiko Takatori

Keyword(s):

Health Status ◽

Functional Capacity ◽

Health Status Indicators ◽

Subjective Health ◽

Community Dwelling ◽

Care Needs ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

History Of ◽

Sectional Analysis

Abstract Background: This study investigated the association between eating alone at each meal and health status including functional capacity according to cohabitation situation among Japanese community-dwelling elderly.Methods: This was a cross-sectional analysis of baseline data from the Keeping Active across Generations Uniting the Youth and the Aged (KAGUYA) study in Japan. A self-administered questionnaire was mailed to all 8004 residents aged 65 or older residing in the same Japanese town the participants in March 2016. Eating alone was assessed by first asking whether participants ate three separate meals each day (i.e., breakfast, lunch, and dinner), and those who answered affirmatively were then asked how many people were usually present at each meal. Health status was assessed in terms of subjective health, medical history, care needs, body mass index, depression, and functional capacity.Results: Data from 3057 respondents were analyzed. Among those living with others, those who reported not being in good subjective health and a history of hypertension were significantly more likely to eat alone at breakfast (odds ratio 1.27; 95% confidence interval 1.01–1.61, and 1.26; 1.06–1.49). Depressive symptoms and many subscales of functional capacity were also significantly associated with eating alone at breakfast, lunch, and dinner (P < 0.05). Among those living alone, those eating alone at breakfast had lower scores for indicators of functional capacity including information practice (P = 0.010) and total scores (P = 0.049).Conclusions: For both cohabitation situations, many health status indicators were related to eating alone at each meal, especially breakfast.

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Sex differences in impact of sarcopenia on falls in community-dwelling Korean older adults

BMC Geriatrics ◽

10.1186/s12877-021-02688-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yunsoo Soh ◽

Chang Won Won

Keyword(s):

Older Adults ◽

Sex Differences ◽

Diagnostic Algorithm ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

History Of ◽

Adjusted Model ◽

The Impact

Abstract Background Falls are one of the most serious health problems among older adults. Sarcopenia is characterized by a decrease in muscle mass, strength, and physical function. Due to potentially age-related conditions, both falls and sarcopenia have common risk factors. However, the association between sarcopenia and falls is controversial. Moreover, the sex differences in the impact of sarcopenia on falls is not yet clear. This study aimed to investigate the sex differences in the impact of sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS), on falls in Korean older adults. Methods In this cross-sectional study, we used data from the Korean Frailty and Aging Cohort Study; 2323 community-dwelling older adults (1111 males and 1212 females) aged 70–84 years were recruited in this cross-sectional study. To evaluate sarcopenia, the AWGS diagnostic algorithm was used. We compared the faller and non-faller groups. We performed unadjusted and fully adjusted logistic regression analyses to evaluate the relationship between sarcopenia, falls, and fall-related fractures. Results A total of 239 (24.1%) females in the faller group had a history of falls in the past year, which was statistically higher than that in males (176, 15.8%). In the fully adjusted model, handgrip strength (odds ratio [OR] = 1.508, 95% confidence interval [CI] = 1.028–2.211), and short physical performance battery (OR = 2.068, 95% CI = 1.308–3.271) were significantly lower in the male faller group. However, in the fully adjusted model, the female faller group only showed a significantly low appendicular skeletal muscle mass index (OR = 1.419, 95% CI = 1.058–1.903). Conclusions This large cohort study aimed to identify the sex differences in the incidence of sarcopenia in the older Korean population, using the AWGS diagnostic algorithm, and its correlation with falls and fall-related fractures. The incidence of falls did not increase in the sarcopenia group. Among the sarcopenia components, sex differences affect the history of falls. Therefore, when studying the risk of falls in old age, sex differences should be considered.

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Sex Differences In Impact of Sarcopenia On Falls In Community-Dwelling Older Adults

10.21203/rs.3.rs-885429/v1 ◽

2021 ◽

Author(s):

Chang Won Won ◽

Yunsoo Soh

Keyword(s):

Older Adults ◽

Sex Differences ◽

Diagnostic Algorithm ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

History Of ◽

Adjusted Model ◽

Community Dwelling Older Adults

Abstract Background: Falls are one of the most serious health problems among older adults. Sarcopenia is characterized by a decrease in muscle mass, strength, and physical function. Due to potentially age-related conditions, both falls and sarcopenia have common risk factors. However, the association between sarcopenia and falls is controversial.Methods: In this cross-sectional study, we used data from the Korean Frailty and Aging Cohort Study; 2,323 community-dwelling older adults (1,111 men and 1,212 women) aged 70–84 years were recruited in this cross-sectional study. To evaluate sarcopenia, the Asian Working Group for Sarcopenia (AWGS) diagnostic algorithm was used. We compared the faller and non-faller groups. Unadjusted and fully adjusted logistic regression analyses were performed to evaluate the relationship between sarcopenia and falls.Results: A total of 239 (24.1%) women in the faller group had a history of falls in the past year, which was statistically higher than that in men (176, 15.8%). In the fully adjusted model, handgrip strength (odds ratio [OR]=1.508, 95% confidence interval [CI]=1.028–2.211), short physical performance battery (OR=2.068, 95% CI=1.308–3.271), and 4-m walking speed (OR=3.499, 95% CI=2.044–5.991) were significantly lower in the male faller group. However, the female faller group only showed a significantly low appendicular skeletal muscle mass index (OR=1.419, 95% CI=1.058–1.903) in the fully adjusted model.Conclusions: This large cohort study aimed to identify the incidence of sarcopenia in older Korean population using the AWGS diagnostic algorithm and its correlation with falls. The incidence of falls did not increase in the sarcopenia group. Among the sarcopenia components, sex differences affect the a history of falls. Therefore, when studying the risk of falls in old age, sex differences should be considered.

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A profile of older community-dwelling home care clients with heart failure in Ontario

Chronic Diseases in Canada ◽

10.24095/hpcdp.31.2.01 ◽

2011 ◽

Vol 31 (2) ◽

pp. 49-57 ◽

Cited By ~ 4

Author(s):

AD Foebel ◽

JP Hirdes ◽

GA Heckman ◽

SL Tyas ◽

EY Tjam

Keyword(s):

Heart Failure ◽

Home Care ◽

Clinical Characteristics ◽

Service Use ◽

Self Care ◽

Home Care Services ◽

Community Dwelling ◽

Emergency Department Visits ◽

Assessment Instrument ◽

At Home

Introduction The aging of the Canadian population is associated with a rising burden of heart failure (HF), a condition associated with significant morbidity, mortality and health service use. Methods We used data from the Ontario Resident Assessment Instrument-Home Care database for all long-stay home care clients aged 65 years or older to (1) describe the demographic and clinical characteristics of home care clients with HF and (2) examine service use among home care clients with HF to promote management at home with appropriate services. Results Compared with other home care clients, HF clients exhibit more health instability, take more medications, experience more comorbid conditions and receive significantly more nursing, homemaking and meal services. They are hospitalized more frequently, have significantly more emergency department visits and use more emergent care. Discussion HF clients are a more complex group than home care clients in general. Patient self-care must be tailored to the clinical characteristics, patterns of service use and barriers to self-care of the client. This is particularly true for older, frail and medically complex HF patients, many of whom require home care services. This work provides a background upon which to base initiatives to help these higher-needs clients manage their HF at home with appropriate support and services.

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Factors Associated with Lower Cognitive Performance Scores Among Older Japanese Men in Hawaii and Japan

Journal of Alzheimer s Disease ◽

10.3233/jad-201084 ◽

2021 ◽

pp. 1-10

Author(s):

Naoko Miyagawa ◽

Takayoshi Ohkubo ◽

Akira Fujiyoshi ◽

Akihiko Shiino ◽

Randi Chen ◽

...

Keyword(s):

Educational Attainment ◽

Cognitive Abilities ◽

Subclinical Atherosclerosis ◽

Lifestyle Factors ◽

Community Dwelling ◽

Multivariable Logistic Regression Analysis ◽

Cross Sectional ◽

Japanese Men ◽

History Of ◽

Cardiometabolic Factors

Background: Few studies have compared factors related to cognitive function among people with similar genetic backgrounds but different lifestyles. Objective: We aimed to identify factors related to lower cognitive scores among older Japanese men in two genetically similar cohorts exposed to different lifestyle factors. Methods: This cross-sectional study of community-dwelling Japanese men aged 71–81 years included 2,628 men enrolled in the Kuakini Honolulu-Asia Aging Study based in Hawaii and 349 men in the Shiga Epidemiological Study of Subclinical Atherosclerosis based in Japan. We compared participant performance through Cognitive Abilities Screening Instrument (CASI) assessment in Hawaii (1991–1993) and Japan (2009–2014). Factors related to low cognitive scores (history of cardiovascular disease, cardiometabolic factors, and lifestyle factors) were identified with questionnaires and measurements. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (ORs) of a low (< 82) CASI score based on different factors. Results: CASI scores were lower in Hawaii than in Japan [21.2%(n = 556) versus 12.3%(n = 43), p < 0.001], though this was not significant when adjusted for age and educational attainment (Hawaii 20.3%versus Japan 17.9%, p = 0.328). History of stroke (OR = 1.65, 95%confidence interval = 1.19–2.29) was positively associated with low cognitive scores in Hawaii. Body mass index ≥25 kg/m2 tended to be associated with low cognitive scores in Japan; there was a significant interaction between the cohorts. Conclusion: Cognitive scores differences between cohorts were mostly explained by differences in educational attainment. Conversely, cardiovascular diseases and cardiometabolic factors differentially impacted cognitive scores among genetically similar older men exposed to different lifestyle factors.

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Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

Sustainability ◽

10.3390/su13137277 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7277

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Paolo Fabbietti ◽

Giovanni Lamura

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Home Care Services ◽

Community Dwelling ◽

European Countries ◽

Care Services ◽

The Impact ◽

Community Dwelling Older Adults ◽

Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

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. Sobrecarga do cuidador de pacientes atendidos na atenção domiciliar

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963.2020.244235 ◽

2020 ◽

Vol 14 ◽

Author(s):

Monique Évellin Alves Cruz ◽

Daniel Vinícius Alves Silva ◽

Júlia Rocha do Carmo ◽

Gabriel Dias de Araújo ◽

Luiza Rodrigues Camisasca ◽

...

Keyword(s):

Home Care ◽

Statistical Significance ◽

Care Program ◽

Home Care Services ◽

Cross Sectional Study ◽

Common Finding ◽

Bivariate Analysis ◽

Daily Routine ◽

Cross Sectional ◽

Zarit Burden Interview

Objetivo: avaliar a sobrecarga de cuidadores de pacientes atendidos por um programa de atenção domiciliar público. Método: trata-se de um estudo quantitativo, descritivo, transversal, com 127 cuidadores de pacientes atendidos pelo Programa Melhor em Casa. Coletaram-se dados sociodemográficos e clínicos e aplicaram-se também a Escala Zarit Burden Interview reduzida e a Escala de Desesperança de Beck. Realizou-se análise descritiva e bivariada de dados. Resultados: verificou-se que, dos 127 cuidadores, a maioria era do sexo feminino (114=89,8%), de cor parda (81=63,8%); composta por solteiros (56=44,1%) e a média de idade foi de 46,66 anos. Destaca-se que 38,6% (49) apresentaram sobrecarga de moderada a grave, 78,7% (110) afirmaram que houve mudanças em sua rotina diária, 59,8% (76) dizem ter sofrido alguma mudança no estado emocional após iniciar o cuidado do paciente e 56,7% (72) sentem dores no corpo. Confirmaram-se, na análise bivariada, 15 variáveis independentes que obtiveram significância estatística. Conclusão: conclui-se que a sobrecarga do cuidador de pacientes da atenção domiciliar é um achado comum e cuidados para a sua prevenção devem ser estabelecidos. Descritores: Cuidadores; Esgotamento Psicológico; Serviços de Assistência Domiciliar; Assistência Domiciliar; Pacientes Domiciliares; Enfermagem.AbstractObjective: to assess the burden of caregivers of patients treated by a public home care program. Method: this is a quantitative, descriptive, cross-sectional study, with 127 caregivers of patients treated by the Melhor em Casa Program. Sociodemographic and clinical data were collected, and the reduced Zarit Burden Interview Scale and the Beck Hopelessness Scale were also applied. Descriptive and bivariate data analyses were performed. Results: of the 127 caregivers, the majority was female (114=89.8%), pardos (81=63.8%); composed of unmarried (56=44.1%) and the mean age was 46.66 years. Importantly, 38.6% (49) had moderate to severe burden, 78.7% (110) stated the occurrence of changes in their daily routine, 59.8% (76) mentioned having suffered some change in emotional state after starting the care with the patients and 56.7% (72) have body ache. The bivariate analysis confirmed the statistical significance of 15 independent variables. Conclusion: the burden of caregivers of homebound patients is a common finding, requiring care actions for its prevention. Descriptors: Caregivers; Burnout, Psychological; Home Care Services; Home Nursing; Homebound Persons; Nursing. ResumenObjetivo: evaluar la sobrecarga de los cuidadores de pacientes tratados mediante un programa de atención domiciliaria público. Método: se trata de un estudio cuantitativo, descriptivo, transversal, con 127 cuidadores de pacientes tratados por el Programa Melhor em Casa. Recogieron datos sociodemográficos y clínicos y se aplicaron la escala Zarit Burden Interview reducida y la Escala de Desesperanza de Beck. Se realizó el análisis descriptivo y bivariado de los datos. Resultados: se constató que, de 127 cuidadores, la mayoría eran mujeres (114=89,8%), pardos (81=63,8%); compuesto de solteros (56=44,1%) y el promedio de edad fue de 46.66 años. Cabe destacar que el 38,6% (49) presentó sobrecarga moderada a severa, el 78,7% (110) declaró que ha habido cambios en su rutina diaria, el 59,8% (76) afirmó tener sufrido algún cambio en el estado emocional después de iniciar los cuidados del paciente, y el 56,7% (72) siente dolor en el cuerpo. Se confirman, en el análisis bivariado, 15 variables independientes que tuvieron significación estadística. Conclusión: se concluye que la sobrecarga de los cuidadores de pacientes en atención domiciliaria es un hallazgo común y cuidados en su prevención deben ser establecidos. Descriptores: Cuidadores; Agotamiento Psicológico; Servicios de Atención de Salud a Domicilio; Atención Domiciliaria de Salud; Personas Imposibilitadas; Enfermería.

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Reliability of HOME FAST BRAZIL—Self-Reported Version for Community-Dwelling Older Adults

Frontiers in Public Health ◽

10.3389/fpubh.2021.713202 ◽

2021 ◽

Vol 9 ◽

Author(s):

Karina Stella Aoki Ferreira ◽

Tamires Terezinha Gallo da Silva ◽

Jarbas Melo Filho ◽

Natacha Verônica Bazanella ◽

Audrin Said Vojciechowski ◽

...

Keyword(s):

Older Adults ◽

Cross Sectional Study ◽

Environmental Risks ◽

Community Dwelling ◽

Cross Sectional ◽

Rater Reliability ◽

Risk Of Falls ◽

History Of ◽

Spearman Test ◽

Community Dwelling Older Adults

Objective: Verify the intra- and inter-rater reliability of the HOME FAST BRAZIL—Self-reported version and correlate household environmental risks with the history of falls by community-dwelling older adults.Method: Cross sectional study with 50 community-dwelling older adults who were screened by the cut-off point of the Mini Mental State Exam and replied to the HOME FAST BRAZIL—Self-reported version using two evaluators, on three occasions. The reliability analysis was determined by the Intra-class Correlation Coefficient (ICC), considering ICC > 0.70 as adequate. To test the correlations, the Spearman test was used.Results: The mean age of the participants was 73.2 ± 5.8 years. The inter- rater reliability of HOME FAST BRAZIL—Self-reported version was ICC 0.83 (IC95%, 0.70–0.90) and the Intra- reliability ICC 0.85 (IC95%, 0.74–0.91). A risk of falls was verified in 88% of the sample and four environmental risks presented significant correlations with the history of falls.Conclusions: The HOME FAST BRAZIL—Self-reported version presented adequate reliability for the evaluation of household environmental risks for community-dwelling older adults. Risks such as inadequate armchairs/ sofas, the absence of anti-slip mats in the shower recess, the presence of pets and inadequate beds require attention in the evaluation of household risks, due to their correlation with the occurrence of falls.

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Factors influencing Fear of Falling in Community-Dwelling Older Adults in Singapore: A Cross-Sectional Study

10.21203/rs.3.rs-963330/v1 ◽

2021 ◽

Author(s):

Jacqueline Giovanna De Roza ◽

David Wei Liang Ng ◽

Blessy Koottappal Mathew ◽

Teena Jose ◽

Ling Jia Goh ◽

...

Keyword(s):

Older Adults ◽

Fear Of Falling ◽

Cross Sectional Study ◽

Community Dwelling ◽

Clinical Factors ◽

Cross Sectional ◽

Frail Older Adults ◽

History Of ◽

The Mean ◽

Community Dwelling Older Adults

Abstract BackgroundFalls in older adults is a common problem worldwide. Fear of falling (FoF) is a consequence of falls which has far-reaching implications including activity restriction, functional decline and reduced quality of life. This study aimed to determine the factors associated with FoF in a segment of Singapore’s community-dwelling older adults. MethodsThis descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors and clinical factors including history of falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale–International (Short FES-I), cut-off score of 14 and above indicated high FoF. Logistic regression was used to determine predictors of high FoF.ResultsOut of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history of falls in the past six months. Almost half (43.1%) were mildly to moderately frail and most (80.6%) had three or more chronic conditions. The mean FoF score was 15.5 (SD 5.97) and 60.8% reported high FoF. Logistic regression found that Malay ethnicity (OR = 5.81, 95% CI 1.77 – 19.13), use of walking aids (OR = 3.67, 95% CI = 1.54 – 8.77) and increasing frailty were significant predictors for high FoF. The odds of high FoF were significantly higher in pre frail older adults (OR = 6.87, 95% CI = 2.66 – 17.37), mildly frail older adults (OR =18.58, 95% CI = 4.88 – 70.34) and moderately frail older adults (OR = 144.78, 95% CI = 13.86 – 1512.60).ConclusionsFoF is a prevalent and compelling issue in community-dwelling older adults, particularly those with frailty. The demographic and clinical factors identified in this study will be helpful to develop targeted and tailored interventions for FoF.

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Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework

Journal of Aging and Physical Activity ◽

10.1123/japa.2016-0286 ◽

2018 ◽

Vol 26 (1) ◽

pp. 114-120 ◽

Cited By ~ 6

Author(s):

Koren L. Fisher ◽

Elizabeth L. Harrison ◽

Brenda G. Bruner ◽

Joshua A. Lawson ◽

Bruce A. Reeder ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Environmental Factors ◽

The Elderly ◽

Home Care Services ◽

Community Dwelling ◽

Nursing Home Care ◽

Activity Levels ◽

Inverse Association ◽

Cross Sectional

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors’ housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors’ housing units should be considered when developing PA programs for older adults.

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