scholarly journals Educational differences in long-term care use in Sweden during the last two years of life

2021 ◽  
pp. 140349482110436
Author(s):  
Susanne Kelfve ◽  
Jonas W. Wastesson ◽  
Bettina Meinow
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Long Term Care ◽  
Negative Binomial ◽  
Age At Death ◽  
Term Care ◽  
Educational Differences ◽  
Health And Social Care ◽  
Cohabitation Status

Background: In old age, many people experience a period of functional decline and require long-term care. Sweden has a universal largely tax-financed health and social care system that is used by all societal groups. However, few studies have investigated if educational groups use publicly paid long-term care equitably. The aim of this study was to explore educational differences in the use of long-term care, including both home care and institutional care, during the last two years of life in Sweden. Methods: We used linked register data on mortality and long-term care use, including all adults aged ⩾67 years who died in Sweden in November 2015 ( N=6329). We used zero-inflated negative binomial regression models to analyse the number of months with long-term care by educational level, both crude and adjusted for age at death and cohabitation status. Men and women were analysed separately. Results: People with tertiary education died more commonly without using any long-term care compared to primary educated people (28.0% vs. 18.6%; p<0.001). In the adjusted model, educational differences in the estimated number of months with long-term care disappeared among men but remained significant among women (primary educated: odds ratio=17.3 (confidence interval 16.8–17.7); tertiary educated: odds ratio=15.8 (confidence interval 14.8–16.8)). Conclusions: Older adults spend considerable time in their last two years of life with long-term care. Only minor educational differences in long-term care use remained after adjustment for cohabitation status and age at death. This suggest that Sweden’s publicly financed long-term system achieves relatively equitable use of long-term care at the end of life.

scholarly journals Effect of Holding Objects on the Occurrence of Head Impact in Falls by Older Adults: Evidence From Real-Life Falls in Long-Term Care

2020 ◽  
Author(s):  
Vicki Komisar ◽  
Nataliya Shishov ◽  
Yijian Yang ◽  
Stephen N Robinovitch
Keyword(s):  
Older Adults ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Long Term Care ◽  
Weight Bearing ◽  
Real Life ◽  
Head Impact ◽  
Term Care ◽  
Validated Questionnaire

Abstract Background Falls cause approximately 80% of traumatic brain injuries in older adults, and nearly one third of falls by residents in long-term care (LTC) result in head impact. Holding objects during falls, such as mobility aids, may affect the ability of LTC residents to avoid head impact by arresting the fall with their upper limbs. We examined the prevalence of holding objects and their effect on risk for head impact during real-life falls in older adults living in LTC. Methods We analyzed videos of 1105 real-life falls from standing height by 425 LTC residents, using a validated questionnaire to characterize the occurrence of head impact and whether the resident held objects during descent and impact. We classified objects as either “weight-bearing” (via contact to the fixed environment, eg, chairs and walkers) or “non-weight-bearing” (eg, cups) and tested their effect on odds for head impact with generalized estimating equations. Results Residents held objects in more than 60% of falls. The odds for head impact were reduced for falls where weight-bearing objects were held or grasped during descent (odds ratio = 0.52; 95% confidence interval = 0.39–0.70) or maintained throughout the fall (odds ratio = 0.34; 95% confidence interval = 0.23–0.49). The most commonly held objects were chairs/wheelchairs (23% of cases), tables/counters (10% of cases), and walkers/rollators (22% of cases); all reduced the odds of head impact when held during descent. Holding non-weight-bearing objects did not affect the odds of head impact (odds ratio = 1.00; 95% confidence interval = 0.64–1.55). Conclusion Our results show that older adults in LTC use held, weight-bearing objects to reduce their risk for head impact during falls.

scholarly journals Use of Long-Term Care Decreased Over Time Among the Oldest-Old With and Without Dementia - A Register-Based Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 995-996
Author(s):  
Mari Aaltonen ◽  
Leena Forma ◽  
Jutta Pulkki ◽  
Jani Raitanen ◽  
Marja Jylhä
Keyword(s):  
Home Care ◽  
Long Term Care ◽  
Negative Binomial ◽  
Oldest Old ◽  
Age Groups ◽  
Term Care ◽  
Total Study Population ◽  
Health And Social Care ◽  
Over Time

Abstract Care policies for older adults emphasize aging-in-place and home care over residential long-term care (LTC). We explore how the use of residential LTC in the last five years of life among people with and without dementia changed between those who died in 2001, 2007, 2013, and 2017 in Finland. Retrospective data drawn from the national health and social care registers include all those who died aged 70+ in 2007, 2013, and 2017, plus a 40% random sample from 2001 (N=128 050). Negative binomial regression analysis was used to estimate the association of dementia with LTC use during the last five years of life (1825 days). The independent variables included dementia, age, marital status, annual income, education, and chronic conditions. In the total study population, the proportion of LTC users and the mean number of days in LTC increased until 2013, after which it decreased. Changes in LTC use differed between different age groups and by dementia status. Over time, the decrease in round-the-clock LTC use was steep in those aged 90≤ with dementia and in people aged 80≤ without dementia. The individual factors related to morbidity and sociodemographic factors did not explain these results. The changes in LTC care policy may have contributed to the decrease in LTC use among the oldest. However, according to national statistics, the availability of formal home care has not increased. This development may suggest that the oldest-old and those with dementia – a highly vulnerable group – are left without proper care.

Importance of Bacterial Burden Among Methicillin-Resistant Staphylococcus aureus Carriers in a Long-Term Care Facility

2008 ◽  
Vol 29 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Nimalie D. Stone ◽  
Donna R. Lewis ◽  
H. K. Lowery ◽  
Lyndsey A. Darrow ◽  
Catherine M. Kroll ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Nasal Swab ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
Culture Positive ◽  
Epidemiologic Characteristics

Objective.To evaluate the prevalence and transmission of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization, as well as risk factors associated with MRSA carriage, among residents of a long-term care facility (LTCF).Design.Prospective, longitudinal cohort study.Setting.A 100-bed Veterans Administration LTCFParticipants.All current and newly admitted residents of the LTCF during an 8-week study period.Methods.Nasal swab samples were obtained weekly and cultured on MRSA-selective media, and the cultures were graded for growth on a semiquantitative scale from 0 (no growth) to 6 (heavy growth). Epidemiologic data for the periods before and during the study were collected to assess risk factors for MRSA carriage.Results.Of 83 LTCF residents, 49 (59%) had 1 or more nasal swab cultures that were positive for MRSA; 34 (41%) were consistently culture-negative (designated “noncarriers”). Of the 49 culture-positive residents, 30 (36% of the total of 83 residents) had all cultures positive for MRSA (designated “persistent carriers”), and 19 (23% of the 83 residents) had at least 1 culture, but not all cultures, positive for MRSA (designated “intermittent carriers”). Multivariate analysis showed that participants with at least 1 nasal swab culture positive for MRSA were likely to have had previous hospitalization (odds ratio, 3.9) or wounds (odds ratio, 8.2). Persistent carriers and intermittent carriers did not differ in epidemiologic characteristics but did differ in mean MRSA growth score (3.7 vs 0.7; P < .001).Conclusions.Epidemiologic characteristics differed between noncarriers and subjects with at least 1 nasal swab culture positive for MRSA. However, in this LTCF population, only the degree of bacterial colonization (as reflected by mean MRSA growth score) distinguished persistent carriers from intermittent carriers. Understanding the burden of colonization may be important when determining future surveillance and control strategies.

The Politics of Entitlement and Personalisation: Perspectives on a Proposed National Disability Long-term Care and Support Scheme in Australia

2012 ◽  
Vol 11 (3) ◽  
pp. 331-343 ◽  
Author(s):  
Michele Foster ◽  
Paul Henman ◽  
Jennifer Fleming ◽  
Cheryl Tilse ◽  
Rosamund Harrington
Keyword(s):  
Long Term Care ◽  
Individual Case ◽  
Term Care ◽  
Case Examples ◽  
The Past ◽  
Care Services ◽  
Trade Offs ◽  
Care And Support ◽  
Health And Social Care

Internationally, over the past two decades the theme of personalisation has driven significant reforms within health and social care services. In the Australian context, the principles of ‘entitlement based on need’ and ‘personalisation’ frame the proposed National Disability Long-Term Care and Support Scheme (LTCSS). In this article, we critically examine the interpretations and ambiguities of need and personalisation. We consider the administrative complexities of applying these principles in practice and the uncertainties about the roles of state and the market, and use individual case examples to illustrate areas of potential tension. Whether principles translate to deliver personalised services and avoid harmful trade-offs between access, equity and choice is the true test of social policy.

scholarly journals Participatory approach in developing the long-term care strategy in Slovakia

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Z Katreniakova ◽  
M Levyova ◽  
M Giertl ◽  
I Nagyova
Keyword(s):  
Online Survey ◽  
Long Term Care ◽  
Social Care ◽  
Slovak Republic ◽  
Participatory Approach ◽  
Term Care ◽  
Starting Point ◽  
Health And Social Care ◽  
Care Systems

Abstract Issue/problem In Slovak Republic (SR) old-age dependency will rise rapidly in the near future and will more than double in the next 15 years. This profound demographic changes will require restructuring of health and social care systems with more people working in the long-term care (LTC) sector and most likely a higher level of public spending to cover the growing LTC needs. Description of the problem Providing LTC in Slovakia has many problem areas. It is governed by several acts and regulations, which are not always linked and sometimes do not cover the situation entirely. There is not coordinated and integrated LTC model implemented and the distribution of the roles between the health and social care systems is lacking. Results Since 2017 a policy dialog between the key stakeholders - the Ministry of Health of the SR; the Ministry of Labour, Social Affairs and Family of the SR; and civic societies led by the Association for the Patients’ Rights Protection has been in place with aim to improve the current LTC Strategy Proposal. Online survey was carried out in May - June 2018, which brought deeper insights into the needs regarding demand and supply, and uncovered the main limitations of the current LTC system, e.g. insufficient capacity of LTC beds or a malfunctioning information system. This was followed by six workshops for professional and lay public, organised between February and March 2019 with aim to collect further evidence on regional level. Lessons The LTC Strategy Proposal development is one of 12 pilot projects within the national project - Promoting partnership and dialogue on participatory public policy making in SR. The initiative takes into account the needs and demands of LTC target groups and will serve as a starting point for further action in this area. [Grant Support: APVV-15-0719]. Key messages In Slovakia, a complex solution of long-term care issues is essential. Developing the LTC Strategy Proposal through participatory approach is an important starting point for future action.

The Prevalence of Fecal Colonization With VRE Among Residents of Long-Term–Care Facilities in Melbourne, Australia

2001 ◽  
Vol 22 (9) ◽  
pp. 576-578 ◽  
Author(s):  
Alexander A. Padiglione ◽  
Elizabeth Grabsch ◽  
Rory Wolfe ◽  
Kimberly Gibson ◽  
M. Lindsay Grayson
Keyword(s):  
Nursing Homes ◽  
Confidence Interval ◽  
Acute Care ◽  
Long Term Care ◽  
Prevalence Survey ◽  
Term Care ◽  
Point Prevalence Survey ◽  
Care Facilities ◽  
General Community

AbstractA point-prevalence survey performed among residents of eight nursing homes in Melbourne, Australia, found a rate of fecal VRE colonization of 3.1% (9/292; 95% confidence interval, 1.1-5.1), allvanBEnterococcusfaecium.This is a higher rate than in the general community (3.1% vs 0.2%). Many residents (16%) had been inpatients in acute-care hospitals in the previous 3 months.

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