Predictors of hospital admissions in the elderly: analysis of data from the Longitudinal Study on Aging

Healthcare for the elderly population presents enormous challenges, which are further complicated by ethnicity-related socioeconomic disparities in the United States. We set out to determine the predictors of hospital admissions in the elderly by conducting a retrospective cohort analysis of a nationally representative sample of community-dwelling individuals aged 70 and older in 1984 (n = 7541). Multivariate logistic regression analysis of data from the Longitudinal Study on Aging revealed that race, health status, type of family relationship, and activities of daily living (ADL) are significant predictors of hospitalization among the elderly. Older blacks are less likely to be admitted into the hospital, compared to their white counterparts (OR 0.68, 95%CI 0.52-0.89). Elderly persons who perceive their health status as being fair or poor are three times as likely to be hospitalized than those who perceived their health status as excellent (OR 2.99, 95%CI 2.15-4.15). Those with impairment in activities of daily living are twice as likely to be confined to the hospital than those without impairment (OR 1.78, 95%CI 1.64-1.96). Elderly persons living with nonrelatives are three times as likely to be admitted for short hospital stays than those living with spouses (OR 2.90, 95%CI 1.44-5.82). Future identification of predictors of hospital admissions in the elderly may help characterize those at risk and perhaps allow for focused and timely intervention.     

The Lighthouse Alarm and Locator trial - a pilot study.

An important factor for health is the possibility to be active and mobile. To make this possible various kinds of support are needed. Integrating geographical information systems technology and user experiences is important in the development of more user-friendly positioning devices. The Lighthouse Alarm and Locator trial aimed to test a new mobile alarm system with additional functionality such as positioning and monitoring of vital signs which can be used regardless of location (in hospital, at home). The system was tested by elderly persons from a pensioner organisation and home care personnel answered up on the alarms. After the tests qualitative interviews were performed with the two groups. The results showed that their experiences of the new mobile alarm system could be described in three main categories: to be supervised, to feel safe and to be mobile. These categories formed a theme: Positioning - an ethical dilemma. The clients' mobility was perceived to increase. The personnel did not think that positioning was ethical but the clients (elderly) did.     

Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk.     

Innovations in health care services: The CAALYX system

PurposeThis paper describes proposed health care services innovations, provided by a system called CAALYX (Complete Ambient Assisted Living eXperiment). CAALYX aimed to provide healthcare innovation by extending the state-of-the-art in tele-healthcare, by focusing on increasing the confidence of elderly people living autonomously, by building on the knowledge base of the most common disorders and respective characteristic vital sign changes for this age group.MethodsA review of the state-of-the-art on health care services was carried out. Then, extensive research was conducted on the particular needs of the elderly in relation to home health services that, if offered to them, could improve their day life by giving them greater confidence and autonomy. To achieve this, we addressed issues associated with the gathering of clinical data and interpretation of these data, as well as possibilities of automatically triggering appropriate clinical measures. Considering this initial work we started the identification of initiatives, ongoing works and technologies that could be used for the development of the system. After that, the implementation of CAALYX was done.FindingsThe innovation in CAALYX system considers three main areas of contribution: (i) The Roaming Monitoring System that is used to collect information on the well-being of the elderly users; (ii) The Home Monitoring System that is aimed at helping the elders independently living at home being implemented by a device (a personal computer or a set top box) that supports the connection of sensors and video cameras that may be used for monitoring and for interaction with the elder; (iii) The Central Care Service and Monitoring System that is implemented by a Caretaker System where attention and care services are provided to elders, where actors as Caretakers, Doctors and Relatives are logically linked to elders. Innovations in each of these areas are presented here.ConclusionsThe ageing European society is placing an added burden on future generations, as the ‘elderly-to-working-age-people’ ratio is set to steadily increase in the future. Nowadays, quality of life and fitness allows for most older persons to have an active life well into their eighties. Furthermore, many older persons prefer to live in their own house and choose their own lifestyle. The CAALYX system can have a clear impact in increasing older persons’ autonomy, by ensuring that they do not need to leave their preferred environment in order to be properly monitored and taken care of.     

Intake of drugs among elderly people in a Danish municipality, R?dovre

Drug intake has been studied among a random group of persons, aged 75 or over, in R?dovre Municipality. Two hundred and eight-three elderly persons living in their own homes have been visited and interviewed about their daily intake of prescribed and nonprescribed drugs (including so-called natural drugs). Similar information was gathered from 146 elderly persons living in nursing homes. Thirty-one per cent of the elderly living in their own homes and 3% of those living in nursing homes did not use prescribed drugs daily. The median daily amount of different types of drugs used was 1.8 (range 0-10) for elderly persons living in their own homes and 4.5 (range 0-11) (p less than 0.001) for those living in nursing homes. Women living at home had a higher intake of drugs than men, especially diuretics. The most frequently used drugs were diuretics, sedatives/hypnotics, analgesics, digitalis and electrolytes. For all types of drugs a higher consumption, especially of phenothiazines, was found among elderly persons living in nursing homes. Drug consumption was independent of age and social stratification in both groups. The use of non-prescribed drugs ranges from 0 to 9 different types in the group living in their own homes, and from 0 to 5 in the group living in nursing homes--laxatives being the type most frequently used.     

Accelerometer’s position independent physical activity recognition system for long-term activity monitoring in the elderly

Mobility is a good indicator of health status and thus objective mobility data could be used to assess the health status of elderly patients. Accelerometry has emerged as an effective means for long-term physical activity monitoring in the elderly. However, the output of an accelerometer varies at different positions on a subject’s body, even for the same activity, resulting in high within-class variance. Existing accelerometer-based activity recognition systems thus require firm attachment of the sensor to a subject’s body. This requirement makes them impractical for long-term activity monitoring during unsupervised free-living as it forces subjects into a fixed life pattern and impede their daily activities. Therefore, we introduce a novel single-triaxial-accelerometer-based activity recognition system that reduces the high within-class variance significantly and allows subjects to carry the sensor freely in any pocket without its firm attachment. We validated our system using seven activities: resting (lying/sitting/standing), walking, walking-upstairs, walking-downstairs, running, cycling, and vacuuming, recorded from five positions: chest pocket, front left trousers pocket, front right trousers pocket, rear trousers pocket, and inner jacket pocket. Its simplicity, ability to perform activities unimpeded, and an average recognition accuracy of 94% make our system a practical solution for continuous long-term activity monitoring in the elderly.     

Elderly persons’ perception and acceptance of using wireless sensor networks to assist healthcare

Purpose

This is an exploratory study carrying out qualitative research into the perceptions, attitudes and concerns of elderly persons towards wireless sensor network (WSN) technologies in terms of their application to healthcare. This work aims to provide guidance on the dimensions and items that may be included in the development of a more in-depth questionnaire to further validate the importance of the identified factors as well as the relationships between them. This study aims to contribute to opening up a communication channel between users and researchers, informing the research community in relation to applications and functionalities that users deem as either desirable, inadequate or in need of further development.

Methods

Focus groups were conducted with elderly individuals who were still living independently. To explore elderly persons’ perceptions and thoughts on current wireless sensor network (WSN) technologies and designs, discussion points were designed from concepts identified from various user acceptance theories and models. Participants were given an introduction to explain the functionality and capabilities of WSN and motes and were shown a sample mote, the Crossbow Mica2Dot. Participants were then asked to discuss their perceptions and concerns towards the likelihood of using a WSN-based healthcare system in their home.

Findings

We have identified sixteen concepts in relation to the elderly participants’ perception, concerns and attitudes towards WSN systems. Those concepts were further classified into six themes describing the determinants that may affect an elderly person's acceptance of WSNs for assisting healthcare. Some of our exploratory findings in this study indicate for example that independence is highly valued by elderly people and hence any system or technology that can prolong that independence tends to be highly regarded, that privacy of WSN health data might not be as important as typically considered, and there are also indications that cost may be the most prominent determinant influencing an elderly person's acceptance of WSNs.

Conclusions

Our findings indicate that participants’ attitudes towards the idea of wireless sensor networks for health monitoring are generally positive. The exploratory findings along with the literature suggest a number of relationships which can be used in future survey design and model building.     

Smart homes and home health monitoring technologies for older adults: A systematic review

BackgroundAround the world, populations are aging and there is a growing concern about ways that older adults can maintain their health and well-being while living in their homes.ObjectivesThe aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs.ResultsWe identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1) technology-readiness level for smart homes and home health monitoring technologies is low; (2) the highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score ≥6); smart homes and home health monitoring technologies are used to monitor activities of daily living, cognitive decline and mental health, and heart conditions in older adults with complex needs; (3) there is no evidence that smart homes and home health monitoring technologies help address disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting evidence that smart homes and home health monitoring technologies help address chronic obstructive pulmonary disease.ConclusionsThe level of technology readiness for smart homes and home health monitoring technologies is still low. The highest level of evidence found was in a study that supported home health technologies for use in monitoring activities of daily living, cognitive decline, mental health, and heart conditions in older adults with complex needs.     

Clinical need variations of disabled persons residing in group homes

Group home research has generally entailed comparison of these settings and their residents to institutions and their residents. Group home residents have frequently been treated as a homogeneous cohort of individuals. When group home development began, initial residents--usually individuals recently deinstitutionalized--were probably relatively homogeneous in regard to functional abilities and service needs, and generally similar to other disabled persons living in the community. Today, the residents of one group home may bear little resemblance to those of another. This report presents information about the types of group homes within a state system based upon the characteristics and service needs of 1,050 persons in 118 group homes and questions the role of community mental health centers in addressing certain service needs of group home residents.     

农村老年人抑郁症状及其影响因素的相关研究

目的了解农村老年人抑郁症状及其影响因素。方法选取唐山市所属县区农村老年人240例采用流调抑郁自评量表(CES-D)、健康自评量表进行问卷调查。结果农村老年人心理健康在有无躯体疾病、年龄、文化程度、有无配偶、家庭关系和睦与否、是否受家人尊重、有无讲心里话的家人等方面有显著差异(P<0.05或P<0.01)。农村老年人的健康总体状况处在中等水平(241.94±35.52);抑郁症状的出现较高。结论农村老年人的心理健康状况受年龄、文化程度、有无配偶、家庭关系和睦与否、是否受家人尊重、有无讲心里话家人的影响,良好的家庭关系能减少农村老年人抑郁症的发生。     

Prevalence of disability and associated social and health-related factors among the elderly in Spain: a population-based study

Objectives: To estimate the prevalence of disability and its association with morbidity and other social and health-related factors among Spain’s non-institutionalized elderly population. Methods: Cross-sectional survey, by home-based personal interview, covering a sample of 4000 subjects representative of the non-institutionalized Spanish population aged 60 years and over. The relationship between disability and social and health-related study variables was studied using logistic regression. Results: A total of 72.9% of subjects reported some type of disability: 59.1% in agility, 51.6% in mobility, 40.1% in instrumental activities and 19.1% in activities of daily living. After adjusting for all relevant variables, disability showed to be significantly more frequent for: female gender (OR=1.83; 1.53–2.19); more advanced age (OR=4.54; 3.27–6.32); low/no educational level (OR=2.01; 1.67–2.42); deteriorated cognitive status (OR=1.67; 1.24–2.23); at least two chronic diseases (OR=2.54; 2.01–3.20); poor perceived health status (OR=3.02; 2.48–3.69); little physical activity (OR=2.57; 1.94–3.42); and greater use of hospital care (OR=1.34; 1.10–1.64). Conclusions: Prevalence of disability among Spain’s non-institutionalized elderly population is very high. This might be explained by a greater number of chronic diseases, a higher percentage of subjects with low educational level and a higher proportion of community-dwelling elderly persons than in Anglo-Saxon countries.     

Elderly peoples' experiences of discharge from hospital.

In a study of patients' perceptions of the transition from hospital to the community, 115 elderly people registered with a central London group practice were interviewed shortly after they arrived home. Many patients received little notice of discharge, a third being told on the day they left the hospital. A third felt they had been discharged too soon and those living alone were significantly less likely to return to a heated home containing basic items of food. Seventy-seven patients, including 80% of those living alone were visited by family, friends or professionals within three days of coming home. Eighty-six per cent of non-professional visitors were women. Several of the elderly couples appeared to be under considerable stress and not all individuals were receiving the help they considered most appropriate to their needs. Many of the problems identified were due to poor communication between practice, hospital and patients. We suggest several measures aimed at improving the quality of that communication, so as to ensure that available resources can be mobilized to support this vulnerable group of people.     

Smartphone application for emergency signal detection

Currently, a number of studies focus on the study and design of new healthcare technologies to improve elderly health and quality of life. Taking advantage of the popularity, portability, and inherent technology of smartphones, we present an emergency application for smartphones, designated as knock-to-panic (KTP). This innovative and novel system enables users to simply hit their devices in order to send an alarm signal to an emergency service. This application is a complete and autonomous emergency system, and can provide an economic, reliable, and unobtrusive method for elderly monitoring or safety protection. Moreover, the simple and fast activation of KTP makes it a viable and potentially superior alternative to traditional ambient assisted living emergency calls. Furthermore, KTP can be further extended to the general population as well and not just be limited for elderly persons. The proposed method is a threshold-based algorithm and is designed to require a low battery power consumption. The evaluation of the performance of the algorithm in collected data indicates that both sensitivity and specificity are above 90%.     

Functional status and use of health care services: longitudinal study on the older adult population in Spain

BACKGROUND: Follow-up studies on the association between functional status and use of health care services among the older people are scarce and have studied only a few types of service. OBJECTIVE: To examine prospectively the relationship between limitation in instrumental activities of daily living (IADL) and utilization of a wide variety of health care services among older adults in Spain. METHODS: Prospective study from 2001 to 2003 of a cohort of 2806 persons, representative of the non-institutionalized Spanish population aged 60 years and over. Limitation in IADL was measured in 2001 using the Lawton and Brody's test. Data on the use of health care services were collected in 2003 and classified into home services (home visits by physicians and nurses) and non-home services (visits to primary care physicians, visits to hospital specialists, hospital admissions, emergency care, and influenza vaccination). Analyses were performed with logistic regression and adjusted for the main confounders. RESULTS: Compared to men with no limitation in IADL, a higher percentage of those with limitation in one IADL in 2001 made use of both home (odds ratio [OR] 2.64; 95% confidence interval [95% CI] 1.73-4.03) and non-home services (OR 2.02; 95% CI 1.04-3.93) in the period 2001-2003. Limitation in one IADL among women was associated with a greater utilization of home services (OR 1.50; 95% CI 1.05-2.14) and visits to hospital specialists (OR 1.61; 95% CI 1.21-2.15). In women, however, a greater number of limited IADL at baseline was inversely associated with visits to primary care physicians in the 2-year follow-up (p for linear trend <0.001). CONCLUSION: Population aging will increase the demand for health services in general, and for home services in particular.     

Asthma severity, atopic status, allergen exposure and quality of life in elderly persons.

BACKGROUND: Although asthma can be associated with significant airflow obstruction in those over the age of 65, it is often underdiagnosed and undertreated. OBJECTIVE: To describe severity of asthma, allergy skin test sensitivities, indoor allergen exposures, and the impact on quality of life (QOL) and health status in elderly persons with asthma. METHODS: A cross-sectional data analysis with 80 elderly persons with asthma recruited from medical, geriatric, and allergy/immunology tertiary care centers. Asthma severity was determined by symptoms and measurements of lung function. House dust specimens were collected from mattresses and bedroom carpets and analyzed separately for the major allergens of house dust, using monoclonal antibody-based immunoenzymetric assays. QOL was measured using Juniper's Asthma Quality of Life Questionnaire. Health status was measured using the Short Form Health Survey Medical Outcome Questionnaire which included Ferrans and Powers' Quality of Life Index subscales. RESULTS: Two-thirds of participants had either moderate or severe persistent asthma. Skin tests to a battery of common airborne allergens were positive to at least one allergen in 56 of the 75 participants tested (74.7%). Reservoir dust allergen levels were often high enough to place participants at risk of symptoms or at risk of developing sensitization. Increased asthma severity was associated with significantly lower QOL and a trend toward decreased health status. CONCLUSIONS: Asthma is a significant chronic problem in the elderly. Atopy was common. Asthma severity impacts on these participants' QOL and health status. Results support interventions aimed at identifying allergens precipitating attacks and reducing them in the home.     

Using mobile phones in healthcare management for the elderly

The increasing average life expectancy is simultaneously increasing the incidence of chronic diseases and the number of healthy elderly people, consequently leading to an increased demand for healthcare management methods that do not involve hospital visits. The development of health management services involving mobile phones will change the focus of medical services from hospital visits and treatments to managing the health decisions made by individuals in their daily lives. However, the elderly may experience specific difficulties in adapting to constantly evolving services.This study reviews various health-related devices such as mobile phones that are available for providing healthcare to the elderly, and the different ways of using them. As the use of mobile phone increases, it is expected that elderly mobile phone users will also be able to regularly check their health status at any time and place.The issues of an ageing population pertain to the entire society rather than only to the elderly, which make mobile-phone-based medical informatics as a health management service a worthy goal.     

Regular planned respite admissions to a geriatric unit

A programme of regular planned respite admissions to the geriatric unit in Cork was established in 1984, for dependent elderly being cared for at home. Retrospective analysis of the respite programme sought to establish its bed utilisation, type of patients admitted, factors in their selection process, their outcome and any associated hospital morbidity. Twenty-four patients have used the scheme during the four years since its commencement, with an efficiency of bed utilisation in 1987 of 14 patients occupying a mean of 4.33 beds per month. The median number of medical problems per patients was five; their median age 77 years and the percentage over 80 years was 46%. Twenty-two patients were already receiving intensive rehabilitation before being placed on the programme, mobility problems dominated. Nine patients continue on the programme with a mean of 23.9 months of respites to date, eight were discharged and seven died. There was no significant difference between the number of respite stays in hospital and "at home" stays complicated by morbidity. The results suggest that even for a highly selected group of dependent elderly, a planned programme of respite admissions is an effective form of care, uses hospital beds efficiently without associated morbidity and may provide an alternative to long stay institutional care.     

Internet access and Internet use for health information among people living with HIV-AIDS

Widespread access to the Internet has the potential to improve the health care and quality of life of people with chronic illnesses, including people living with HIV-AIDS. However, the Internet is not equally accessible to all persons. We surveyed 96 men and 51 women living with HIV-AIDS regarding their experiences using the Internet. Results showed that persons with 12 or fewer years of education were significantly less likely to have used the Internet and were less likely to have been instructed in Internet use. A broad range of health-related Internet activities was reported including searching for health, AIDS-specific information, and using the Internet to communicate with providers. Among current Internet users, individuals who had an Internet connection in their home reported significantly more experiences using the Internet, including Internet use for interpersonal communication and search functions. A digital divide therefore exists among people living with HIV-AIDS, and the benefits of the Internet appear better achieved with home access.