Objective To identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support. Methods An audit was conducted of all community‐dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. Results The audit comprised 1597 community‐dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12‐month period. Factors significantly associated with admission to LTC were “cognitive dysfunction” [OR 2.10 (1.41‐3.14), P < .001] and the intensity of home support [OR 1.05 (1.01‐1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). Conclusion “Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive‐specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.
The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.
Introduction Maintaining skeletal muscle function throughout life is a crucial component of successful aging. Disadvantaged socioeconomic position (SEP) is associated with adverse health outcomes, but has not been extensively studied for the muscle disease sarcopenia. We aimed to determine the prevalence of probable sarcopenia, a precursor to sarcopenia diagnosis, based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines overall, and according to SEP. Methods This cross-sectional study comprised 3342 community-dwelling older adults [mean age (SD) 68.9 ± 6.3 years] from Wave 1 of the Irish Longitudinal Study on Ageing. Probable sarcopenia was identified using gender-specific cut-off values for handgrip strength as recommended by EWGSOP2. SEP was defined by educational attainment. Multivariate regression analysis was employed to determine associations between probable sarcopenia and pre-defined risk factors. Results Overall, 23.4% of the population had probable sarcopenia and was significantly higher in the subset with low compared with high SEP (28.9% vs 18.1%, p<0.001). Consistent with this, multivariate logistic regression analysis showed that disadvantaged SEP was a significant determinant of probable sarcopenia [OR, CI 1.48 (1.17, 1.87) p<0.001]. Other known risk factors, namely, increased age, low physical activity, comorbidity, and osteoarthritis were significantly associated with an increased likelihood of probable sarcopenia, while overweight/obesity appeared to be protective. Conclusion Disadvantaged SEP was an independent determinant of probable sarcopenia in community-dwelling older adults. These findings highlight that SEP and health inequality should be considered in prevention and treatment policy for sarcopenia in the community.
BackgroundThere is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty.MethodsA total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis.ResultsThe cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65–84 years. However, in the oldest age groups, namely 90–94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508.ConclusionA high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0508-2) contains supplementary material, which is available to authorized users.
This article explores perceptions of time reported by service users, family carers, care workers, nurses, social workers and agency managers across home support services for older adults in Ireland. The findings are organised around: time spent waiting for care; time spent ‘processing’ care across primary and secondary care boundaries; time and person-centred care; and time, technology and communication. Time emerges as a problematic aspect of all processes and structures around formal home care, suggesting that addressing issues around time is central to resolving systemic challenges. Greater flexibility in time allocation and effective communication among stakeholders could improve experiences of care.
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