Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.
An evidence-based review was undertaken to answer the question, "What is the evidence for the effect of interventions designed to establish, modify, and maintain activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, and social participation on quality of life (QOL), health and wellness, and client and caregiver satisfaction for people with Alzheimer's disease and related dementias?" A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 26 articles. Limited high-level evidence on ADL interventions was identified. IADL interventions for people living in the community showed promise. Tailored and activity-based leisure interventions were common and seemed to have positive impacts on caregiver satisfaction, and some interventions had positive results for client well-being and QOL. Social participation interventions focused on people with dementia still able to engage in verbal social interactions; these interventions had at least short-term positive effects.
Despite encouragement, routine outcome measurement is not standard practice in occupational therapy. This applies across most practice areas and outcome measures, including occupational therapy measures such as the Canadian Occupational Performance Measure. Barriers to using outcome measures have been proposed, but are gathered from therapists not measuring outcomes routinely. This study gathered therapists' perceptions on outcome measurement following a period of routine outcome measure use. A secondary aim was to propose a therapist-driven template for summarising outcome data routinely. Procedures: Using a process evaluation, a short answer survey was used with three occupational therapists following 5 months of Canadian Occupational Performance Measure use in older people's rehabilitation. The data were summarised descriptively, using a proposed template based on therapist feedback. Findings: The therapists perceived that the measure facilitated treatment for both therapists and clients but they experienced challenges related to client cognition and sustaining use. Template creation indicated that the therapists placed more importance on individual than group level data. Conclusion: The therapists perceived benefit in routine Canadian Occupational Performance Measure use. The instrument appears feasible for meaningful and routine use but not necessarily for sustained use. Increasing outcome measure use is complex, requiring more knowledge on barriers, expectations of value and methods of data utilisation.
ObjectivesTo estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents.Study designTo estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a ‘de novo’ analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated.ResultsOur calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies.ConclusionsThe total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation.
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