Care available to severely disabled older persons living at home in Florence, Italy

Abstract

Aims-To characterize the epidemiology of disability in, and the level of care available to, older community-dwellers in an Italian urban sample.Methods-In a 2-phase survey, persons aged 65+ years, randomly selected from the patients lists of 98 primary care physicians (PCP), were screened (phase I) by their PCP with a structured questionnaire to detect the presence of: 1) need of help in performing Basic and 2) Instrumental Activities of Daily Living (BADL, IADL); 3) poor vision or 4) hearing; 5) weight loss; 6) use of homecare services; 7) self-perceived inadequacy of income. Subjects reporting 2+ problems were further evaluated in face-to-face structured interviews (phase II).Results-Of 5445 participants, 597 (11%) screened positive in phase I and 416 were interviewed in phase II. Of these, 4, 29, 19 and 49% were disabled in 1-2 IADL, 3+ IADL, 1-2 BADL, and 3+ BADL. The extent of the support network increased with disability severity (p<0.01). The 274 participants with BADL disability received most of their help from close relatives (58.3±2.5%), followed by salaried assistants (20.5±2.1%), other relatives (19.5±1.9%), and public healthcare services (0.6±0.36%). Of the 397 care-givers interviewed, one-third were willing to institutionalize the older participants in case of further functional deterioration. This propensity was predicted only by a self-reported poor attitude towards caring.Conclusion-Many severely disabled older Italians receive care in their home by highly supportive family members. The level of assistance provided to them by public healthcare services is minimal.

Incidence of ADL Disability in Older Persons, Physical Activities as a Protective Factor and the Need for Informal and Formal Care – Results from the SNAC-N Project

“…A study examining community care in 11 different countries in Europe found that formal care was small in Italy, while in the UK it was more than double the European average across all levels of dependency [ 37 ]. Another study from Italy reported that the amount of formal care was low and that is was common that disabled older Italians received care from family members and usually from two or more persons [ 38 ]. However, informal caregivers have reported a greater burden, isolation and lower perceived health compared to same-age persons not providing such care [ 39 ].…”

Screening of Older Community‐Dwelling People at Risk for Death and Hospitalization: The Assistenza Socio‐Sanitaria in Italia Project

“…Limits of the study should be recognized. Functional status of participants whose PCPs had indicated that they were impaired was subsequently verified using appropriate instruments, 15 yet no representative sample of participants who had screened negative was evaluated. Thus, whereas the proportion of subjects who screened positive and were eventually confirmed as disabled from direct interview was high, some false negative subjects might have been missed.…”

“…ASSI is a prospective cohort study of persons aged 65 and older randomly abstracted from the rosters of 98 PCPs in Florence, Italy 15 . At the January 2003 baseline, using a seven‐item structured questionnaire, PCPs screened 5,445 (92%) of 5,927 eligible older community‐dwelling people living in the local health unit of Florence, Italy, which covers the entire metropolitan area, for the presence of disability and other general health problems.…”

Day Care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress

“…The assistance of elderly subjects with dementia imposes a great physical and psychological burden on relatives with caregiving role (Schulz et al, 1995;Di Bari et al, 2008) and on society as a whole. Behavioral and psychological symptoms (BPSD) are strong predictors of caregiver stress, independent of cognitive impairment (Donaldson et al, 1998;Pinquart and Sorensen, 2003).…”