Home-Based Multidisciplinary Diagnosis and Treatment of Inner-City Elders With Dementia

Edwards, Dorothy Farrar; Baum, Carolyn; Meisel, Marie; Depke, Marilyn; Williams, James H.; Braford, Teresa; Morrow‐Howell, Nancy; Morris, John C.

doi:10.1093/geront/39.4.483

Cited by 20 publications

(4 citation statements)

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“…Conventional home health care services for elderly people, [25][26][27][28]51 volunteers who train to gain from their abilities in healthcare provision in order to serve elderly people, 41 the provision of active healthcare, 41 the provision of physical activity facilities, 5,54,68 meal services, 5,62,63 immunization against common diseases in the elderly 76,77 and free or subsidized healthcare services 20,26,29,31,68 are among the list of facilities that are scheduled in mostly developed countries for the ageing population but they are not currently available for the elderly Iranian population.…”

Section: Resultsmentioning

confidence: 99%

<p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>

Abbasian¹,

Shaghaghi²

2020

RMHP

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Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran's National health care system (INHS). The main aim of this study was to scrutinize the best available scientific evidence on the international integrated elderly health care governance (HCG) models to revamp health care practice and policy-making processes in Iran. Materials and Methods: This multiphasic study consists of a scoping review of existent HCP modalities for the elderly population worldwide, and the disposition of an optimal HCP scheme for the elderly population and its application for the detection of the gaps in Iran. The final stage includes a Delphi-based consultation and consensus process which was reciprocated in three rounds and the key subjects were requested to give their judgment on the eventuated HCP layout designed to serve the ageing Iranian population. Results: The yielded model (IEHCG-IR) included four dimensions consistent with the four levels of prevention along with social support services. The structure and feasibility of the preliminary framework were approved by 83.6% of the study participants. Conclusion: The study findings could have important implications for future policy making in the INHS and the suggested healthcare framework for the elderly Iranian population could be a preliminary model for health system re-engineering.

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Section: Resultsmentioning

confidence: 99%

<p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>

Abbasian¹,

Shaghaghi²

2020

RMHP

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“…More than 25% reported a fall in the past 12 months, and 40% are “worried about falling.” The average score on performance of activities of daily living (ADLs) was 4 (range 1–7), indicating moderate ADL impairment). We estimate more than 800 older adults will meet eligibility criteria in the cohort [37, 38]. …”

Section: Methodsmentioning

confidence: 99%

Protocol for the home hazards removal program (HARP) study: a pragmatic, randomized clinical trial and implementation study

et al. 2017

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BackgroundFalls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network.MethodsWe will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study.DiscussionThis intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency.Trial registration Clinicaltrials.gov identifier: NCT02392013. Retrospectively registered on March 5, 2015.

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“…Finally, our study suggests that early nutritional interventions may improve the prognosis for patients with a good cognitive function [4]. For clinicians, recognition of cognitive impairment and malnutrition promotes disposal decisions early in hospitalization [34], ensures clarity of discharge instructions [33,35]. Future trials of ED-based cognitive dysfunction and malnutrition case-nding will need to assess the effects of such screening on patient-oriented outcomes, like preventable recidivism (including readmission), functional decline, and the quality of life of patients and caregivers after discharge [33].…”

Section: Limitationsmentioning

confidence: 99%

Impact and Clinical Implications of the Cognitive Function and Nutritional Assessment at Admission on Hospital Outcomes and Mortality in Acutely Ill Geriatric Patients

Yamamoto,

Ogawa,

Matsuo

et al. 2024

J Surg Res

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Background The nutritional and mental status of older patients are closely related and may serve as an indicator of hospital outcomes and early nutrition interventions.Objective We aim to appraise the impact on mortality and hospital outcomes by the revised simpli ed short-term memory recall test (STMT-R) and the short-form mini-nutritional assessment (MNA-SF) simultaneous at admission. Methods The subjects were 727 acute inpatients with ≥50 years of age from December 2014 to September 2015. Following the collection of clinical data (base illness, length of stay, etc.), survival was subsequently measured for 4-5 years until September 2019. An STMT-R score of ≤4 and MNA-SF score ≤7 were considered to indicate cognitive dysfunction and malnourishment respectively. Cox's proportional hazards regression models were used to evaluate the hazard of death according to the severity of dementia and the nutrition status, with adjustment for potential covariates. Survival was estimated using the Kaplan-Meier method. ResultsThe mean age of the study population was 78.9 years old, and 52.7% of the patients were female. 118 patients could not complete the cognitive test (Incomplete Testing Group [ITG]). 385 and 224 patients were classi ed into the cognitive dysfunction (CDG) and non-cognitive dysfunction groups (NCDG), respectively. 370, 299 and 58 patients were classi ed into the "malnourished" (MNG), "at risk of malnutrition" (ARNG) and "well-nourished" (WNG) groups, respectively. A poor cognitive function and poor nutritional status at admission were associated with worse clinical indicators. 276 patients (38.0%) died during the 4 to 5 years of follow-up. The risks of mortality in the ITG, CDG and MNG was 3.88 (hazard ratio; 95% con dence interval: 2.57-5.98), 1.84 (1.28-2.72) and 4.22 (1.76-13.9), respectively. In addition, the cumulative survival rate was 23.6% for the combination of advanced dementia and malnutrition, but 51.0% for moderate dementia and malnutrition. Even undernourishment may improve the prognosis of patients with mild to moderate cognitive impairment. ConclusionThe early simultaneous measurements of the cognitive function and nutritional status is expected to be useful for predicting the the hospital prognosis, mortality and the effects of early comprehensive nutritional intervention in acute elderly patients with cognitive decline.

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Home-Based Multidisciplinary Diagnosis and Treatment of Inner-City Elders With Dementia

Cited by 20 publications

References 0 publications

<p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>

<p>An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR)</p>

Protocol for the home hazards removal program (HARP) study: a pragmatic, randomized clinical trial and implementation study

Impact and Clinical Implications of the Cognitive Function and Nutritional Assessment at Admission on Hospital Outcomes and Mortality in Acutely Ill Geriatric Patients

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