Risk assessment during preventive home visits among older people

Abstract

BackgroundPreventive home visits (PHV) may contribute to identify risks and needs in older people, and thereby delay the onset of functional decline and illness, otherwise often followed by home care or admission to hospital or nursing homes. There is a need to increase knowledge about which factors are associated with different risk areas among older people, so that the PHV questionnaire focuses on relevant tests and questions to make the PHV more specific and have a clear focus and purpose.ObjectiveThe objective of this study was to examine associations between five kinds of risks: risk of falls, malnutrition, polypharmacy, cognitive impairment, and risk of developing illness and factors related to lifestyle, health, and medical diagnoses among older people living at home.MethodsA cross-sectional study design was applied. PHV were conducted by nurses among 77-year-old people in an urban municipality and among ≥75-year-old people in a rural municipality. A questionnaire including tests and a risk assessment score for developing illness was used. Descriptive and inferential statistics including regression models were analyzed.ResultsThe total sample included 166 persons. Poor perceived health was associated with increased risk of developing illness and risk of fall, malnutrition, and polypharmacy. Lifestyle and health factors such as lack of social support, sleep problems, and feeling depressed were associated with risk of developing illness. Risk of falls, malnutrition, polypharmacy, and cognitive impairment were also associated with increased risk of developing illness. None of the independent factors related to lifestyle, health, or medical diagnosis were associated with risk of cognitive impairment.ConclusionPoor perceived health was associated with health-related risks in older persons living at home. Preventive health programs need to focus on social and lifestyle factors and self-reported health assessment to identify older people at risk of developing illnesses.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

“…Of the total 40 included studies, 36 were cross-sectional [13,14,17,18,[20][21][22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][51][52][53] and four were cohort studies [16,19,33,50]. The study population was 60 years old and above, except for two studies that focused only on people aged over either 85 years [26] or 90 years [37].…”

“…All of the studies included people of both genders, except two studies [50,51]-one of them was only focused on men [50] and the other only on women [51]. Of the 40 studies included in the systematic review, according to the Development Human Index from the United Nations Development Program (UNDP) [54], 33 were conducted in regions with a high development human index (Poland [39], Sweden [38,40], China [30,37,53], Turkey [52], Canada [49,50], Italy [14,35], Taiwan [16], Lebanon [17,20,25], Brazil [18], Ireland [19,31], Finland [21], Spain [13,22,26], Norway [23,34], Portugal [24], Korea [27], Iran [28], Sri Lanka [29], New Zealand [48], Mexico [32], Amsterdam [33], Malaysia [36], and Shanghai [51]), five were conducted in regions with a medium development human index (Bangladesh [41,44], India [42], South Africa [43], and Egypt [45]), and two were conducted in regions with a low development human index (Central Africa…”

“…Of the 40 observational studies included in the systematic review, regarding the tools used to assess the nutritional status, 29 studies used the MNA [13,14,[16][17][18]20,21,[23][24][25][26][28][29][30][31][32][34][35][36][37][39][40][41][42][43]45,[51][52][53], one of which also used the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) [34]. Of the other studies, five used only the Body Mass Index (BMI) [19,22,33,44,46] and one also used self-reported weight loss [19], four used the Senior in the community: risk evaluation for eating and nutrition (SCREEN II) [38,[48][49][50] and two used the Nutritional Screening Initiative (NSI) [27,47].…”

“…Of the total of 40 observational studies included in the systematic review, eight different socioeconomic variables were evaluated: 31 studies evaluated the educational level [13,14,16,18-20, 22,24-30,33,35-37,39,41-49,51-53], 27 the fact of living alone or cohabiting [13,14,19,21,22,[25][26][27][28][29]31,32,[36][37][38][39][40][42][43][44][45][48][49][50][51][52][53], 24 the marital status [13,14,16,19,23,24,26,27,29,30,[33][34][35][36]39,41,42,[44][45][46]48,…”

“…A total of 24 studies evaluated the relation between the marital status and malnutrition or malnutrition risk, of which 11 showed significant results [14,19,27,30,[33][34][35]39,42,45,53] and 13 were not significant [13,16,23,24,26,29,36,41,44,46,48,51,52] (Table S4). Of those 11 studies with significant results, 10 showed that the elderly who were single, widowed, or divorced had a greater malnutrition risk than those who were married [14,19,27,[33][34][35]39,42,45,53].…”