Www.interrai.org Tromsø: June 2007. Tromsø: June 2007 Characteristics of female 65+ in home care...
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Transcript of Www.interrai.org Tromsø: June 2007. Tromsø: June 2007 Characteristics of female 65+ in home care...
www.interrai.org
Tromsø: June 2007
www.interrai.org
Tromsø: June 2007
Characteristics of female 65+ in home care service – at 11 sites in Europe
www.interrai.org
Tromsø: June 2007
The age wave is a female wave• We want to help
older females in their surfing on the wave
• They may need help to cope with up and downs www.studvest.no
www.interrai.org
Tromsø: June 2007
Baby-boomers
• The importance of seniors will accelerate in 2011 until 2031 when the last of the boomers turns 65
Statistics Canada September 2006. White; interRAI Ottawa 2007
www.linksbuketten.dk
www.interrai.org
Tromsø: June 2007
Bad prognosis for Southern -Europe
www.ssb.no (EU-data)
www.interrai.org
Tromsø: June 2007
“The health politicians rely on women to care for their husbands.”
(Sørbye 2007)
• In residential care the portion of women is 75-80% – usually widowed (Gabrel 2000).
• Women in the western world live in average five to six years longer than men (Arias 2002, Kõnig 2004).
www.interrai.org
Tromsø: June 2007
Man has a wife - who cares for the widow?
• Few significant others are able to undertake a similar care burden as carried out by a wife (Bonke & Koch-Weser 2001).
• To keep these older women able to live in their own home with an acceptable quality of life is an important socioeconomical concern.
www.interrai.org
Tromsø: June 2007
Community-based care at the margin is a substitute for
institutional care
Three factors are considered critical: • definitions of eligibility, • assessment procedures and • balance of care
(Challis & Hughes 2002)
www.interrai.org
Tromsø: June 2007
The Aged in HOme Care project
The data for this presentation are derived form the AdHOC study. Community Care at 11 sites in Europe
Measurement: Resident Assessment Instrument for Home Care (RAI-HC).
(Carpenter et al. 2004, Henrard et al.
2006)
www.interrai.org
Tromsø: June 2007
2974 females 65+ in Home Care Service
Monza N=259
Prague(CZ) N=337
Helsinki (FIN) N=152
Amiens(F) N=274
Copenhagen(DK) N=371
Maidstone Ashford(UK) N=215
Amsterdam (NL) N=153
Reykjavik (IS) N=301
Oslo (N) N=278
Stockholm (S) N=179
NurnbergBayreuth (G) N=454
www.interrai.org
Tromsø: June 2007
AdHOC data: Female vs. male• Frequency: Female 74.2% vs. male 25.8%
• Age: in average 2 years older
Female: Mn=82.80 Std 7.20
Male : Mn= 80.88 Std 7.48
• Lived alone: Female 67.8% vs. male 39.6%
OR=3.2 (2.78-3.72)
www.interrai.org
Tromsø: June 2007
AdHOC: Selected conditionsConditions N (%)
Daily pain 1377 (45.3)
Use of incontinence pads 1292 (43.4)
Problems with short-term memory 977 (32.9)
Self rated bad health 903 (30.4)
Loneliness 672 (22.9)
Use of antidepressants 412 (14.6)
Unintended weight loss 370 (13.1)
Extremely obese 120 (4.0)
Signs of abuse 138 (4.6)
www.interrai.org
Tromsø: June 2007
Activity of Daily Living (ADL) index (0-8)
• mobility in bed, • transfer, • eating, • toilet use, • personal hygiene,• dressing upper and lower body,• locomotion inside and outside home, • and bathing
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Tromsø: June 2007
ADL>3
6,8 %
5,9 %
5,3 %
67,3 %
29,3 %
3,7 %
68,7 %
5,9 %
9,4 %
3,4 %
21,4 %
21,7 %
0,0 % 10,0 % 20,0 % 30,0 % 40,0 % 50,0 % 60,0 % 70,0 % 80,0 %
Czech rep.
Denmark
Finland
France
Germany
Iceland
Italy
Netherlands
Norway
Sweden
UK
Total
www.interrai.org
Tromsø: June 2007
Instrumental Activity of Daily Living Index (IADL) (0-7)
• meal preparation, • house work, • managing medication, • managing finance, • phone use, • shopping and • transport
www.interrai.org
Tromsø: June 2007
IADL>3
84,0 %
46,1 %
50,0 %
86,4 %
77,5 %
57,1 %
86,9 %
47,7 %
51,4 %
38,8 %
78,6 %
66,3 %
0 % 20 % 40 % 60 % 80 % 100 %
Czech rep.
Denmark
Finland
France
Germany
Iceland
Italy
Netherlands
Norway
Sweden
UK
Total
www.interrai.org
Tromsø: June 2007
Cognitive Performance Scale (CPS)
• Memory• Cognitive skill of daily decision making• Expressive communication• Eating• CPS measures the level of cognitive
performance; it runs from 0 to 6 (6 is worst). Cut off point CPS=3 was chosen to indicate significant cognitive impairment of dementia severity. “3” is equivalent average to 15 points in Mini Mental State Examination (MMSE).
www.interrai.org
Tromsø: June 2007
CPS>3
2,1 %
4,6 %
0,7 %
31,8 %
11,7 %
1,7 %
22,4 %
4,6 %
3,6 %
2,2 %
11,2 %
9,2 %
0 % 5 % 10 % 15 % 20 % 25 % 30 % 35 %
Czech rep.
Denmark
Finland
France
Germany
Iceland
Italy
Netherlands
Norway
Sweden
UK
Total
www.interrai.org
Tromsø: June 2007
0 % 20 % 40 % 60 % 80 % 100 %
Czech rep.
Denmark
Finland
France
Germany
Iceland
Italy
Netherlands
Norway
Sweden
UK
Total
CPS>3
IADL>3
ADL>3
www.interrai.org
Tromsø: June 2007
Living alone
69,8 %
81,4 %87,5 %
45,2 %
70,0 %75,1 %
17,0 %
65,4 %
81,7 %86,0 %
70,7 %67,8 %
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
Czech
rep.
Denmar
k
Finlan
d
Franc
e
Germ
any
Icela
ndIta
ly
Nether
lands
Norway
Sweden UK
Total
www.interrai.org
Tromsø: June 2007
”The car is my umbrella to my social life”
Many older widows are unnecessarily isolated because their common drivers license was buried together with the husband.
In Norway 82% of the men and 29% of women have a driver licence at the age of 75+ (SSB 2006).
www.vgb.no
www.interrai.org
Tromsø: June 2007
Security alarm
0,0 %
38,0 %40,8 %
8,4 %12,3 %
34,9 %
1,2 %
19,0 %
71,9 %
36,9 %
60,5 %
27,4 %
0 %
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
Czech
rep.
Denmar
k
Finlan
d
Franc
e
Germ
any
Icela
ndIta
ly
Nether
lands
Norway
Sweden UK
Total
www.interrai.org
Tromsø: June 2007
“It's worth is weight in diamonds”• Ulla 85, years old had reached the stage when
living on her own is becoming difficult. She was frail and had just got a diabetes diagnosis. The visiting nurse asked her if she got sufficient help to make her secure to live by herself. She grabbed her old bony fingers around a security alarm that looked like a necklace. “Do you see this piece of jewellery? It is the most gorgeous jewellery I ever had. It is worth is weight in diamonds.” She had several times been in need of emergency help and her security alarm had worked out nicely.
www.interrai.org
Tromsø: June 2007
Assistive technology (AT)• Sensors can track people and alarms can
be activated if something unnatural such as a fall is detected. Neither the old people nor their next of kin have sufficient information about the terminology of AT or the concept of “smart house”.
www.interrai.org
Tromsø: June 2007
Cost of care• Lansely et al (2004) analysed detailed design
studies to measure the cost of technology versus use of formal care. They concluded that “Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence. They can both substitute for traditional formal care services and supplement these services in a cost-effective way.
www.interrai.org
Tromsø: June 2007
Assistive technology vs. institution
• Tinker & Lansely (2005) found that older people welcomed AT when it addressed a perceived need. Their personal integrity would still be better taken care of in their own home, than in an institution.
www.interrai.org
Tromsø: June 2007
Problems with short-term memory
• For those cognitive impaired who wish to live in their own homes the main problems are fire prevention or wandering not knowing where they are.
www.interrai.org
Tromsø: June 2007
Fire prevention
Fire may be prevented by installation of heath sensors that automatically cut the electricity before fire gets started.
www.interrai.org
Tromsø: June 2007
Wandering
The GSM bracelet is designed to help Alzheimer's patients by notifying the careers if the wearer wanders outside a pre-defined "secure zone." It is monitored via Assisted GPS and has a GSM/GPRS transmitter/receiver with a SIM card for voice and data.
www.interrai.org
Tromsø: June 2007
Summary• In Europe there is a huge variation
between northern and southern countries.
• The Nordic welfare model allows older people of both sexes to live independently for longer and this is what the majority wants.
www.interrai.org
Tromsø: June 2007
• Moderate to severe decline in personal and cognitive functions (ADL & CPS) qualifies Nordic women to an institution bed.
• Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence.
• For tailoring the best care a comprehensive assessment is needed.
Summary cont.
www.interrai.org
Tromsø: June 2007EuroFellows
• Sørbye LW: Norway
• Finne-Soveri H: • Finland
• Schroll M: Denmark
• Jónsson PV: Iceland
• Ljungren G: Sweden
• Jean-Claude Henrard France
• Topinkova E:The Czech Republic
• Ian CarpenterUK
• Dinnus Frijters The Netherlands
• Vjenka Garms-HomolováGermany
• Bernabei R:
Italy
www.interrai.org
Tromsø: June 2007
Medical Problems in Women over 70 ed. Rees & Keith
London: Taylor and Frances 2007 http://www.rcog.org.uk/index.asp?
PageID=73&BookCategoryID=1&BookTypeID=35&BookDetailsID=1857
Chapter 15Home, residential and
palliative care Liv Wergeland Sørbye
ISBN:978-0415373524
www.interrai.org
Tromsø: June 2007
References• http://www.linksbuketten.dk/z044.htm• Carpenter I, Gambassi G, Topinkova E. et al. Community care in Europe. The Aged in
Home Care project (AdHOC). Aging Clin Exp Res 2004;16(4):259-69. • Henrard JC, Ankri J, Frijters D, Carpenter I, Topinkova E, Garms-Homolova V,
Finne-Soveri H, Sorbye LW, Jonsson PV, Ljunggren G, Schroll M, Wagner C, Bernabei R. Proposal of a service delivery integration index of home care for older persons: application in several European cities. Int J Integr Care. 2006 Jul 6;6:e11.
• Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I,Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R; AdHOC Project Research Group. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005 Mar 16;293(11):1348-58.
• Challis D,Hughes J. Frail old people at the margins of care: some recent research findings. The British Journal of Psychiatry. 2002 (180): 126-130.
• Sørye LW. Home, residential and palliative care. In Medical Problems in Women over 70 ed. Rees M & Keith L. London: Taylor and Francis 2007.
• Sørbye LW, Schroll M, Finne-Soveri H, Jónnson PV, Ljunggren G, Topinkova E, Bernabei R; The AdHOC Project Research Group. Home care needs of extremely obese elderly European women. Menopause Int. 2007 Jun;13(2):84-7.
www.interrai.org
Tromsø: June 2007
References cont.
• Gabrel CS. Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey. Adv Data. 2000 Apr 25;(312):1-15.http://www.cdc.gov/nchs/data/ad/ad312.pdf
• Arias E. United States life tables 2002. National vital statistic report volum 53 (6) 2002. http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf
• Kõnig B. Life expectancy in the new EU. Federal statistical office Germany. http://www.destatis.de/presse/englisch/pm2004/p2050022.htm
• Bonke J, Koch-Weser E. The Welfare State and Time Allocation 9:2001 http://www.sfi.dk/graphics/SFI/Pdf/Working_papers/workingpaper2001_9.pdf.
• http://www.vgb.no/keyw.php?blog=7736&keyword=gravst%F8tterhttp://www.engadget.com/2005/06/07/columba-gsm-gps-bracelet-helps-alzheimers-patients/
• http://www.globalsources.com/gsol/I/Personal-alarm/p/2000000003844/3000000149681/sm/1000668247.htm http://www.studvest.no/reportasjer.php?art_id=5365&seksjon=midten
www.interrai.org
Tromsø: June 2007
References cont.• Lansley P, McCreadie C, Tinker A. Can adapting the homes of older people
and providing assistive technology pay its way? Age Ageing. 2004 Nov;33(6):571-6. Epub 2004 Sep 3.
• Tinker A, Lansley P. Introducing assistive technology into the existing homes of older people: feasibility, acceptability, costs and outcomes. J Telemed Telecare. 2005;11 Suppl 1:1.