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ORGANIZATION OF CARE IN PSYCHIATRY OF THE ELDERLY: A TECHNICAL CONSENSUS STATEMENT
Functioning loss is the inability to perform certain physical or mental tasks, such as lifting, walking, balancing, reading, writing, counting, and using fingers and hands to grasp and open. Functioning loss generally results from the onset of diseases and conditions and occurs at a later age than disease onset. Disability is the inability to perform an expected social role. For older people, this has generally been defined as independent living and self-care.
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Health-related quality of life of elderly living in nursing home and homes in a district of Iran: Implications for policy makers
For middle-aged people, disability is defined in terms of ability to work or do housework. For children, disability is the inability to participate in mainstream education. An important difference between functioning loss and disability is the potential influence of the external environment. Although in practice it may sometimes be difficult to clearly separate the two concepts, functioning loss is defined as a functioning deficit in an individual; disability on the other hand is an inability to perform within the environment. Disability can be affected by conditions external to the person. For instance, moving to a house without stairs or a home with a walk-in shower might allow someone to...
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EXERCISE AND PHYSICAL ACTIVITY AMONG HEALTHY ELDERLY IRANIANS
Some people have a heart attack and die from heart disease before they ever know they have the condition, before they have a chance to be disabled. In addition, individuals can move in and out of some of these health states: Disability and functioning loss may be transitory, and people can return to full functioning and ability. Whether chronic diseases are absorbing states from which there is no return to the healthy population depends somewhat on the condition. We do not think of cures from heart disease, but we do speak of cured cancer after some number of years have passed. Additionally, there is a strong link between...
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Improving Health Outcomes for the Elderly: An Analytic Framework
During the entire twentieth century, mortality among the old declined about 1% per year, and the whole period has been a time of fairly regular increase in life expectancy (43, 62, 81). There have been some years of more rapid decline in old age mortality, such as from 1968 until the early 1980s, and years of slower decline, such as from 1954 to 1968 (10, 43). Even the last two decades have been a mixture of slower and more rapid periods of mortality decline for the older population (81). Compared to the 1970s, there was substantial slowing in the rate of mortality decline in the 1980s among...
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New Respiratory Viruses and the Elderly
In the 1990s the overall rate of decline was somewhat higher than in the 1980s. Trends in annual death rates by gender from 1981 to 1998 for three age groups of the old are shown in Figure 2. Mortality for males in each age group shows a fairly regular decline during the 20 years. For females in some age groups, the early 1980s were not even a period of decline. This differential trend by gender is almost the opposite of what occurred in the 1970s when females experienced greater decline than males. One explanation for the different gender patterns of change is that because of their higher likelihood...
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Loneliness, Depression and Health Status of the Institutionalized Elderly in Korea and Japan
There is mixed opinion on the likelihood of continued long-term increase in life expectancy. Most demographers including Vaupel and Lee (44, 45, 62) are optimistic about continued increases in life expectancy and decreases in mortality among older persons. Olshansky (63) has been a promoter of the idea that future increases will be minimal. The arguments for modest expectations generally rest on the notion that it would take very substantial decreases in mortality at older ages to achieve continued increases in life expectancy, and these would require scientific understanding and an ability to address the basic mechanisms of aging that are unlikely. The argument for continued optimism is that...
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Comparison of Gait of Young Men and Elderly Men
Although the studies differ in population coverage, sample design, method and periodicity of measurement, use of proxies, and treatment of nonresponse and missing data, the authors conclude that most analyses using data from the post- 1980 period show declines in the percentage with moderate disability and IADL disability. These declines have been shown to vary by gender (18, 47) and level of education (18); and they also differ between the young-old and the old-old (19). Generally, there is more improvement in less-severe disability....
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HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender
Trends in needing help with such activities as housework or shopping may be due to changes in the physical abilities of the older population, but they may also be related to the availability of help in the house, either familial or paid, the availability of appliances, and the accessibility of transportation (1, 12). However, causes of trends in IADL functioning have not been apportioned to reasons residing in the person and reasons outside the person. The trends in what is termed ADL disability have not been nearly as consistent as those in IADL disability (31). Conflicting evidence has been provided by a number of researchers (18, 20, 47,...
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Sleep disorders in the elderly
Stroke is a vascular disease for which mortality and morbidity are relatively well-documented because most stroke victims are admitted to hospitals. Trends in stroke mortality, incidence, and prevalence are somewhat similar to those for other cardiovascular conditions. Stroke mortality has been decreasing since the 1960s, but without a consistent decrease in stroke incidence. Stroke incidence has even been reported to have been higher in the 1980s than during the 1970s, and there was no sustained decline in incidence during the 1990s....
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Six minute walking distance in healthy elderly subjects
Among those above age 70, the average number of diseases that each person reports has increased in recent years (17). This increase is because people have survived a number of diseases that once would have been fatal, and they have lived to acquire additional conditions, both potentially fatal and nonfatal, such as arthritis. Thus, older people have more diseases, but less disability, than in the past. Inclusion of indicators of cognitive functioning in nationally representative surveys of the older population has allowed Freedman and colleagues (29) to estimate change in the prevalence of cognitive impairment during a five-year period during the mid 1990s. They estimate very significant reduction...
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Lipid profile variations in a group of healthy elderly and centenarians
There are a number of well-recognized indicators of biological risk for cardiovascular disease, diabetes, and death for which change over some period of time can be determined from the U.S. National Health and Nutrition Examination Surveys (NHANES). Collection of some measures began as early as the 1960s, and some are not available until the 1980s. NHANES data show that the percentage of the older population with high cholesterol has decreased since the 1960s, somewhat faster for women than men (60). Examination of recent change shows a reduction in average total cholesterol during the 1990s for the older population (Table 2)....
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Biomechanical Walking Pattern Changes in the Fitand and Healthy Elderly
In the past two decades a number of investigators have attempted to combine measures of mortality and morbidity in order to address issues of whether Americans are living longer, healthy lives, as well as just longer lives. In general, a life-table approach is used to divide increases in years lived into healthy and unhealthy years. These measures have the same useful characteristics as life-table measures based only on mortality. They can be compared across time and place, and they summarize a large amount of age-specific data. Because indicators of disability are the most frequently collected measures in surveys, they have been used most frequently to examine change over...
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The effect of Qigong on general and psychosocial health of elderly with chronic physical illnesses: a randomized clinical trial
The general picture is that older people of today are healthier than older people of two decades ago. There have been improvements in most dimensions of health. People live longer and have fewer disabilities, have less functioning loss, and report themselves to be in better health. Over time there has been some reduction in risk from smoking and a lowering of cholesterol and average triglyceride levels. However, weight increase has been notable during this period. Because people live longer, a greater percentage of people have some specific common diseases, and, on average, older people live with more diseases. The decade of the 1990s was not one of improvement...
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Epidemiology of hypertension in the elderly
and gait is mostly derived from studies that measured and reported EF as a composite score [12,18,19]. Relatively few studies have focused on the age-related deficits in specific components of executive function and most of these studies were based on a traditional set of tests of executive function, without detailing specific components. The conclusions drawn from these studies might, therefore, be limited by their methodologies. The putative executive measures might not load on a single executive construct, and might overlap with each other [20,21]. The differential breakdown for the executive functioning performance across patients with chronic schizophrenia, for example, suggests that the fractionation of central executive functioning occurs in schizophrenia and not all EF...
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Environmental conditions, health and satisfaction among the elderly: Some empirical results
Testing was performed in the gait laboratory of the City Hospital Waid in Zurich, Switzerland. To measure steady state walking, the central 7.32 m active sensor area of the GAITRite® system was used as the test distance. During the measurements, the subjects walked on the walkway while wearing their own comfortable clothing and low-heeled habitual shoes. Since mean values of eight strides have been shown to be appropriately representing gait characteristics and can be considered as representative of normal gait [33] we ensured the capturing of at least 25 steps per test condition. Each subject was instructed to walk the walkway three times, in randomised order, at I) self-selected comfortable speed, II) a...
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The use of technology by the elderly
In community-dwelling elders, the relation between dietary quality, social support and living arrangements is controversial. Some studies have found positive relations,21,65,68,70,78-80 whereas others have found diet quality to be unaffected by a poor social network.81 It has been suggested that geographical isolation has an adverse effect on nutritional status among the elderly.82 For instance, an urban-rural difference in meal structure was observed in Poland,83 with lower consumption of certain food groups (meat, fish and eggs, fruit and their products, and fats and oils) in rural-dwelling seniors. It was suggested that food distribution systems and decreased buying power among rural inhabitants profoundly affect food habits. In contrast, other comparative studies of urban and rural-dwelling seniors in the US84,85 showed that nutrient...
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DEVELOPING MODEL OF HEALTH CARE MANAGEMENT FOR THE ELDERLY BY COMMUNITY PARTICIPATION IN ISAN
More specifically, we must further examine health beliefs, and food beliefs and practices that have symbolic or traditional importance to determine how knowledge, beliefs and attitudes translate into eating behaviour in older adults, especially at advanced ages. More research is needed to clarify the relative contribution of income, ethnic background and other personal predictors of healthy eating – self-control, emotions, resistance to change, time constraints, lack of knowledge – and environmental factors governing food availability and cost. Information is needed linking nutritional services, health, psychological, cognitive and social characteristics, as well as financial constraints to procuring healthy foods. More information is needed on barriers, both real and perceived, that discourage healthy eating. For instance, the impact of therapeutic or self-imposed restrictive...
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Cognitive effects of acute tryptophan depletion in the healthy elderly
Gaps in knowledge were detected in the course of this review. These are summarized in the following section, which also suggests directions for further investigation. Further study and regular dietary monitoring are needed in order to know more about food consumption habits in seniors. These investigations must be adapted to the reality of targeted aging populations using precise measurements, diverse approaches, appropriate methods and accurate dietary assessment tools to reflect the great heterogeneity typical of older populations. The research agenda should be focussed on interactions between individual and collective determinants of healthy eating that are unique to the elderly in Canada. To achieve this goal, longitudinal studies should be conducted to examine the epidemiological and social aspects of aging; describe the...
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24-Hour Sleep/Wake Patterns in Healthy Elderly Persons
Food consumption research suggests that widowhood confers potentially negative effects on food intake through weight change, increased adverse health outcomes, including depression, and diminished “nutritional self-management”, leading to changes in dietary behaviour and food intakes.86,87 This is particularly evident among men over the age of 7540,65,78,88 with low incomes.89 Indeed, there is a strong relation between living alone and dietary intakes among men,80,88-90 but these findings have not been consistent91,92 and are even less so among women.88 Information on the influence of living arrangements on dietary intake in seniors appears to be inconclusive and may depend on cultural or other differences in the samples studied....
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iCare: A Mobile Health Monitoring System for the Elderly
In an effort to modernize Medicare insurance, the Federal government has allowed private insurers who meet strict requirements to sell private insurance to the elderly, as a substitute for 'traditional' Medicare insurance. There are many forms of private insurance now being sold to the elderly, including some managed care plan types. Managed care plans restrict the choice of physicians and hospitals to include a set selected by the insurance plan, over whom the plan has more control in terms of utilization and expenditures. Managed care plans also provide preventive care and disease management services to their constituents, to keep them healthier and reduce their expenditures. Managed care plans are paid a set...
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The health of Canada’s elderly population: current status and future implications
THE GROWING SIZE OF CANADA’S ELDERLY POPULATION and its use of health care services has generated much discussion in policy circles and the popular press. With data from the National Population Health Survey, undertaken in 1994–95, the authors examine the health status of Canada’s elderly population using 3 sets of measures: level of activity limitations, prevalence of chronic illnesses and self-assessment of overall health. They also analyse the utilization of physician and institutional services. The profile of this population the authors develop is in many respects not much different from that of the remaining adult population, until the age of 75. People aged 75 and over are much...
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Research and Library Services Division Provisional Legislative Council Secretariat
Herbert Simon’s work on bounded rationality has had little impact on health policy discourse, despite numerous supportive findings. This is particularly sur- prising in regard to the elderly, a group marked by a decline in higher cognitive functions. Elders’ cognitive capacity to make decisions will be challenged even further with the introduction of the new Medicare prescription drug benefit program, mainly because of the many options available. At the same time, a growing body of evidence points to the perils of having too many choices. By combining research fromdecision science, economics, and psychology, we high- light the potential problems with the expanding health insurance choices facing the elderly and...
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Can Limiting Choice Increase Social Welfare? The Elderly and Health Insurance
How important are these issues, and do they carry any ramifications for the newMedicare prescription drug benefit? One of the problems, to which Rubinstein alluded, is that elders may be facing too many options and too much information and thus need to devise “impression manage- ment” techniques in order to compensate for cognitive or physical loss. To investigate this problem, which affects millions of elders throughout the United States, our study brings together Herbert Simon’s work on bounded rationality and research on the elderly’s cognitive ability with more recent studies suggesting that more information and choice could adversely affect decision makers. We provide examples from the many temporary prescription drug...
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Social Networks among Elderly Women: Implications for Health Education Practice
During the past twenty-five years, numerous research studies conducted in several fields have identified various psychosocial factors as predictors of health and mental health status. These include: (a) stress, (b) social support and social networks, (c) competence, (d) socioeconomic status and (e) coping.’-&dquo; For example, loss of a spouse (stress) may be related to depression for one individual and high blood pressure for another person, while a third person may experience no significant effects on his or her well-being. One factor that has gained prominence in the last decade as having a...
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Trajectory Patterns of Self-Rated Health among the Elderly in Taiwan: A Comparison across Ethnicity
Relatively healthy older people, particularly those in the 60 to 70 age range, are likely to need services similar to other adult health center populations. They may face challenges similar to their younger counterparts; language barriers, limited health literacy, or cultural factors may impact health care access. Yet for the older-old, these familiar challenges are compounded by additional barriers to optimal care and quality of life. The disabled of any age often need supportive services to remain as healthy as possible and in the community. As the population ages into the 75+ or 85+ categories, there is more likelihood for...
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Medicare 2000: 35 Years of Improving Americans’ Health and Security
In the field of aging, disability is measured by judging how a person performs Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs). ADLs include very basic activities like eating, toileting, bathing, transferring in and out of bed, and walking (Katz, Ford, Moskowitz, Jackson and Jaffee, 1963). IADLs include additional activities needed to get along in the world such as shopping, taking medications, using the phone, and other activities. (Lawton and Brody, 1969.) People may be disabled if they do not have the cognitive ability to perform functions without supervision or assistance. Broader definitions of disability may...
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SUPPORT SERVICES FOR CARERS OF ELDERLY PEOPLE LIVING AT HOME
The elderly disabled often have numerous chronic conditions and functional disabilities that require clinicians and service providers to take an ongoing cooperative management approach with the patient and family. The goal of this approach is to live the best possible life with chronic problems and avoid preventable deterioration of health and functional ability. In this arena, the patient, the family, and paid or unpaid caregivers often have a significant impact on care and quality of life, although the health center medical provider is still a critical partner in the process of providing and authorizing necessary care....
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Health Inequalities: Report, together with formal minutes
Not every physician chooses to focus on caring for disabled elders. Physicians who work with this population must value chronic medical and disability care and be able to work closely with the patient, family, caregivers and other professionals to provide the best care. There are also physiological differences in the elderly population that must be taken into account in treating and prescribing medications. Some health centers may be lucky to have on staff some of the scarce group of physicians who are sub-boarded in geriatric medicine. Others will have internists or family practitioners providing care to the disabled...
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The Effects of Land Use on the Mobility of Elderly and Disabled and Their Homecare Workers, and the Effects of Care on Client Mobility: Findings from Contra Costa, California
Most health centers will be serving elders with disabilities in their normal adult clinics. Some may wish to set aside special clinic times for the elderly including those with disabilities and special needs. Set-aside times can allow for somewhat longer patient visits which are helpful in treating elders with long histories and multiple chronic problems. Some health centers may also choose to set up additional services as part of their approach to primary care for the elderly. These may include adult day health care, home health care, assisted living, and nursing homes. Unfortunately we do not have an accurate count...
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Prevention of falls in the elderly living at home
ADHC is a community-based health and long term care service aimed at elders or adults who are disabled enough to be in a nursing home or at risk of nursing home placement. When coordinated with other health center services, particularly primary care clinic services, ADHC can be critical in allowing elders to avoid nursing home placement and helping informal caregivers to continue providing care over an extended period. Participants live at home and are brought into the center from 3 to 5 days a week. Services may vary from state to state but typically include an assessment and care plan with...
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