Sample records for older london residents

  1. Multidimensional attitudes of emergency medicine residents toward older adults.

    PubMed

    Hogan, Teresita M; Chan, Shu B; Hansoti, Bhakti

    2014-07-01

    The demands of our rapidly expanding older population strain many emergency departments (EDs), and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM) resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score). Attitudes trended to more negative in successive post-graduate year (PGY) levels. EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels.

  2. Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

    PubMed Central

    Hogan, Teresita M.; Chan, Shu B.; Hansoti, Bhakti

    2014-01-01

    Introduction The demands of our rapidly expanding older population strain many emergency departments (EDs), and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM) resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Methods Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. Results 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score). Attitudes trended to more negative in successive post-graduate year (PGY) levels. Conclusion EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels. PMID:25035760

  3. Motivators for physical activity among ambulatory nursing home older residents.

    PubMed

    Chen, Yuh-Min; Li, Yueh-Ping

    2014-01-01

    The purpose of this study was to explore self-identified motivators for regular physical activity among ambulatory nursing home older residents. A qualitative exploratory design was adopted. Purposive sampling was performed to recruit 18 older residents from two nursing homes in Taiwan. The interview transcripts were analyzed by qualitative content analysis. Five motivators of physical activity emerged from the result of analysis: eagerness for returning home, fear of becoming totally dependent, improving mood state, filling empty time, and previously cultivated habit. Research on physical activity from the perspectives of nursing home older residents has been limited. An empirically grounded understanding from this study could provide clues for promoting and supporting lifelong engagement in physical activity among older residents. The motivators reported in this study should be considered when designing physical activity programs. These motivators can be used to encourage, guide, and provide feedback to support older residents in maintaining physical activity.

  4. Sexual Abuse of Older Nursing Home Residents: A Literature Review

    PubMed Central

    Malmedal, Wenche; Iversen, Maria Helen; Kilvik, Astrid

    2015-01-01

    Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons. PMID:25642347

  5. Communication Skills Training for Surgical Residents: Learning to Relate to the Needs of Older Adults.

    PubMed

    Roberts, Linda; Cornell, Charles; Bostrom, Mathias; Goldsmith, Sandra; Ologhobo, Titilayo; Roberts, Timothy; Robbins, Laura

    2018-03-30

    It is vital for physicians and surgeons to communicate successfully with older adults, who will constitute one-fifth of the US population by 2030. Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Effective communication leads to better patient compliance and satisfaction, which is now a component of Medicare hospital reimbursement and physician and surgeon compensation from hospitals and networks. To increase orthopaedic surgery resident understanding of the unique needs of older adults in order to maintain effective and sensitive communication with this vulnerable population. A two-part training program (ongoing for 8 years) comprised of: 1) small-group interactive didactic sessions on aging issues; and 2) workshop demonstrations given by the residents to a group of older adults, followed by a Question & Answer session. Residents were assessed using a 22-item pre-post questionnaire covering medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging. Older adult participants were surveyed for perceptions of residents' sensitivity toward them. Hospital for Special Surgery in New York City, a specialized urban academic center, with a 5-year Orthopedic Surgery Residency program. 70 PGY3 residents, for whom the program is a requirement, and 711 older adult participants recruited from a community convenience sample. Older adult participants: Of 711 participants, 672 (95%) responded; 96% strongly agreed/agreed that the residents had demonstrated sensitivity toward them. Residents: Of 70 residents, 35 (50%) were assessed. Mean knowledge scores increased significantly (p ≤ 0.001); five of nine attitude items (p ≤ 0.05) and one of four anxiety items improved significantly (p ≤ 0.001). Significant change was seen in residents' attitudes and anxiety levels toward older adults, attributes that are usually deep seated and hard to change. Residents moved along the Accreditation Council for Graduate

  6. Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan.

    PubMed

    Hu, Sophia H; Chuang, Yeu-Hui; Ting, Yeh-Feng; Lin, Kuan-Yu; Hsieh, Chia-Jung

    2018-03-25

    The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution. © 2018 Wiley Periodicals, Inc.

  7. Vision impairment and nutritional status among older assisted living residents.

    PubMed

    Muurinen, Seija M; Soini, Helena H; Suominen, Merja H; Saarela, Riitta K T; Savikko, Niina M; Pitkälä, Kaisu H

    2014-01-01

    Vision impairment is common among older persons. It is a risk factor for disability, and it may be associated with nutritional status via decline in functional status. However, only few studies have examined the relationship between vision impairment and nutritional status, which was investigated in this cross-sectional study. The study included all residents living in the assisted living facilities in Helsinki and Espoo in 2007. Residents in temporary respite care were excluded (5%). Of permanent residents (N=2214), 70% (N=1475) consented. Trained nurses performed a personal interview and assessment of each resident including the Mini Nutritional Assessment (MNA), functional and health status. Patient records were used to confirm demographic data and medical history. Mortality in 2010 was retrieved from central registers. Of the residents, 17.5% (N=245) had vision impairment and they were not able to read regular print. Those with vision impairment were older, more often females, and malnourished according to MNA. They had lower BMI, and suffered more often from dementia and chewing problems than those without vision impairment. In logistic regression analysis controlling for age, gender, chewing problems and dementia, vision impairment was independently associated with resident's malnutrition (OR 2.51, 95% CI 1.80-3.51). According to our results older residents in assisted living with vision impairment are at high risk for malnutrition. Therefore it is important to assess nutritional status of persons with vision impairment. It would be beneficial to repeat this kind of a study also in elderly community population. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. A temporary home to nurture health: lived experiences of older nursing home residents in Taiwan.

    PubMed

    Tsai, Hsiu-Hsin; Tsai, Yun-Fang

    2008-07-01

    This study explored the lived experiences of older nursing home residents in Taiwan. With more long-term care institutions in Taiwan, older people are more often placed in nursing homes than in the past. Increased understanding of their lived experience is essential to assess residents' needs and determine the effectiveness of nursing interventions. A qualitative design was used to gain a deeper understanding of the lived experiences of older nursing home residents in Taiwan. Focus groups, followed by in-depth interviews, were used to gather information from 33 older residents at eight nursing homes in northern Taiwan. Participants were asked to describe what was important to them and what impressed them most in their daily lives in the nursing home. Participants (24 females and nine males) were on an average 75.3 years old. Verbatim transcripts of audiotaped focus groups and interviews were analysed by thematic analysis via ATLAS.ti software. The core theme of older residents' nursing home experience was 'a temporary home to nurture health'. This core theme was reflected in participants' descriptions of their overall life in the nursing home as a temporary experience to nurture their health. Their everyday experience was characterised by four subthemes: highly structured lifestyle, restricted activities, safety concerns and social interactions. Our findings may enhance policy makers' and healthcare providers' understanding of the lived experience of older nursing home residents, thus guiding the evaluation and development of nursing home services to improve residents' lives. For example, residents with the same characteristics could be placed in the same room or same floor, thus increasing their interactions with other residents. Residents' interactions with family members could also be developed using the Internet or mobile telephones.

  9. "Everyone was looking at you smiling": East London residents' experiences of the 2012 Olympics and its legacy on the social determinants of health.

    PubMed

    Thompson, C; Lewis, D J; Greenhalgh, T; Smith, N R; Fahy, A E; Cummins, S

    2015-11-01

    Mega-sporting event regeneration, as a specific approach to urban renewal, uses impending host-city status as a catalyst for revitalisation and has the potential to improve health both through addressing deprivation and by promoting increased sport and physical activity among the host-city's population. This qualitative study explored how hosting of the London 2012 Games impacted upon the way East London residents perceived and experienced the social determinants of health in their local neighbourhood. We conducted narrative family interviews, go-along interviews and video focus group workshops with 66 Newham residents, aged 12-55 years, immediately after the Games. A narrative analytic approach examined accounts of health and wellbeing experiences in terms of neighbourhood change and the spectacle of the Games. Participants of this qualitative study generally welcomed the respite and the unexpected chance to live in a cleaner, safer and more unified environment. However, this positivity was underscored by an acute awareness that this was a very temporary situation and one that was intended to support the event rather than residents. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

    PubMed

    Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

    2015-01-01

    The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Characteristics of walking, activity, fear of falling, and falls in community-dwelling older adults by residence.

    PubMed

    Wert, David M; Talkowski, Jaime B; Brach, Jennifer; VanSwearingen, Jessie

    2010-01-01

    Research focusing on community-dwelling older adults includes adults living in senior living residences (SLR) and independent community residences (ICR). Walking, physical activity, fear of falling, and fall history may differ on the basis of residence. We describe characteristics of walking, physical activity, fear of falling, and fall history between community-dwelling older adults by residence. Participants of this secondary analysis included community-dwelling older adults from independent living units within a senior life care community (SLR) and older adults recruited from the Pittsburgh community (ICR). Demographic information and physical (gait speed and physical activity), psychosocial (fear of falling and confidence in walking), and fall history measures were collected. Adults living in SLR compared with those in ICR were older, were more likely to live alone, and had greater disease burden. Compared with individuals in ICR, individuals in SLR reported less fear of falling (Survey of Activity and Fear of Falling in the Elderly tool fear results 0.24 and 0.50, respectively). Fewer older adults in SLR compared with those in ICR reported falling in the past year. Older adults living in SLR compared with those in ICR had similar physical function but differed in report of fear of falling and fall history. Recognizing the possible differences in psychosocial function by place of residence is important for health care providers and researchers conducting interventions and studies for community-dwelling older adults.

  12. Dentition status, malnutrition and mortality among older service housing residents.

    PubMed

    Saarela, R K T; Soini, H; Hiltunen, K; Muurinen, S; Suominen, M; Pitkälä, K

    2014-01-01

    Oral health status and oral health problems can affect eating habits and thus consequently the nutritional status of frail older people. To assess older service house residents' dentition and its associations with nutritional status and eating habits, and as well as to explore the prognostic value of dentition status for mortality. A cross-sectional study with a three-year follow-up. In 2007, we assessed the nutritional status of all residents in service houses in the two cities of Helsinki and Espoo in Finland (N=2188). Altogether 1475 subjects (67%) participated in the study; dentition status data were available for 1369 of them. Using a personal interview and assessment, trained nurses familiar to the resident collected the subjects' demographic data, medical history, functional and cognitive status, information on dentition status, oral symptoms, eating habits and diets. We assessed nutritional status with the Mini Nutritional Assessment (MNA), and retrieved information on mortality from central registers on 6 July 2010. Edentulousness was common; more than half of the residents (52%) had lost all their teeth: 7% (n=94) were totally edentulous without prosthesis (Group 1), 45% (n=614) had removable dentures (Group 2), and 48% (n = 661) of the residents, had some natural teeth left (Group 3). Dentition status was associated with age, gender, education and disability. According to the MNA, 13% were malnourished, 65% were at risk for malnutrition, and 22% were well nourished. Edentulousness without prosthesis was associated with malnutrition, oral symptoms and infrequent use of oral care services. In Group 1, 52% were deceased during follow-up period. The respective figures for Groups 2 and 3 were 48% and 40% (p=0.004). However, in Cox regression analysis adjusted for age, gender, comorbidity and MNA score, dentition status no longer predicted mortality. Edentulousness is still common among older service housing residents. Edentulousness without prosthesis was

  13. The Dependence on Smokeless Tobacco in the South Asian Communities in East London.

    PubMed

    Khaja, Amjad Hussain; Ali Zwiad, Abdulsalam; Tarakji, Bassel; Gazal, Giath; Albaba, Feras; KalajI, Nader; Petro, Waleed

    2015-05-17

    The purpose of the study was to understand the dependency on smokeless tobacco. The major aspect of the interview was to study the type of chewing tobacco used, frequency of purchase of chewing tobacco, change in attitude and behavior after the use of chewing tobacco. This study was done in 2005 in London. Of the 110 respondents interviewed 88 were used for the data analysis. An exploratory study was conducted in East London, United Kingdom. The selected sample was interviewed through a questionnaire, based on the Severson Smokeless Tobacco Dependence Scale. Cross tabulations report that in a sample of 88 South Asian UK resident men 46.6% used leaf (paan), 43.2% used processed form of chewing tobacco and 10.2% used gutka. Older age (67%) respondents were more likely than the younger age (30%) respondents to chew tobacco. The frequency of purchase of chewing tobacco is reported high (67.2%) in the older age group than the younger age group (50%). This current study used an amended form of the Severson Smokeless Tobacco Scale questionnaire to study the dependency on smokeless tobacco. The study could be developed in the selection of the sample, which would include both males and females to study the dependency on smokeless tobacco.

  14. Cosmopolitanism, geographical imaginaries and belonging in North London.

    PubMed

    Devadason, Ranji

    2010-01-01

    Cosmopolitanism has been described as the cultural habitus of globalisation. It is therefore, albeit defined somewhat loosely, often associated with ethnically diverse, global cities. This paper considers the extent to which London engenders cosmopolitan values amongst its residents. It draws on survey data from the LOCAL MULTIDEM study of minorities' political participation to address these themes. The analysis examines perceptions of respect, belonging and geographical imaginaries - amongst established minorities and the ethnic majority - in north London. It is argued that cosmopolitan ethics are transformative and dialectical and, critically, cannot remain the preserve of the privileged in multi-ethnic neighbourhoods. The analysis presented demonstrates that a sense of belonging and cosmopolitan imaginaries are not evenly accessed by different ethnic groups; notably, that Bangladeshi Londoners who are born and bred in the city are less likely to appropriate these discourses than Caribbean, Indian or White residents.

  15. Relationships of Assertiveness, Depression, and Social Support Among Older Nursing Home Residents

    ERIC Educational Resources Information Center

    Segal, Daniel

    2005-01-01

    This study assessed the relationships of assertiveness, depression, and social support among nursing home residents. The sample included 50 older nursing home residents (mean age=75 years; 75% female; 92% Caucasian). There was a significant correlation between assertiveness and depression (r=-.33), but the correlations between social support and…

  16. Sleep/awake status throughout the night and circadian motor activity patterns in older nursing-home residents with or without dementia, and older community-dwelling people without dementia.

    PubMed

    Kume, Yu; Kodama, Ayuto; Sato, Kotaro; Kurosawa, Satoko; Ishikawa, Takashi; Ishikawa, Sachiko

    2016-12-01

    Sleep disturbances are commonly observed in older nursing home residents, mainly in combination with dementia. However, sleep-associated circadian motor activity patterns have not been thoroughly investigated in Japanese nursing homes. The present study aimed to respectively clarify the effect of community living and the presence of dementia on sleep disturbances and interrupted activity rhythm of older nursing-home residents with or without dementia and older community-dwelling people without dementia. Actigraph devices worn on the participants' non-dominant wrists for seven days were used to collect objective measurements of the sleep/awake status throughout the night and the circadian motor activity patterns. The presence of dementia was assessed by a trained medical doctor using the residents' records and the Clinical Dementia Rating (CDR). The functional capacity of the participants was determined using the Barthel Index (BI). Fifty-one older people in Akita prefecture were included in the current study, consisting of 17 residents with dementia (mean age: 82.2 years), 17 residents without dementia (84.5 years), and 17 community-dwelling people (83.6 years). The results showed that older nursing-home residents with dementia had significantly a lower rate of sleep efficiency and a longer awake time throughout the night than the other groups. Older nursing-home residents with and without dementia had more fragmented rhythm than community-dwelling people without dementia. These results provide evidence of poor sleep/awake status throughout the night and interrupted circadian activity rhythms in nursing-home residents with and without dementia. However, further studies performed according to dementia classifications are needed.

  17. Madness and Rulers: Events in Coorg and London in 1810, as observed by the Hon. Arthur Cole, the resident at Mysore

    PubMed Central

    Jain, Sanjeev; Sarin, Alok

    2015-01-01

    What happens if a King becomes mentally ill? Excerpts from the personal papers of Arthur Henry Cole, Resident to the Kingdom of Mysore in 1809, open up fascinating insights into the madness of rulers, in neighboring Coorg and faraway London, and ways in which different societies responded to this. Musings on legal capacity and restrictions imposed on account of insanity, as well as migration and ennui in imperial colonies inevitably follow. PMID:26124533

  18. Key Barriers to Community Cohesion: Views from Residents of 20 London Deprived Neighbourhoods

    PubMed Central

    Bertotti, Marcello; Adams-Eaton, Faye; Sheridan, Kevin; Renton, Adrian

    2016-01-01

    The notion of community has been central to the political project of renewal of New Labour in the UK. The paper explores how the discourses of community are framed within New Labour and discusses these in the light of the results from research which focuses on how people within urban deprived areas construct their community. It draws upon the results of one part of a larger research project (the ‘Well London’ programme) which aimed to capture the views of residents from 20 disadvantaged neighbourhoods throughout London using an innovative qualitative method known as the ‘World Café’. Our results show the centrality of young people to the development of cohesive communities, the importance of building informal relationships between residents alongside encouraging greater participation to policy making, and the need to see these places as fragile and temporary locations but with considerable social strengths. Government policies are only partially addressing these issues. They pay greater attention to formally encouraging citizens to become more involved in policy making, largely ignore the contribution young people could make to the community cohesion agenda, and weakly define the shared norms and values that are crucial in building cohesive communities. Thus, the conclusion is that whilst an emphasis of the government on ‘community’ is to be welcome, more needs to be done in terms of considering the ‘voices’ of the community as well as enabling communities to determine and act upon their priorities. PMID:27761059

  19. Re-Imagining the Care Home: A Spatially Responsive Approach to Arts Practice with Older People in Residential Care

    ERIC Educational Resources Information Center

    Hatton, Nicola

    2014-01-01

    This paper considers some of the spatial challenges of doing arts projects with older people in care homes, including those living with dementia. It reflects on the author's own experience of running a performance project with residents with at a care home in North London. Drawing on Lefebvre's concept of socially produced space, it argues that…

  20. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services.

    PubMed

    Ewen, Heidi H; Washington, Tiffany R; Emerson, Kerstin G; Carswell, Andrew T; Smith, Matthew Lee

    2017-03-22

    Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results : When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions : Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as

  1. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

    PubMed Central

    Ewen, Heidi H.; Washington, Tiffany R.; Emerson, Kerstin G.; Carswell, Andrew T.; Smith, Matthew Lee

    2017-01-01

    Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs

  2. Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki

    PubMed Central

    Stafford, M.; Martikainen, P.; Lahelma, E.; Marmot, M.

    2004-01-01

    Study objective: Mortality and morbidity vary across neighbourhoods and larger residential areas. Effects of area deprivation on health may vary across countries, because of greater spatial separation of people occupying high and low socioeconomic positions and differences in the provision of local services and facilities. Neighbourhood variations in health and the contribution of residents' characteristics and neighbourhood indicators were compared in London and Helsinki, two settings where inequality and welfare policies differ. Design: Data from two cohorts were used to investigate associations between self rated health and neighbourhood indicators using a multilevel approach. Setting: London and Helsinki. Participants: From the Whitehall II study (London, aged 39–63) and the Helsinki health study (aged 40–60). Main results: Socioeconomic segregation was higher in London than in Helsinki. Age and sex adjusted differences in self rated health between neighbourhoods were also greater in London. Independent of individual socioeconomic position, neighbourhood unemployment, proportion of residents in manual occupations, and proportion of single households were associated with health. In pooled data, residence in a neighbourhood with highest unemployment was associated with an odds ratio of less than good self rated health of 1.51 (95% CI 1.30 to 1.75). High rates of single parenthood were associated with health in London but not in Helsinki. Conclusions: Neighbourhood socioeconomic context was associated with health in both countries, with some evidence of greater neighbourhood effects in London. Greater socioeconomic segregation in London may have emergent effects at the neighbourhood level. Local and national social policies may reduce, or restrict, inequality and segregation between areas. PMID:15310804

  3. Quality of Life in the Nursing Home: Perspectives of Younger and Older Residents

    ERIC Educational Resources Information Center

    Watt, Ashli; Konnert, Candace

    2007-01-01

    Adults aged 65 and younger make up a significant proportion of nursing-home residents. To date, however, there is no research examining their quality of life (QOL), including how their perceptions of QOL compare to those of older nursing-home residents. This study used a multidimensional approach to (a) assess the QOL of younger nursing-home…

  4. Disaster preparedness networks in rural Midwest communities: Organizational roles, collaborations, and support for older residents.

    PubMed

    Ashida, Sato; Zhu, Xi; Robinson, Erin L; Schroer, Audrey

    2018-05-17

    This study investigated the roles and interconnections among community organizations belonging to local disaster coalitions in Midwest in supporting older residents. Representatives from 44 organizations participated in one-time survey. Most were non-profit (68%) or federal/state/local government agencies (23%). The analyses of 761 relationships showed stronger collaborations in assessment (average strength=2.88 on a 5-point scale), emergency response (2.72), and planning (2.61); and weaker collaborations in co-sponsoring programs (1.71) and supporting older residents (2.03). The extent of collaboration (network density) to support older adults was also low. Coalitions may enhance network density and centralization by developing sub-committee structure and strengthening existing collaborations.

  5. Older residents' perspectives on aged sexuality in institutionalized elderly care: a systematic literature review.

    PubMed

    Mahieu, Lieslot; Gastmans, Chris

    2015-12-01

    The aim of this systematic literature review is to investigate older residents' thoughts on, experiences of and engagement in sexual behavior and aged sexuality within institutionalized elderly care. Systematic literature review. We conducted an extensive search of the electronic databases Cinahl, Medline, Pubmed, Embase, Web of Science and Invert for papers published between January 1980 and October 2014 when the searches were closed. Additional papers were identified through forward and backward citation chasing. Data from relevant studies were extracted by means of a data extraction form. Relevant data were isolated, summarized, compared, related and categorized according to theme. Quality assessment of the included studies focused on their adequacy of reporting the study's research aim, sampling, collection, and analysis procedures, ethical considerations and results. Twenty-five appropriate studies were identified. These studies varied in research design (using surveys, vignettes, focus groups, interviews, or observation), objectives, quality of reporting, and sample characteristics (i.e. male and/or female long-term care residents with and/or without dementia). Yet, they all point to the relevance of sex and sexuality in old age and emphasize the highly individual character of both sexual interest and expression. Older residents who wish to sexually express themselves, might do this in a wide variety of ways, including, but not limited to, daydreaming, dressing-up, looking for emotional and intellectual intimacy, stroking, caressing, kissing, and engaging in sexual intercourse. Overall, residents appear to have a rather positive attitude toward aged sexuality as such. When it comes to specific sexual behaviors or homosexuality, however, attitudes tend to be more negative. The perceived appropriateness of the displayed behavior is a predominant factor in determining older people's reactions to the sexual behavior of co-residents, rather than the potential

  6. Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

    PubMed Central

    Knapp, Martin; Chua, Kia-Chong; Broadbent, Matthew; Chang, Chin-Kuo; Fernandez, Jose-Luis; Milea, Dominique; Romeo, Renee; Lovestone, Simon; Spencer, Michael; Thompson, Gwilym; Stewart, Robert; Hayes, Richard D

    2016-01-01

    Objectives To examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs. Design Observational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations. Setting Catchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London. Participants Every individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075). Interventions Usual treatment. Main outcome measures Risk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care. Results Predictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination. Conclusions Most people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older

  7. Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

    PubMed

    Bynum, Debra L; Wilson, Lindsay A; Ong, Thuan; Callahan, Kathryn E; Dalton, Thomas; Ohuabunwa, Ugochi

    2015-09-01

    In order to determine how often internal medicine and family medicine residents performed specific actions related to the geriatric competencies established by the American Geriatrics Society (AGS) when caring for older hospitalized adults, a cross-sectional anonymous survey of residents at the University of North Carolina, University of Washington, Wake Forest University, Duke University, and Emory University was undertaken. Data on frequency of self-reported behaviors were analyzed, with comparisons made for different levels of training, institution, and program. A total of 375 residents responded for an overall response rate of 48%. Residents reported that they often do not demonstrate all of the AGS recommended core competencies when caring for older adults in the hospital setting. Residents report more frequently performing activities that are routinely integrated into hospital systems such as reviewing medication lists, working with an interdisciplinary team, evaluating for inappropriate bladder catheters, and evaluating for pressure ulcers. There were no consistent differences between institutions and only minor differences noted between Family Medicine and Internal Medicine residents. Operationalizing core competencies by integrating them into hospital systems' quality process indicators may prompt more consistent high-quality care and ensure systems support residents' competence. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  8. Community Engagement using World Café: The Well London Experience

    PubMed Central

    Sheridan, Kevin; Adams-Eaton, Faye; Trimble, Allison; Renton, Adrian; Bertotti, Marcello

    2016-01-01

    The Well London programme was launched across twenty boroughs in London during late 2007 to improve the health and well-being of residents living in some of the most deprived communities in London. Well London employed a multi-stage community engagement process which informed the overall project strategy for each intervention area. In this article we establish and describe the key principles that guided the design of this innovative community engagement process. Principles included building collaborative partnerships, working with whole-systems, privileging community knowledge and working with the deficit of experience in each area. The article then describes in detail how these principles were operationalised throughout the preparation and delivery of forty World Cafes, which were the first open community activities of the Well London community engagement process. Finally, this article reflects on and summarises the lessons learned when employing innovative, inclusive and transparent community engagement for health promotion. PMID:27857453

  9. Community Engagement using World Café: The Well London Experience.

    PubMed

    Sheridan, Kevin; Adams-Eaton, Faye; Trimble, Allison; Renton, Adrian; Bertotti, Marcello

    2010-01-01

    The Well London programme was launched across twenty boroughs in London during late 2007 to improve the health and well-being of residents living in some of the most deprived communities in London. Well London employed a multi-stage community engagement process which informed the overall project strategy for each intervention area. In this article we establish and describe the key principles that guided the design of this innovative community engagement process. Principles included building collaborative partnerships, working with whole-systems, privileging community knowledge and working with the deficit of experience in each area. The article then describes in detail how these principles were operationalised throughout the preparation and delivery of forty World Cafes, which were the first open community activities of the Well London community engagement process. Finally, this article reflects on and summarises the lessons learned when employing innovative, inclusive and transparent community engagement for health promotion.

  10. Bangladeshi women's experiences of infant feeding in the London Borough of Tower Hamlets.

    PubMed

    Rayment, Juliet; McCourt, Christine; Vaughan, Lisa; Christie, Janice; Trenchard-Mabere, Esther

    2016-07-01

    This study examined the main factors that influence Bangladeshi women living in London's decisions to partially breastfeed their children, including the influence of older women within the community. Fifty-seven women of Bangladeshi origin living in the London Borough of Tower Hamlets took part in seven discussion groups between April and June 2013. Five groups were held with women of child-bearing age and two groups with older women in the community. A further eight younger women and three older women took part in one-on-one interviews. Interviews were also carried out with eight local health care workers, including public health specialists, peer support workers, breastfeeding coordinators and a health visitor. The influences on women's infant feeding choices can be understood through a 'socio-ecological model', including public health policy; diverse cultural influences from Bangladesh, London and the Bangladeshi community in London; and the impacts of migration and religious and family beliefs. The women's commitment to breastfeeding was mediated through the complexity of their everyday lives. The tension between what was 'best' and what was 'possible' leads them not only to partially breastfeed but also to sustain partial breastfeeding in a way not seen in other socio-cultural groups in the United Kingdom. © 2015 John Wiley & Sons Ltd.

  11. Health-Related Quality of Life in Older Coastal Residents After Multiple Disasters.

    PubMed

    Cherry, Katie E; Sampson, Laura; Galea, Sandro; Marks, Loren D; Baudoin, Kayla H; Nezat, Pamela F; Stanko, Katie E

    2017-02-01

    Exposure to multiple disasters, both natural and technological, is associated with extreme stress and long-term consequences for older adults that are not well understood. In this article, we address age differences in health-related quality of life in older disaster survivors exposed to the 2005 Hurricanes Katrina and Rita and the 2010 BP Deepwater Horizon oil spill and the role played by social engagement in influencing these differences. Participants were noncoastal residents, current coastal residents, and current coastal fishers who were economically affected by the BP oil spill. Social engagement was estimated on the basis of disruptions in charitable work and social support after the 2005 hurricanes relative to a typical year before the storms. Criterion measures were participants' responses to the SF-36 Health Survey which includes composite indexes of physical (PCS) and mental (MCS) health. The results of logistic regressions indicated that age was inversely associated with SF-36 PCS scores. A reduction in perceived social support after Hurricane Katrina was also inversely associated with SF-36 MCS scores. These results illuminate risk factors that impact well-being among older adults after multiple disasters. Implications of these data for psychological adjustment after multiple disasters are considered. (Disaster Med Public Health Preparedness. 2017;11:90-96).

  12. Barriers to exercise in younger and older non-exercising adult women: a cross sectional study in London, United Kingdom.

    PubMed

    El Ansari, Walid; Lovell, Geoff

    2009-04-01

    A survey of 100 women in the south of London, United Kingdom (UK) compared exercise barrier intensities between non-exercising younger (20-27 years) and older (28-35 years) adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS) comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement). Participants' number of children was also noted. Non-exercising older women reported significantly higher total exercise barriers, as well as across three barrier subscales: exercise milieu, time expenditure, and family discouragement. For both age groups, significant correlation existed between number of children and women's total exercise barrier scores. Number of children explained approximately 25% and approximately 30% of the variance of younger and older women's total barrier scores respectively. For both women groups, the strongest correlation between exercise barrier and number of children was for the time expenditure subscale. Broad grouping of 20-35 year old non-exercising women does not reflect a homogenous sample. Age categories employing narrower age brackets are recommended. Issues surrounding family responsibilities e.g. childcare duties may be shared between these groups and require further research and policy attention.

  13. Individual and contextual determinants of resident-on-resident abuse in nursing homes: a random sample telephone survey of adults with an older family member in a nursing home.

    PubMed

    Schiamberg, Lawrence B; von Heydrich, Levente; Chee, Grace; Post, Lori A

    2015-01-01

    Few empirical investigations of elder abuse in nursing homes address the frequency and determinants of resident-on-resident abuse (RRA). A random sample of 452 adults with an older adult relative, ≥65 years of age, in a nursing home completed a telephone survey regarding elder abuse experienced by that elder family member. Using a Linear Structural Relations (LISREL) modeling design, the study examined the association of nursing home resident demographic characteristics (e.g., age, gender), health and behavioral characteristics (e.g., diagnosis of Alzheimer's Disease, Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), types of staff abuse (e.g., physical, emotional), and factors beyond the immediate nursing home setting (e.g., emotional closeness of resident with family members) with RRA. Mplus statistical software was used for structural equation modeling. Main findings indicated that resident-on-resident mistreatment of elderly nursing home residents is associated with the age of the nursing home resident, all forms of staff abuse, all ADLs and IADLs, and emotional closeness of the older adult to the family. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Relationships of assertiveness, depression, and social support among older nursing home residents.

    PubMed

    Segal, Daniel L

    2005-07-01

    This study assessed the relationships of assertiveness, depression, and social support among nursing home residents. The sample included 50 older nursing home residents (mean age = 75 years; 75% female; 92% Caucasian). There was a significant correlation between assertiveness and depression (r = -.33), but the correlations between social support and depression (r = -.15) and between social support and assertiveness (r = -.03) were small and nonsignificant. The correlation between overall physical health (a subjective self-rating) and depression was strong and negative (r = -.50), with lower levels of health associated with higher depression. An implication of this study is that an intervention for depression among nursing home residents that is targeted at increasing assertiveness and bolstering health status may be more effective than the one that solely targets social support.

  15. Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes.

    PubMed

    Tsai, Yun-Fang; Wong, Thomas Ks; Ku, Yan-Chiou

    2008-05-01

    To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan. With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide. A cross-sectional design was used. Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data. The prevalence of poor sleep in these older nursing home residents was 46.4%. Only 48.5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was 'take prescribed medicines'. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep. This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents' inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances. As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.

  16. Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register.

    PubMed

    Knapp, Martin; Chua, Kia-Chong; Broadbent, Matthew; Chang, Chin-Kuo; Fernandez, Jose-Luis; Milea, Dominique; Romeo, Renee; Lovestone, Simon; Spencer, Michael; Thompson, Gwilym; Stewart, Robert; Hayes, Richard D

    2016-11-18

    To examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs. Observational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations. Catchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London. Every individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075). Usual treatment. Risk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care. Predictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination. Most people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older people do not want. Routinely collected data can be used to reveal local patterns of admission

  17. Trend analysis of imported malaria in London; observational study 2000 to 2014.

    PubMed

    Rees, Eleanor; Saavedra-Campos, Maria; Usdin, Martine; Anderson, Charlotte; Freedman, Joanne; de Burgh, Jane; Kirkbride, Hilary; Chiodini, Peter; Smith, Valerie; Blaze, Marie; Whitty, Christopher J M; Balasegaram, Sooria

    We describe trends of malaria in London (2000-2014) in order to identify preventive opportunities and we estimated the cost of malaria admissions (2009/2010-2014/2015). We identified all cases of malaria, resident in London, reported to the reference laboratory and obtained hospital admissions from Hospital Episode Statistics. The rate of malaria decreased (19.4[2001]-9.1[2014] per 100,000). Males were over-represented (62%). Cases in older age groups increased overtime. The rate was highest amongst people of Black African ethnicity followed by Indian, Pakistani, Bangladeshi ethnicities combined (103.3 and 5.5 per 100,000, respectively). The primary reason for travel was visiting friends and relatives (VFR) in their country of origin (69%), mostly sub-Saharan Africa (92%). The proportion of cases in VFRs increased (32%[2000]-50%[2014]) and those taking chemoprophylaxis decreased (36%[2000]-14%[2014]). The overall case fatality rate was 0.3%. We estimated the average healthcare cost of malaria admissions to be just over £1 million per year. Our study highlighted that people of Black African ethnicity, travelling to sub-Saharan Africa to visit friends and relatives in their country of origin remain the most affected with also a decline in chemoprophylaxis use. Malaria awareness should focus on this group in order to have the biggest impact but may require new approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Barriers to Exercise in Younger and Older Non-Exercising Adult Women: A Cross Sectional Study in London, United Kingdom

    PubMed Central

    Ansari, Walid El; Lovell, Geoff

    2009-01-01

    A survey of 100 women in the south of London, United Kingdom (UK) compared exercise barrier intensities between non-exercising younger (20–27 years) and older (28–35 years) adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS) comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement). Participants’ number of children was also noted. Non-exercising older women reported significantly higher total exercise barriers, as well as across three barrier subscales: exercise milieu, time expenditure, and family discouragement. For both age groups, significant correlation existed between number of children and women’s total exercise barrier scores. Number of children explained ≈25% and ≈30% of the variance of younger and older women’s total barrier scores respectively. For both women groups, the strongest correlation between exercise barrier and number of children was for the time expenditure subscale. Broad grouping of 20–35 year old non-exercising women does not reflect a homogenous sample. Age categories employing narrower age brackets are recommended. Issues surrounding family responsibilities e.g. childcare duties may be shared between these groups and require further research and policy attention. PMID:19440527

  19. Connecting Londoners with Their City through Digital Technologies

    ERIC Educational Resources Information Center

    Swift, Frazer

    2013-01-01

    London is one of the most complex, dynamic and diverse cities in the world, with 8 million residents, over 300 languages spoken in its schools, and some 30 million overseas visitors every year. Reaching out to and connecting all these people with the city's heritage while catering to their many interests, motivations and learning needs is a huge…

  20. Epidemiology of Drug-Disease Interactions in Older Veteran Nursing Home Residents

    PubMed Central

    Aspinall, Sherrie L.; Zhao, Xinhua; Semla, Todd P.; Cunningham, Francesca E.; Paquin, Allison M.; Pugh, Mary Jo; Schmader, Kenneth E.; Stone, Roslyn A.; Hanlon, Joseph T.

    2014-01-01

    Objectives Few studies have examined drug-disease interactions (DDIs) in older nursing home residents. Therefore, the objective is to describe the prevalence of, and factors associated with, DDIs according to The American Geriatrics Society 2012 Beers Criteria. Design Cross-sectional study. Setting Fifteen Veterans Affairs Community Living Centers. Participants Patients≥65 years old with a diagnosis of dementia/cognitive impairment, history of falls/hip fractures, heart failure (HF), history of peptic ulcer disease (PUD) and/or stage IV or V chronic kidney disease (CKD). Measurements Prevalence of medications that could exacerbate the above conditions (i.e., DDIs). Results Overall, 361 of 696 (51.9%) eligible residents had ≥1 DDI. None involved those with a history of PUD; one involved a resident with CKD, and four occurred in those with HF. In residents with dementia/cognitive impairment (N=540), 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). In those with a history of falls/hip fractures (N=267), 67.8% received an interacting medication, with SSRIs (33.1%), antipsychotics (30.7%) and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in both dementia/cognitive impairment and falls/fractures included: age 85+ (Adjusted Odds Ratio [aOR] and 95% confidence interval [CI] of 0.38; 0.24–0.60 and aOR 0.48; 95%CI 0.24–0.96, respectively); taking 5–8 medications (aOR 2.06; 95%CI 1.02–4.16 and aOR 4.76; 95%CI 1.68–13.5, respectively) and ≥9 medications (aOR 1.99; 95%CI 1.03–3.85 and aOR 3.68; 95%CI 1.41–9.61, respectively), and being a long stay patient (aOR 1.80; 95%CI 1.04–3.12 and aOR 2.35; 95%CI 1.12–4.91, respectively). Conclusion Drug-disease interactions were common in older nursing home residents with dementia/cognitive impairment and/or a history

  1. The varying influence of socioeconomic deprivation on breast cancer screening uptake in London.

    PubMed

    Jack, Ruth H; Robson, Tony; Davies, Elizabeth A

    2016-06-01

    We assessed the relationship between screening uptake and socioeconomic deprivation for London women aged 50-52 invited to their first routine screening appointment between 2006 and 2009. We examined uptake for London overall and within six screening areas, using deprivation quintile, based on post code of residence. After adjustment for age, area and ethnicity, overall uptake decreased with increasing deprivation (adjusted odds ratio (OR) = 0.95, P < 0.001). However, in two screening areas with lower uptake, women living in deprived areas had higher uptake than women from affluent areas. These potential inequalities in early diagnosis across London require further investigation. © Crown copyright 2015.

  2. Urban form and older residents' service use, walking, driving, quality of life, and neighborhood satisfaction.

    PubMed

    Patterson, Patricia K; Chapman, Nancy J

    2004-01-01

    This study explored the relationship between pedestrian-friendly urban form as reflected in new urbanism design guidelines, and neighborhood service use, walking, driving, quality of life, and neighborhood satisfaction among older women. A cross-sectional survey compared residents of census tracts similar indemographic characteristics but differing in urban form. The setting was urban and suburban areas of Portland, Oregon. The sample consisted of 372 females living alone over age 70 in six census tracts; 133 (36%) completed surveys. The New Urbanism Index rated the physical features of respondents' neighborhoods. The Neighborhood Resident Survey assessed travel modes and neighborhood satisfaction. The Quality of Life Index measured resident well-being. The Dartmouth COOP Functional Health Charts measured health status. Group comparisons were made with t-tests and regression analysis. Although limited by the cross-sectional design, the study showed that new urbanism partially explained several differences in service use and activity: distance to a grocery store (r2 change = .11, p = .001), number of services used within 1 mile from home (r2 change = .06, p = .007), number of walking activities (r2 change = .08, p = .001), number of services accessed by walking (r2 change = .14, p = .000), and number of services accessed by driving (r2 change = .05, p = .001). Traditional urban neighborhoods with mixed services and good pedestrian access were associated with increased walking among older residents.

  3. Stress and Depression among Older Residents in Religious Monasteries: Do Friends and God Matter?

    ERIC Educational Resources Information Center

    Bishop, Bishop J.

    2008-01-01

    The purpose of this investigation was to explore how friendship and attachment to God provide protective benefits against stress and depression. Participants included 235 men and women, age 64 and older, residing in religious monasteries affiliated with the Order of St. Benedict. Hierarchical multiple regression analyses were completed to assess…

  4. Birth Outcomes among Older Mothers in Rural versus Urban Areas: A Residence-Based Approach

    ERIC Educational Resources Information Center

    Lisonkova, Sarka; Sheps, Samuel B.; Janssen, Patricia A.; Lee, Shoo K.; Dahlgren, Leanne; MacNab, Ying C.

    2011-01-01

    Purpose: We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity. Methods: A population-based retrospective cohort study, including all singleton…

  5. The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study.

    PubMed

    Potter, Rachel; Sheehan, Bart; Cain, Rebecca; Griffin, James; Jennings, Paul A

    2018-05-08

    Forty percent of residents living in care homes in the United Kingdom have significant depressive symptoms. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown. This study explores the relationship between the physical environment and depressive symptoms of older people living in care homes. In a prospective cohort study the physical environment of 50 care homes were measured using the Sheffield Care Environment Assessment Matrix (SCEAM) and depressive symptoms of 510 residents measured using the Geriatric Depression Scale (GDS-15). The study was supplemented with semi-structured interviews with residents living in the care homes. Quantitative data were analyzed using multi-level modeling, and qualitative data analyzed using a thematic framework approach. The overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Controlling for dependency, social engagement, and home type, having access to outdoor space was the only environmental variable to significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside. We provide new evidence to suggest that access to outdoor space predicts depressive symptoms in older people living in care home. Interventions aimed at increasing access to outdoor spaces could positively affect depressive symptoms in older people.

  6. The effect of a music programme during lunchtime on the problem behaviour of the older residents with dementia at an institution in Taiwan.

    PubMed

    Chang, Fang-Yu; Huang, Hui-Chi; Lin, Kuan-Chia; Lin, Li-Chan

    2010-04-01

    To study the effect of a music programme during lunchtime on problem behaviour among institutionalised older residents with dementia. Symptoms of dementia among older people include depression, problems with memory, insomnia and problem behaviours. Problem behaviour has been identified by families and nurses as the greatest challenge that needs to be addressed. Several studies have found that music therapy can reduce problem behaviours among dementia sufferers and, based on this finding, music has been recommended for incorporation as part of dementia management. This study used a quasi-experimental design with an eight-week time series follow-up. The intervention was background music when residents had their lunch meal. A purposive sampling technique was used. Forty-one participants were selected from an institution housing residents with dementia located in a city in Taiwan. The mean age of participants was 81.68 (SD 6.39) years old. The mean score for Mini-Mental State Examination (MMSE) was 10.66 (SD 6.85). The mean of Barthel Activity of Daily Living score was 56.83 (SD 38.12). The results showed that the music programme reduced, significantly, physical and verbal aggressive behaviour among the older residents with dementia. The study identified that there was a one-week time lag between the implementation of the music programme and a significant effect on the residents. The results from this study suggested that music is able to reduce the degree of problem behaviours among the older residents with dementia and this helps to ease work-load of nurse aides and nurses during meal times. The results may serve as a reference for the future treatment of problem behaviour among the older with dementia.

  7. Making sure the residents get their tablets: medication administration in care homes for older people.

    PubMed

    Barnes, Lynne; Cheek, Julianne; Nation, Roger L; Gilbert, Andrew; Paradiso, Lisa; Ballantyne, Alison

    2006-10-01

    This paper reports an exploratory study of issues concerning the nursing practice of altering medication dose forms prior to administration of medicines to residents in homes for older people. Medication use and administration is a major issue in residential homes for older people. Research suggests that the alteration of medication dose forms in these homes is a widespread practice. Despite its prevalence, there is limited nursing or pharmaceutical literature exploring the decision-making processes surrounding this practice, the methods by which medicines are altered, or the types of medicines which are modified. Semi-structured interviews were carried out with 11 Registered Nurses working in a purposive sample of 10 residential homes for older people drawn from each of the six regions of South Australia. The data were collected in 2000. Nurses felt constrained to ensure that prescribed medication was administered to residents, despite their concern that this was not without risk. Nurses were concerned that they were working in an information vacuum, due to limited information resources and informal communication with other healthcare professionals such as speech pathologists, pharmacists and general practitioners. There was also concern about the difficulty of coordinating information and policies about altering medications and of implementing appropriate procedures in individual facilities. Clinical guidelines for the processes surrounding the alteration of medication dose forms and relevant pharmaceutical information are needed in all residential homes for older people. Ongoing education for nurses in this area is also required.

  8. Ethnicity, migration status and dental caries experience among adults in East London.

    PubMed

    Delgado-Angulo, Elsa K; Marcenes, Wagner; Harding, Seeromanie; Bernabé, Eduardo

    2018-05-16

    To assess the interrelationship between ethnicity, migration status and dental caries experience among adults in East London. We analysed data from 1910 adults (16-65 years) representing 9 ethnic groups, who took part in a community-based health survey in East London. Participants completed a supervised questionnaire and were clinically examined by trained dentists. Dental caries was assessed with the number of decayed, missing and filled teeth (DMFT). The association of ethnicity, nativity status and migration history with DMFT was assessed in negative binomial regression models controlling for demographic, socioeconomic and behavioural factors. White migrants had greater DMFT than UK-born adults, whereas every Asian and Black migrant group had lower DMFT than adults of the same ethnic group born in the UK (albeit significant only for Black Caribbean and Asian Others). Among foreign-born adults, age at arrival (Rate Ratio: 1.03; 95% Confidence Interval: 1.01-1.05) and length of residence (1.04; 95% CI: 1.02-1.06) were positively associated with DMFT. A significant interaction between both factors was also found, with more pronounced differences between older and younger migrants at longer stay in the UK for White Others, Black Caribbean and Asian Others. Large inequalities in caries experience were found between foreign- and UK-born adults, with considerable variation across ethnic groups. Looking beyond cultural explanations, in favour of social and environmental factors, may help to explain those inequalities. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Influence of Urban Residence on Use of Psychotropic Medications in Pennsylvania, USA: Cross-sectional Comparison of Older Adults Attending Senior Centers

    PubMed Central

    Edelstein, Offer; Pater, Karen; Sharma, Ravi; Albert, Steven M.

    2014-01-01

    Background Differences in medication use by geographic region may indicate differences in access to specialist medical care, especially in the case of prescriptions for psychotropic medications. We assessed the effect of more or less urbanized residence on likelihood of psychotropic medication use in a large cohort of older adults in Pennsylvania, USA. Methods Community-dwelling older adults were recruited from senior centers across PA. Participant residences were geocoded and categorized according to U.S. Department of Agriculture Rural-Urban Continuum Codes. We used the codes to identify respondents who live in relatively urban counties with 250,000 or more residents (n=1360) or less urban counties with fewer than 250,000 residents (n=401). Participants reported prescription medications in a clinical interview. Psychotropic medications were categorized by class. Logistic regression models were estimated to assess the independent effect of residence on likelihood of psychotropic medication use. Results Geographic region was significantly associated with use of psychotropic medications. Psychotropic medication use was higher in less urban areas (19.7%) relative to more urban areas (14.2%), p =.007. In adjusted models, degree of urban residence was a significant correlate in models that adjusted for sociodemographic features and medical status (odds ratio, 1.62; 95% confidence interval 1.13–2.31, p < .01). Use of psychotropic medications on the Beers list also increased with less urban residence (13.0% vs. 8.3%, p = .005). Conclusions Older adults living in less urbanized areas are more likely to be prescribed psychotropic drugs. This difference may indicate a health disparity based on access to geriatric specialists or mental health care. PMID:24357135

  10. Influence of urban residence on use of psychotropic medications in Pennsylvania, USA: cross-sectional comparison of older adults attending senior centers.

    PubMed

    Edelstein, Offer; Pater, Karen; Sharma, Ravi; Albert, Steven M

    2014-02-01

    Differences in medication use by geographic region may indicate differences in access to specialist medical care, especially in the case of prescriptions for psychotropic medications. We assessed the effect of more or less urbanized residence on likelihood of psychotropic medication use in a large cohort of older adults in Pennsylvania, USA. Community-dwelling older adults were recruited from senior centers across Pennsylvania. Participant residences were geocoded and categorized according to US Department of Agriculture Rural-Urban Continuum Codes. We used the codes to identify respondents who live in relatively urban counties with 250,000 or more residents (n = 1,360) or less urban counties with fewer than 250,000 residents (n = 401). Participants reported prescription medications in a clinical interview. Psychotropic medications were categorized by class. Logistic regression models were estimated to assess the independent effect of residence on likelihood of psychotropic medication use. Geographic region was significantly associated with use of psychotropic medications. Psychotropic medication use was higher in less urban areas (19.7%) relative to more urban areas (14.2%), p = 0.007. In adjusted models, degree of urban residence was a significant correlate in models that adjusted for sociodemographic features and medical status (odds ratio 1.62; 95% confidence interval 1.13-2.31, p < 0.01). Use of psychotropic medications on the Beers list also increased with less urban residence (13.0 vs. 8.3%, p = 0.005). Older adults living in less urbanized areas are more likely to be prescribed psychotropic drugs. This difference may indicate a health disparity based on access to geriatric specialists or mental health care.

  11. The North West London Integrated Care Pilot: innovative strategies to improve care coordination for older adults and people with diabetes.

    PubMed

    Harris, Matthew; Greaves, Felix; Patterson, Sue; Jones, Jessica; Pappas, Yannis; Majeed, Azeem; Car, Josip

    2012-01-01

    The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together more than 100 general practices, 2 acute care trusts, 5 primary care trusts, 2 mental health care trusts, 3 community health trusts, 5 local authorities, and 2 voluntary sector organizations (Age UK and Diabetes UK) to improve the coordination of care for a pilot population of 550 000 people. Specifically, the ICP serves people older than 75 years and those with diabetes. Although still in the early stages of implementation, the ICP has already received national awards for its innovations in design and delivery. This article critically describes the ICP objectives, facilitating processes, and planned impact as well as the organizational and financial challenges that policy makers are facing in the implementation of the pilot program.

  12. Effect of Residence in Temporary Housing After the Great East Japan Earthquake on the Physical Activity and Quality of Life of Older Survivors.

    PubMed

    Moriyama, Nobuaki; Urabe, Yukio; Onoda, Shuichi; Maeda, Noriaki; Oikawa, Tomoyoshi

    2017-12-01

    This study aimed to compare the physical activity level and health-related quality of life (HRQOL) between older survivors residing in temporary housing after the Great East Japan Earthquake (GEJE; temporary housing group) and older individuals residing in their own homes (control group) and to clarify whether mobility function and muscle strength were correlated with physical activity among older temporary housing residents. Subjects were recruited to the temporary housing group (n=64, 19 men and 45 women) or control group (n=64, 33 men and 31 women) according to their residence. Physical activity was assessed by the number of walking steps determined by using a triaxial accelerometer, mobility function by the Timed Up and Go test, muscle strength by the grasping power test, and HRQOL by the Medical Outcome Study 36-Item Short Form Survey v2. In the temporary housing group, reduced physical activity and correlation between physical activity and mobility function in men, and muscle strength in both men and women, were observed. There was no significant difference in HRQOL between groups except for bodily pain in women. Support for older evacuees should focus on maintaining their physical activity level as well as on HRQOL to avoid deterioration of health in these survivors. (Disaster Med Public Health Preparedness. 2017;11:701-710).

  13. Entitlement to concessionary public transport and wellbeing: a qualitative study of young people and older citizens in London, UK.

    PubMed

    Jones, Alasdair; Goodman, Anna; Roberts, Helen; Steinbach, Rebecca; Green, Judith

    2013-08-01

    Access to transport is an important determinant of health, and concessionary fares for public transport are one way to reduce the 'transport exclusion' that can limit access. This paper draws on qualitative data from two groups typically at risk of transport exclusion: young people (12-18 years of age, n = 118) and older citizens (60+ years of age, n = 46). The data were collected in London, UK, where young people and older citizens are currently entitled to concessionary bus travel. We focus on how this entitlement is understood and enacted, and how different sources of entitlement mediate the relationship between transport and wellbeing. Both groups felt that their formal entitlement to travel for free reflected their social worth and was, particularly for older citizens, relatively unproblematic. The provision of a concessionary transport entitlement also helped to combat feelings of social exclusion by enhancing recipients' sense of belonging to the city and to a 'community'. However, informal entitlements to particular spaces on the bus reflected less valued social attributes such as need or frailty. Thus in the course of travelling by bus the enactment of entitlements to space and seats entailed the negotiation of social differences and personal vulnerabilities, and this carried with it potential threats to wellbeing. We conclude that the process, as well as the substance, of entitlement can mediate wellbeing; and that where the basis for providing a given entitlement is widely understood and accepted, the risks to wellbeing associated with enacting that entitlement will be reduced. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Health effects of the London bicycle sharing system: health impact modelling study.

    PubMed

    Woodcock, James; Tainio, Marko; Cheshire, James; O'Brien, Oliver; Goodman, Anna

    2014-02-13

    To model the impacts of the bicycle sharing system in London on the health of its users. Health impact modelling and evaluation, using a stochastic simulation model. Central and inner London, England. Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). 578,607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change -72 DALYs (95% credible interval -110 to -43) among men using cycle hire per accounting year; -15 (-42 to -6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change -49 DALYs (-88 to -17) among men; -1 DALY (-27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled benefits of cycling were much larger than the harms. Using background injury rates in the youngest age

  15. Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility

    PubMed Central

    2011-01-01

    Background Mindfulness-based stress reduction (MBSR) programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges. Methods We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes. Results and discussion Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger. Conclusion A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health. PMID:21627807

  16. Posterior teeth occlusion and dysphagia risk in older nursing home residents: a cross-sectional observational study.

    PubMed

    Okabe, Y; Takeuchi, K; Izumi, M; Furuta, M; Takeshita, T; Shibata, Y; Kageyama, S; Ganaha, S; Yamashita, Y

    2017-02-01

    The total number of natural teeth was related to swallowing function among older adults; however, limited information is available regarding the impact of occluding pairs of teeth on swallowing function. This study aimed to examine the association between posterior teeth occlusion and dysphagia risk in older nursing home residents. This cross-sectional study included 238 residents aged ≥60 years from eight nursing homes in Aso City, Japan. Swallowing function was evaluated using the modified water swallowing test (MWST); the primary outcome was dysphagia risk (MWST score ≤3). Posterior teeth occlusion was assessed using number of functional tooth units (FTUs), determined based on number and location of the remaining natural and artificial teeth on implant-supported, fixed or removable prostheses. Univariate and multivariate logistic regression analyses were performed to examine the association between posterior teeth occlusion and dysphagia risk, adjusted for the covariates of number of natural teeth, demographic characteristics, comorbidities, physical function, body mass index and cognitive function. Of the 238 subjects, 44 (18·5%) were determined to be at risk of dysphagia based on the MWST scores. The odds ratio (OR) of dysphagia risk decreased in subjects with higher total FTUs [OR = 0·92, 95% confidence interval (CI) 0·87-0·98]. After adjusting for covariates, this association remained significant (OR = 0·90, 95% CI 0·84-0·97). Loss of posterior teeth occlusion was independently associated with dysphagia risk in older nursing home residents. Maintaining and restoring posterior teeth occlusion may be an effective measure to prevent dysphagia. © 2016 John Wiley & Sons Ltd.

  17. Accelerometer Assessment of Physical Activity and Its Association with Physical Function in Older Adults Residing at Assisted Care Facilities.

    PubMed

    Corcoran, M P; Chui, K K H; White, D K; Reid, K F; Kirn, D; Nelson, M E; Sacheck, J M; Folta, S C; Fielding, R A

    2016-01-01

    To describe levels of physical activity among older adults residing at assisted care facilities and their association with physical function. Cross-sectional analysis. Assisted care facilities within the greater Boston, MA area. Older adults aged 65 years and older (N = 65). Physical Activity Level (PAL) as defined by quartiles from accelerometry (counts and steps), Short Physical Performance Battery (SPPB) Score, gait speed, and handgrip strength. Participants in the most active accelerometry quartile engaged in 25 minutes/week of moderate to vigorous physical activity (MVPA) and walked 2,150 steps/day. These individuals had an SPPB score, 400 meter walk speed, and handgrip strength that was 3.7-3.9 points, 0.3-0.4 meters/second, and 4.5-5.1 kg greater respectively, than individuals in the lowest activity quartile, who engaged in less than 5 min/wk of MVPA or took fewer than 460 steps/day. Despite engaging in physical activity levels far below current recommendations (150 min/week of MVPA or > 7000 steps/day), the most active older adults in this study exhibited clinically significant differences in physical function relative to their less active peers. While the direction of causality cannot be determined from this cross-sectional study, these findings suggest a strong association between PAL and physical function among older adults residing in an assisted care facility.

  18. Urinary and fecal incontinence in a community-residing older population in Japan.

    PubMed

    Nakanishi, N; Tatara, K; Naramura, H; Fujiwara, H; Takashima, Y; Fukuda, H

    1997-02-01

    To estimate the prevalence and risk factors of urinary and fecal incontinence among a community-residing older population in Japan. Population-based cross-sectional study. A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992. Data collected via in-home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence. Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/ 1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found. By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence. Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.

  19. Predictors of chewing ability among community-residing older adults in Korea.

    PubMed

    Park, Kyongok; Hong, Gwi-Ryung Son

    2017-01-01

    Decreased chewing ability in older adults can lead to poor nutritional and physical conditions, and eventually death. The present study examined the relationships between chewing ability and related characteristics (e.g. health promotion habits, health status and functional status), and identified predictors of chewing ability in community-residing older adults. Among the total of 11 542 participants in the 2011 National Survey on Older Adults in Korea, data from 10 543 participants were used for analysis. Chewing ability was evaluated using a self-report of chewing ability. Exercise ability was assessed by objective exercise ability and perceived exercise ability in both the upper and lower extremities. Depression and cognitive functions were measured using the Geriatric Depression Scale-Short Form and the Mini-Mental State Examination, respectively. A total of 56.9% of participants had poor chewing abilities. After adjusting for age and sex, logistic regression analysis showed that depression (OR 1.76, 95% CI 1.60-1.92), cognitive impairment (OR 1.28, 95% CI 1.17-1.40), objective exercise ability (OR 1.24, 95% CI 1.11-1.41), regular exercise habits (OR 1.23, 95% CI 1.13-1.34), medical check-up history (OR 1.17, 95% CI 1.05-1.32), number of chronic diseases (OR 1.12, 95% CI 1.09-1.15) and perceived exercise ability in the lower extremities (OR 1.08, 95% CI 1.05-1.10) were significant predictors of chewing ability. Chewing ability in older adults should be improved in consideration of mental and general health condition. Geriatr Gerontol Int 2017; 17: 78-84. © 2015 Japan Geriatrics Society.

  20. Smoking history, knowledge, and attitudes among older residents of a long-term care facility.

    PubMed

    Carosella, Ann Marie; Ossip-Klein, Deborah J; Watt, Celia A; Podgorski, Carol

    2002-05-01

    In the absence of empirical literature from the resident perspective, this study provided a first assessment of smoking history, knowledge of the risks of smoking, the risks of environmental tobacco exposure, and the benefits of quitting among older (age 50+) nursing home unit residents, as well as readiness to quit, barriers to quitting, frequency of cessation advice by healthcare givers, and quit-attempt history of residents who smoke. Subjects were 25 smokers and 70 non-smokers housed on long-term nursing home units in a county hospital. Results indicated that smoking status for the majority of residents was similar to when they were admitted, although smokers smoked fewer cigarettes (M = 11.6, SD = 9.2) than prior to admission (M = 18.6, SD = 11.8). Smokers were less likely than non-smokers to agree that smoking is harmful to their health. Both smokers and non-smokers were not well informed of the dangers of passive smoke exposure. The majority of smokers were in precontemplation (no interest in quitting within the next 6 months). Fewer than half of residents who smoked reported receiving cessation advice from physicians (40%) or nurses (36%), and no in-house cessation programs were available. These results suggest gaps in knowledge and resources for smoking cessation in this setting and an opportunity for intervention. This study begins to build an evidence base from the residents' perspective that can be used by healthcare providers, administrators, and policy makers in addressing smoking in the nursing home.

  1. 111. Shaws Cove Bridge. New London, New London Co., CT. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    111. Shaws Cove Bridge. New London, New London Co., CT. Sec. 4209, MP 122.65. - Northeast Railroad Corridor, Amtrak Route between New York/Connecticut & Connecticut/Rhode Island State Lines, New Haven, New Haven County, CT

  2. 110. Shaws Cove Bridge. New London, New London Co., CT. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    110. Shaws Cove Bridge. New London, New London Co., CT. Sec. 4209, MP 122.65. - Northeast Railroad Corridor, Amtrak Route between New York/Connecticut & Connecticut/Rhode Island State Lines, New Haven, New Haven County, CT

  3. Posterior Teeth Occlusion Associated with Cognitive Function in Nursing Home Older Residents: A Cross-Sectional Observational Study

    PubMed Central

    Takeuchi, Kenji; Izumi, Maya; Furuta, Michiko; Takeshita, Toru; Shibata, Yukie; Kageyama, Shinya; Ganaha, Seijun; Yamashita, Yoshihisa

    2015-01-01

    Early detection and subsequent reduction of modifiable risk factors for cognitive decline is important for extending healthy life expectancy in the currently aging society. Although a recent increase in studies on the state or number of the teeth and cognitive function, few studies have focused on the association between posterior teeth occlusion necessary to maintain chewing function and cognitive function among older adults. This study examined the association between posterior teeth occlusion and cognitive function in nursing home older residents. In this cross-sectional study, 279 residents aged ≥60 years from eight nursing homes in Aso City, Japan participated in cognitive function and dental status assessments and completed a comprehensive questionnaire survey in 2014. Cognitive function was measured using a Mini-Mental State Examination (MMSE). Posterior teeth occlusion was assessed using a total number of functional tooth units (total-FTUs), depending on the number and location of the remaining natural and artificial teeth on implant-supported, fixed, and removable prostheses. Linear regression models were used to assess univariate and multivariate associations between total-FTUs and MMSE scores. Models were sequentially adjusted for demographic characteristics, number of natural teeth, socioeconomic status, health behaviors, comorbidities, physical function, and nutritional status. Among the 200 residents included in our analysis, mean MMSE scores and total-FTUs were 11.0 ± 8.6 and 9.3 ± 4.6, respectively. Higher total-FTUs were significantly associated with higher MMSE scores after adjustment for demographics and teeth number (B = 0.48, 95% confidence interval [CI] = 0.22–0.74). The association remained significant even after adjustment for all covariates (B = 0.25, 95% CI = 0.01–0.49). The current findings demonstrated that loss of posterior teeth occlusion was independently associated with cognitive decline in nursing home older residents in

  4. Active Residents in Care Homes (ARCH): study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people.

    PubMed

    Koskela, Sian A; Jones, Fiona; Clarke, Natasha; Anderson, Liezl; Kennedy, Bernadette; Grant, Robert; Gage, Heather; Hurley, Michael V

    2017-03-01

    To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. Feasibility study. Residential care homes for older people. 10-15 residents, staff and family members will be recruited in each of the three participating care homes. ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them. ISRCTN24000891. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  5. Drinking patterns and adherence to "low-risk" guidelines among community-residing older adults.

    PubMed

    Lewis, Ben; Garcia, Christian C; Nixon, Sara Jo

    2018-06-01

    Older adults constitute a rapidly expanding proportion of the U.S. Contemporary studies note the increasing prevalence of alcohol consumption in this group. Thus, understanding alcohol effects, consumption patterns, and associated risks in aging populations constitute critical areas of study with increasing public health relevance. Participants (n = 643; 292 women; ages 21-70) were community residing adult volunteers. Primary measures of interest included four patterns of alcohol consumption (average [oz./day]; typical quantity [oz./occasion]; frequency [% drinking days]; and maximal quantity [oz.]). Regression analyses explored associations between these measures, age, and relevant covariates. Subsequent between-group analyses investigated differences between two groups of older adults and a comparator group of younger adults, their adherance to "low-risk" guidelines, and whether alcohol-associated risks differed by age and adherence pattern. Average consumption did not vary by age or differ between age groups. In contrast, markedly higher frequencies and lower quantities of consumption were observed with increasing age. These differences persisted across adherence categories and were evident even in the oldest age group. Exceeding "low-risk" guidelines was associated with greater risk for alcohol-related problems among the older groups. These results emphasize the utility of considering underlying constituent patterns of consumption in older drinkers. Findings highlight difficulties in identifying problem drinking among older adults and contribute to the few characterizations of "risky" drinking patterns in this group. Taken together, our data contribute to literatures of import for the design and enhancement of screening, prevention, and education initiatives directed toward aging adults. Copyright © 2018. Published by Elsevier B.V.

  6. Patterns of dignity-related distress at the end of life: a cross-sectional study of patients with advanced cancer and care home residents.

    PubMed

    Hall, Sue; Davies, Joanna M; Gao, Wei; Higginson, Irene J

    2014-10-01

    To provide effective palliative care in different settings, it is important to understand and identify the sources of dignity-related distress experienced by people nearing the end of life. To describe and compare the sources of dignity-related distress reported by cancer patients and care home residents. Secondary analysis of merged data. Participants completed the Patient Dignity Inventory (assessing 25 sources of dignity-related distress) and measures of quality of life and depression. A total of 45 adult patients with advanced cancer referred to hospital-based palliative care teams in London, United Kingdom, and 60 residents living in one of 15 care homes in London. Care home residents were older and had poorer functioning. Both groups reported a wide range of dignity-related problems. Although the number or problems reported on the Patient Dignity Inventory was similar for the two groups (mean (standard deviation): 5.9 (5.5) for cancer patients and 4.1 (4.3) for care home residents, p = 0.07), there was a tendency for more cancer patients to report some existential problems. Experiencing physically distressing symptoms and functional limitations were prevalent problems for both groups. Patient Dignity Inventory problems were associated with poorer performance status and functioning for residents, with age and cognitive impairment for cancer patients and with poorer quality of life and depression for both groups. Although characteristics of the samples differed, similarities in the dignity-related problems reported by cancer patients and care home residents support research suggesting a common pathway towards death for malignant and non-malignant disease. A wider understanding of the sources of dignity-related distress would help clinicians provide more effective end-of-life care. © The Author(s) 2014.

  7. Fritz London

    NASA Astrophysics Data System (ADS)

    Gavroglu, Kostas

    2005-11-01

    Preface; Acknowledgements; Part I. From Philosophy to Physics: The years that left nothing unaffected; 1. The appeal of ideas; 2. Goëthe as a scientist; 3. How absolute is our knowledge?; 4. How do we come to know things?; 5. London's teachers in philosophy; 6. Husserl's teachings; 7. Expectations of things to come; 8. The thesis in philosophy; 9. Tolman's principle of similitude; 10. The necessary clarifications; 11. Work on quantum theory; 12. Transformation theory; 13. Unsuccessful attempts at unification; Part II. The Years in Berlin and the Beginnings of Quantum Chemistry: The mysterious bond; 14. London in Zürich; 15. Binding forces; 16. The Pauli principle; 17. Reactions to the Heitler-London paper; 18. Polyelectronic molecules and the application of group theory to problems of chemical valence; 19. Chemists as physicists?; 20. London's first contacts in Berlin; 21. Marriage; 22. Job offers; 23. Intermolecular forces; 24. The book which could not be written; 25. Leningrad and Rome; 26. Difficulties with group theory; 27. Linus Pauling's resonance structures; 28. Robert Mulliken's molecular orbitals; Part III. Oxford and Superconductivity: The rise of the Nazis; 29. Going to Oxford; 30. Lindemann, Simon and Heinz London; 31. Electricity in the very cold; 32. The end of old certainties; 33. The thermodynamic treatment; 34. The theory of Fritz and Heinz London; 35. Initial reactions by von Laue; 36. The discussion at the Royal Society; 37. Termination of the ICI fellowship; Part IV. Paris and Superfluidity: The Front Populaire; 38. The article in Nature 1937 and 'Nouvelle Conception'; 39. Laue again; 40. The structure of solid helium; 41. The peculiar properties of helium; 42. Bose-Einstein condensation; 43. The note in Nature; 44. The two-fluid model; 45. The trip to Jerusalem; 46. Leaving again; 47. The observer in quantum mechanics; Part V. United States and the Typing up of Loose Ends: Duke University, North Carolina; 48. The Soviet Union, Kapitza and

  8. Stress and depression among older residents in religious monasteries: do friends and God matter?

    PubMed

    Bishop, Alex J

    2008-01-01

    The purpose of this investigation was to explore how friendship and attach-0 ment to God provide protective benefits against stress and depression. Participants included 235 men and women, age 64 and older, residing in religious monasteries affiliated with the Order of St. Benedict. Hierarchical multiple regression analyses were completed to assess main and moderating effects of friendship and attachment to God relative to the influence of stress on depressive symptomology. Lower degree of friendship closeness (beta = -.12, p < .10) and greater insecurity with God (beta = -.15, p < .01) were directly associated with greater depressive symptoms. A significant three-way interaction (Stress x Friendship x Attachment to God) also existed relative to depressive symptoms (beta = .14, p < .05). Three "stress-buffering" mechanisms emerged relative to the influence of stress on depressive symptomology. First, a greater degree of friendship closeness in combination with less secure attachment to God represented a greater risk for depressive symptoms. Second, greater friendship closeness in combination with greater secure attachment to God reduced the risk for depressive symptoms. Third, lower degree of friendship closeness combined with less secure attachment to God diminished the noxious effects of stress on depressive symptoms. This has implications relative to how social and spiritual resources can be used to reduce stress and improve quality of life for older adults residing in religious communities.

  9. Investigating the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults.

    PubMed

    Heisel, Marnin J; Flett, Gordon L

    2016-01-01

    To investigate the psychometric properties of the Geriatric Suicide Ideation Scale (GSIS) among community-residing older adults. We recruited 173 voluntary participants, 65 years and older, into a 2+ year longitudinal study of the onset or exacerbation of depressive symptoms and suicide ideation. We assessed the internal consistency of the GSIS and its four component subscales, and its shorter and longer duration test-retest reliability, convergent (depression, social hopelessness, and loneliness), divergent (psychological well-being, life satisfaction, perceived social support, and self-rated health), discriminant (basic and instrumental activities of daily living and social desirability), criterion (history of suicide behavior), and predictive validity (future suicide ideation). The GSIS demonstrated strong test-retest reliability and internal consistency. Baseline GSIS scores were significantly positively associated with suicide risk factors, negatively associated with potential resiliency factors, and not associated with functional impairment or social desirability. GSIS scores significantly differentiated between participants with as compared to those without a history of suicide behavior. Baseline GSIS scores significantly predicted suicide ideation at a 2+ year follow-up assessment. Findings suggest strong measurement characteristics for the GSIS with community-residing older adults, including impressive consistency over time. These results are consistent with research attesting to the empirical and pragmatic strengths of this measure. These findings have implications for the monitoring of suicide risk when aiming to enhance mental health and well-being and prevent suicide in later life.

  10. Risk and protective factors associated with intentional self-harm among older community-residing home care clients in Ontario, Canada.

    PubMed

    Neufeld, Eva; Hirdes, John P; Perlman, Christopher M; Rabinowitz, Terry

    2015-10-01

    We aim to concurrently examine risk and protective factors associated with intentional self-harm among community-residing older adults receiving home care services in Ontario, Canada. Administrative health data from the home care sector were linked to hospital administrative data to carry out the analyses. Home care data are collected in Ontario using the Resident Assessment Instrument-Home Care (RAI-HC), an assessment tool that identifies strengths, preferences and needs of long-stay home care clients. The sample included Ontario home care clients aged 60 years or older assessed with the RAI-HC between 2007 and 2010 (N = 222,149). Multivariable analyses were performed using SAS. Hospital records of intentional self-harm (ISH) were present in 9.3 cases per 1000 home care clients. Risks of ISH included younger age (60-74 years; OR = 3.14, CI: 2.75-3.59), psychiatric diagnosis (OR = 2.29, CI: 2.06-2.54), alcohol use and dependence (OR = 1.69, CI: 1.34-2.14), psychotropic medication (OR = 1.94, CI: 1.75-2.15) and depressive symptoms (OR = 1.58, CI: 1.40-1.78). Protective effects were found for marital status and positive social relationships, yet these effects were more pronounced for men. Cognitive performance measures showed the odds of ISH 1.86 times higher for older adults with moderate to severe cognitive impairment. This study based on provincial data points to tangible areas for preventative assessment by frontline home care professionals. Of interest were the risk and protective factors that differed by sex. As demand for home care in Canada is expected to increase, these findings may inform home care professionals' appraisal and approach to suicide prevention among community-residing older adults. Copyright © 2015 John Wiley & Sons, Ltd.

  11. Effects of Horticultural Therapy on Psychosocial Health in Older Nursing Home Residents: A Preliminary Study.

    PubMed

    Chen, Yuh-Min; Ji, Jeng-Yi

    2015-09-01

    This preliminary study examined the effect of horticultural therapy on psychosocial health in older nursing home residents. A combined quantitative and qualitative design was adopted. Convenience sampling was used to recruit 10 older residents from a nursing home in Taichung, Taiwan. Participants joined a 10-week indoor horticultural program once a week, with each session lasting for about 1.5 hours. A single-group design with multiple measurements was adopted for the quantitative component of this study. Interviews held 1-2 days before the intervention (T0) were used to collect baseline data. The two outcome variables of this study, depression and loneliness, were reassessed during the 5th (T1) and 10th (T2) weeks of the intervention. Generalized estimating equations were used to test the mean differences among T0, T1, and T2 measures. After the 10-week program, qualitative data were collected by asking participants to share their program participation experiences. The results of generalized estimating equation showed significant improvements in depression and loneliness. Four categories emerged from the qualitative data content analysis: social connection, anticipation and hope, sense of achievement, and companionship. Given the beneficial effects of the horticulture therapy, the inclusion of horticultural activities in nursing home activity programs is recommended.

  12. Postprandial hypotension among older residents of a nursing home in Korea.

    PubMed

    Son, Jung Tae; Lee, Eunjoo

    2012-12-01

    The purpose of this study was to identify changes in blood pressure and pulse rate after a meal for elders living in a nursing home. Postprandial hypotension is a major health issue for older persons, because it has been shown to cause increased incidence of falls, syncope, coronary disease, strokes and deterioration in the quality of life. However, there has been little systematic investigation into blood pressure changes after meals in older people. A descriptive, cross-sectional design was used to identify postprandial blood pressure and pulse rate changes in residents of a nursing home. Blood pressure and pulse rates of 121 people aged 65 and above were measured before and after a meal and at 15-minute intervals for six more measurements. Data were analysed with descriptive statistics, repeated measures anova and paired t-tests using SPSS (SPSS Inc., Chicago, IL, USA). There were significant differences in systolic and diastolic pressure by time. The biggest drop in systolic and diastolic blood pressure occurred at 45 minutes after the meal. There was no significant change in pulse rates except for immediately after the meal. To prevent complications from drops in postprandial blood pressure, nurses should carefully monitor blood pressure of elders at least from 30-90 minutes after meals. Further study of drops in postprandial blood pressure should be conducted for various types and times of meals. Nurses caring for older persons can identify drops in the postprandial blood pressure to manage the incidence of falls, syncope and stroke more effectively, especially in nursing homes. © 2012 Blackwell Publishing Ltd.

  13. Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.

    PubMed

    Barthalos, Istvan; Dorgo, Sandor; Kopkáné Plachy, Judit; Szakály, Zsolt; Ihász, Ferenc; Ráczné Németh, Teodóra; Bognár, József

    2016-10-01

    Nursing home residing older adults often experience fear of sickness or death, functional impairment and pain. It is difficult for these older adults to maintain a physically active lifestyle and to keep a positive outlook on life. This study evaluated the changes in quality of life, attitude to aging, assertiveness, physical fitness and body composition of nursing home residing elderly through a 15-week organized resistance training based physical activity program. Inactive older adults living in a state financed nursing home (N.=45) were randomly divided into two intervention groups and a control group. Both intervention groups were assigned to two physical activity sessions a week, but one of these groups also had weekly discussions on health and quality of life (Mental group). Data on anthropometric measures, fitness performance, as well as quality of life and attitudes to aging survey data were collected. Due to low attendance rate 12 subjects were excluded from the analyses. Statistical analysis included Paired Samples t-tests and Repeated Measures Analysis of Variance. Both intervention groups significantly improved their social participation, and their upper- and lower-body strength scores. Also, subjects in the Mental group showed improvement in agility fitness test and certain survey scales. No positive changes were detected in attitude towards aging and body composition measures in any groups. The post-hoc results suggest that Mental group improved significantly more than the Control group. Regular physical activity with discussions on health and quality of life made a more meaningful difference for the older adults living in nursing home than physical activity alone. Due to the fact that all participants were influenced by the program, it is suggested to further explore this area for better understanding of enhanced quality of life.

  14. Employment hardship among older workers: does residential and gender inequality extend into older age?

    PubMed

    Slack, Tim; Jensen, Leif

    2008-01-01

    The realities of a rapidly aging society make the employment circumstances of older workers an increasingly important social issue. We examine the prevalence and correlates of underemployment among older Americans, with a special focus on residence and gender, to provide an assessment of the labor market challenges facing older workers. We analyzed data from the March Current Population Surveys for the years 2003, 2004, and 2005. We used descriptive statistics to explore the prevalence of underemployment among older workers and developed multivariate models to assess the impact of age, residence, and gender on the likelihood of underemployment, net of other predictors. We found clear disadvantages for older workers relative to their middle-aged counterparts, and particular disadvantages for older rural residents and women. Multivariate models showed that the disadvantages of older age held net of other predictors. The results also indicated that much of the disadvantage faced by older rural workers and women was explained by factors other than age, particularly education. In an aging society, underemployment among older workers comes at an increasing social cost. Policies aimed at supporting older workers and alleviating employment hardship among them are increasingly in the public interest.

  15. Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway.

    PubMed

    Drageset, Jorunn; Natvig, Gerd Karin; Eide, Geir Egil; Clipp, Elizabeth C; Bondevik, Margareth; Nortvedt, Monica W; Nygaard, Harald A

    2008-05-01

    To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years. All nursing home residents had a Clinical Dementia Rating Scale score > or =0.5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23.2 and mean general population 62.9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. This study

  16. Physiotherapists' perceived motivators and barriers for organizing physical activity for older long-term care facility residents.

    PubMed

    Baert, Veerle; Gorus, Ellen; Guldemont, Nele; De Coster, Sofie; Bautmans, Ivan

    2015-05-01

    Information regarding factors that hinder or stimulate older adults in long-term care facilities (LTCF) for being physically active is available in the literature, but much less is known regarding perceived motivators and barriers among physiotherapists (PTs) to organize physical activity (PA) in LTCF. The main purpose of this study was to examine factors influencing PTs to organize PA in LTCF for older adults. A secondary goal was to examine the PTs' knowledge about and their barriers at the PA guidelines for older adults of the World Health Organization (WHO). A mixed qualitative and quantitative study was carried out using semistructured interviews (n = 24) followed by an online survey (n = 254). As a frame the social-ecological model (McLeroy) was used, distinguishing factors at the intrapersonal, interpersonal, and community level. In the qualitative component the PTs reported 41 motivators and 35 barriers for organizing PA in LTCF. The survey revealed that although the majority of the respondents (71%) are convinced of the usefulness of PA in LTCF, 84% are not familiar with the WHO-guidelines. Seventy-five percent of the respondents believe that the WHO-guidelines are not feasible for LTCF-residents. The strongest motivators on the intrapersonal level were maintaining the independence of the residents (98%), reducing the risk of falling (98%), and improving the physical (93%) and psychological (90%) wellbeing of LTCF-residents. The social interaction among LTCF-residents (91%) during PA was the strongest motivator on the interpersonal level. Motivators on the community level are the belief that PA is the basis of their physiotherapeutic work (89%) and that offering varied activities avoids PA becoming monotonous (71%). Barriers on the intra- and interpersonal level were of less influence. On the community level, they felt hindered to organize PA because of lack of time (38%) and the overload of paperwork (33%). This study described different motivators

  17. The relationship between older Americans act in-home services and low-care residents in nursing homes.

    PubMed

    Thomas, Kali S

    2014-03-01

    The aim of the study was to investigate the relationship between supportive services provided under Title III-B of the Older Americans Act (OAA) and the prevalence of low-care residents in nursing homes (NHs). State Program Reports (state-level expenditure and utilization data for each OAA service) and NH facility-level data were analyzed using a two-way fixed effects model. Results suggest that every additional 1% of the population age 65+ that receives personal care services is associated with a 0.8% decrease in the proportion of low-care residents in NHs. Despite efforts to rebalance long-term care, there are still many NH residents who have the functional capacity to live in a less restrictive environment. This is among the first studies to suggest that states that have invested in their in-home supportive services, particularly personal care services provided through the OAA, have proportionally fewer of these people.

  18. Does Recognition of Meaning in Life Confer Resiliency to Suicide Ideation Among Community-Residing Older Adults? A Longitudinal Investigation.

    PubMed

    Heisel, Marnin J; Flett, Gordon L

    2016-06-01

    To test a theoretical model of the onset and/or exacerbation of late-life suicide ideation, incorporating consideration of risk, resiliency, and precipitating factors. A longitudinal study investigating whether recognition of meaning in life (MIL) at baseline confers resiliency to the onset and/or exacerbation of suicide ideation over a 6- to 22-month period of follow-up, controlling for baseline depression, self-rated health, and physical functioning, and for frequency and intensity of intervening daily hassles. Mental health research offices in an urban academic health sciences center. 173 community-residing older adults (mean: 73.9 years, SD: 6.1 years, range: 65-93 years) recruited from health, wellness, and interest programs, and from newspaper ads and flyers posted in London, Ontario, a mid-sized Canadian city. A total of 126 (73%) completed follow-up assessments. Participants completed a demographics form, a cognitive screen, and measures of suicide ideation and of risk (depressive symptom severity, self-rated health problems, and physical functioning) and potential resiliency (recognition of MIL) factors at baseline and follow-up assessment points, and a measure of intervening daily hassles. MIL at baseline was negatively associated with the onset and/or exacerbation of suicide ideation over time, controlling for risk factors and intervening precipitating factors. The extent and relative significance of this finding differed with the manner in which MIL and suicide ideation were operationalized. Study findings add to a growing body of knowledge suggesting that MIL may play an important role in promoting mental health and well-being and potentially conferring resiliency to contemplations of suicide in later life. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  19. Health effects of the London bicycle sharing system: health impact modelling study

    PubMed Central

    Tainio, Marko; Cheshire, James; O’Brien, Oliver; Goodman, Anna

    2014-01-01

    Objective To model the impacts of the bicycle sharing system in London on the health of its users. Design Health impact modelling and evaluation, using a stochastic simulation model. Setting Central and inner London, England. Data sources Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). Participants 578 607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. Main outcome measures Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. Results Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change −72 DALYs (95% credible interval −110 to −43) among men using cycle hire per accounting year; −15 (−42 to −6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change −49 DALYs (−88 to −17) among men; −1 DALY (−27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled

  20. Biomedicine and 'Risky' Retirement Destinations: Older Western Residents in Ubud, Bali.

    PubMed

    Green, Paul

    2016-01-01

    International retirement migration is often conflated with the generic emergence of a new stage in the life course, the third age. I describe how well-travelled, globally orientated retirees are drawn to and experience biomedical provision in 'risky' retirement destinations. Drawing on ethnographic research in Ubud, Bali, Indonesia, I consider how older Western residents shape, share, and manage their health concerns in light of an Indonesian biomedical system that is transforming in the context of modern medical provision and an emerging retirement industry. Building on Rose and Novas's notion of biological citizenship, I illustrate the ways in which Western retirees engage with multiple biomedical realities built around localized, symbolic distinctions between 'hospital' and 'doctor,' immigration frameworks, the transregional context of medical tourism, and broader concerns relating to change and overdevelopment in Ubud and Bali.

  1. Employment Hardship Among Older Workers: Does Residential and Gender Inequality Extend Into Older Age?

    PubMed Central

    Slack, Tim; Jensen, Leif

    2008-01-01

    Objectives. The realities of a rapidly aging society make the employment circumstances of older workers an increasingly important social issue. We examine the prevalence and correlates of underemployment among older Americans, with a special focus on residence and gender, to provide an assessment of the labor market challenges facing older workers. Methods. We analyzed data from the March Current Population Surveys for the years 2003, 2004, and 2005. We used descriptive statistics to explore the prevalence of underemployment among older workers and developed multivariate models to assess the impact of age, residence, and gender on the likelihood of underemployment, net of other predictors. Results. We found clear disadvantages for older workers relative to their middle-aged counterparts, and particular disadvantages for older rural residents and women. Multivariate models showed that the disadvantages of older age held net of other predictors. The results also indicated that much of the disadvantage faced by older rural workers and women was explained by factors other than age, particularly education. Discussion. In an aging society, underemployment among older workers comes at an increasing social cost. Policies aimed at supporting older workers and alleviating employment hardship among them are increasingly in the public interest. PMID:18332197

  2. Patient, resident, or person: Recognition and the continuity of self in long-term care for older people.

    PubMed

    Pirhonen, Jari; Pietilä, Ilkka

    2015-12-01

    Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of 'total' institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Constructing the meaning of quality of life for residents in care homes in the Lebanon: perspectives of residents, staff and family.

    PubMed

    Adra, Marina Gharibian; Hopton, John; Keady, John

    2015-12-01

    Located in two care homes in Lebanon, the study explores the perspectives of quality of life for a sample of older residents, care staff and family caregivers. Quality of life for older people living in care homes is traditionally reported in the literature as a Westernised construct and so far little is known about its meanings from an Arabic cultural perspective and context. There is also a knowledge gap about the conditions of older people living in care homes in Lebanon. The study was a qualitative exploration of perspectives of quality of life of older residents, care staff and family caregivers. Two care homes for older people situated in Beirut took part in the study. Between 2010 and 2011 semi-structured interviews were undertaken with a sample of 20 residents, eight family caregivers and 11 care staff. Data were analysed using the constant comparative method. Four categories emerged from this analytical process: (i) maintaining family connectedness; (ii) engaging in worthwhile activities; (iii) maintaining and developing significant relationships; and (iv) holding and practicing spiritual beliefs. The emergence of these categories confirmed the complex, interrelated and multidimensional nature of quality of life for residents and other stakeholders. The findings supplement an emerging body of knowledge about the composition of quality of life for older residents in Lebanon. Improving the quality of life of older residents will require action in respect of all of the domains identified in study. Moving nursing practice from task-based care to relationship-centred approaches was seen as pivotal in helping to develop quality of life for residents living in the participating care homes. The findings have implications for education, nursing practice and research in Lebanon and help start an evidence base for care. © 2015 John Wiley & Sons Ltd.

  4. London's historic pea-soupers''

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Urbinato, D.

    Americans may think smog was invented in Los Angeles. Not so. In fact, a Londoner coined the term smog'' in 1905 to describe the city's insidious combination of natural fog and coal smoke. By then, the phenomenon was part of London history, and dirty, acrid smoke-filled pea-soupers'' were as familiar to Londoners as Big Ben and Westminster Abby. Smog in London predates Shakespeare by four centuries. Until the 12th century, most Londoners burned wood for fuel. But as the city grew and the forests shrank, wood became scarce and increasingly expensive. Large deposits of sea-coal'' off the northeast coast providedmore » a cheap alternative. Soon, Londoners were burning the soft, bituminous coal to heat their homes and fuel their factories. Sea-coal was plentiful, but it didn't burn efficiently. A lot of its energy was spent making smoke, not heat. Coal smoke drifting through thousands of London chimneys combined with clean natural fog to make smog. If the weather conditions were right, it would last for days. Early on, no one had the scientific tools to correlate smog with adverse health effects, but complaints about the smoky air as an annoyance date back to at least 1272, when King Edward I, on the urging of important noblemen and clerics, banned the burning of sea-coal. Anyone caught burning or selling the stuff was to be tortured or executed. The first offender caught was summarily put to death. This deterred nobody. Of necessity, citizens continued to burn sea-coal in violation of the law, which required the burning of wood few could afford.« less

  5. The impact of private-sector provision on equitable utilisation of coronary revascularisation in London.

    PubMed

    Mindell, J; Klodawski, E; Fitzpatrick, J; Malhotra, N; McKee, M; Sanderson, C

    2008-08-01

    To investigate the impact of including private-sector data on assessments of equity of coronary revascularisation provision using NHS data only. Analyses of hospital episodes statistics and private-sector data by age, sex and primary care trust (PCT) of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. Gini coefficients were derived to provide an index of inequality across subpopulations, with parametric bootstrapping to estimate confidence intervals. London. London residents undergoing coronary revascularisation April 2001-December 2003. Coronary artery bypass graft or angioplasty. Directly standardised revascularisation rates, Gini coefficients. NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p = 0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS-funded care alone. Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place.

  6. A relational perspective on autonomy for older adults residing in nursing homes.

    PubMed

    Sherwin, Susan; Winsby, Meghan

    2011-06-01

    To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent's deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population. © 2010 Blackwell Publishing Ltd.

  7. Are Londoners Prepared for an Emergency? A Longitudinal Study Following the London Bombings

    PubMed Central

    Rubin, James; Amlôt, Richard; Simpson, John; Wessely, Simon

    2008-01-01

    The UK government sees increasing individual preparedness as a priority, but the level of preparedness of people in the UK for a large-scale emergency is not known. The London bombings of July 7, 2005, affected many Londoners and may have altered their sense of vulnerability to a future terrorist attack. We used a longitudinal study design to assess individual preparedness within the same sample of Londoners at 2 points in time: immediately after the bombings (T1) and 7 to 8 months later (T2). A demographically representative sample of 1,010 Londoners participated in a phone interview at T1. Subsequently, at T2, 574 of the same people participated in a follow-up phone interview. At T1 51% of Londoners had made 4 or more relevant emergency plans; 48% had gathered 4 or more relevant supplies in case of emergency. There was evidence of increased preparedness at T2, by which time 90% had made 4 or more emergency plans. Ethnicity, low social status, and having felt a sense of threat during the bombings predicted increased preparedness between T1 and T2. Women in general, and women of low social status in particular, perceived themselves to be unprepared in the event of a future terrorist attack. In summary, Londoners show moderate levels of emergency preparedness, which increased following the London bombings. Although we cannot know whether this association is causal, the prospective nature of the study increases the likelihood that it is. However, preparedness is still patchy, and there are important demographic associations with levels of preparedness and perception of vulnerability. These findings have implications for future development of individual and community emergency preparedness policy. PMID:19117430

  8. Beck Exportation: London and Sydney

    NASA Astrophysics Data System (ADS)

    Cartwright, William; Field, Kenneth

    2018-05-01

    Henry (Harry) Beck's schematic map of the London Underground is the foundation for most `modern' representations of metropolitan rail systems. From its introduction in the 1930s, it has been the image of the London underground rail transportation system, and, indeed, the image of London itself. Following the launch of the schematic map in 1933 Londoners adopted his representation of the underground as the favoured transportation navigation tool, but also as a physical affirmation that they were citizens of a modern city, a city of electricity and the avant-garde. The London Underground map, as well as being the physical image of the underground rail system, became the signature of the modern city itself. It projected order, systematic transportation and commuter convenience. The map reinforced the general belief that a modern transportation system was at the very heart of what made a city a city. Building upon the success of the map, Beck, and the London Passenger Transport Board, explored how this `take' on the representation of an urban transportation system might be exported to other European, and Antipodean rail networks. This paper provides a dialogue on how Beck's concept for the `metromap' was offered as an alternative navigational diagram to the, then new, Sydney underground system. It then outlines the results of an investigation about how this `Exportation' of Beck's design resulted in the 1939 Sydney metromap that was a clone of the London Underground map.

  9. SOS--Satisfied or Stuck, Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah

    ERIC Educational Resources Information Center

    Erickson, Lance D.; Call, Vaughn R. A.; Brown, Ralph B.

    2012-01-01

    As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan…

  10. Urban-rural differences in social capital in relation to self-rated health and subjective well-being in older residents of six regions in Poland.

    PubMed

    Tobiasz-Adamczyk, Beata; Zawisza, Katarzyna

    2017-06-12

    The aim of the study was to assess the differences between rural and urban areas as regards the role of social capital and its effect on self-rated health and subjective well-being among older people in Poland. The sample was selected on the basis of multi-stage clustered design from the non-institutionalized adult population. Analysis was based on 1,299 elderly people aged 65 and over from the general Polish population who participated in the COURAGE in Europe project. Six regions of Poland were distinguished according to first level of Nomenclature of Units for Territorial Statistics (NUTS) classification . As an indicator of social capital, the COURAGE Social Network Index, the OSLO-3 Social Support Scale, and the three item UCLA Loneliness scale were used, as well as social participation and trust was assessed. Self-rated health (SRH) was measured by WHO-Europe recommended version (ranging from 'very good' to 'very bad'). Well-being was assessed by the Day Reconstruction Method. Results: The results showed that in urban areas, social network and social participation supported positive self-rated health; in rural, older residents the number of years of education and social support played the same role, while self-rated health decreased with an increasing level of loneliness. Self-rated health decreased in both groups of older people with a growing number of diseases. The multivariate linear regression model of predictors of well-being in older age also confirmed differences between urban and rural elderly residents. In rural residents, subjective well-being significantly increased with the positive effect of the social network. In both urban and rural areas, poor assessment of subjective well-being in older age increased with a higher level of loneliness and growing number of chronic diseases.

  11. Effects of a community health promotion program on social factors in a vulnerable older adult population residing in social housing.

    PubMed

    Agarwal, Gina; Brydges, Madison

    2018-04-16

    Supporting older adults' health and wellbeing in the community is an important policy goal that can be supported by health promotion. Despite widespread acceptance of the biopsychosocial model of health and its relation to health, many health promotion programs fail to realize this model in program design. Further, there is limited evidence to support program design targeting social determinants of health such as social isolation or connectedness. To fill this gap, we aimed to understand older adult's experiences participating in cardiovascular health promotion program in a subsidized residential building to capture unintended 'spin-off' psychosocial effects. This study took a constructivist, ethnographic approach utilizing participant observation and semi-structured interviews with participants of the program to understand participant's lived experiences of a health promotion program. In total, we conducted eighty hours of field work and fifteen semi-structured interviews with participants of the program. Thematic analysis was used to analyze the data. Four themes emerged. First, the health promotion program filled a perceived gap caused by a constrained and impersonal health care system. Secondly, the program connected older adults with resources and provided regular and secure access to health information and support. Third, for some residents, the program facilitated social relationships between older adults, leaving participants feeling more socially connected to other residents. Lastly, a paradox of loneliness emerged where older adults talked openly about feelings of loneliness, however not in relation to themselves, but rather regarding their peers. Psychosocial aspects of health, such as loneliness, social connectedness, and social support may be of equal value as the physical health benefits to the older adults who participate in health promotion programs. Incorporating these elements into programming is a complex goal, and the complexity of targeting

  12. Social Resources and Disordered Living Conditions: Evidence from a National Sample of Community-Residing Older Adults

    PubMed Central

    Cornwell, Erin York

    2015-01-01

    For older adults aging in the community, living conditions can promote health, enhance coping, and reduce disablement – but they can also create stress and increase risks of illness, accidents, and decline. While socioeconomic disparities in housing likely contribute to inequalities in interior conditions, I argue that living conditions are also shaped by social resources such as co-residential relationships, social network ties, and social support. In this paper, I examine the distribution of a set of risky or stressful physical and ambient living conditions including structural disrepair, clutter, lack of cleanliness, noise, and odor. Using data from the National Social Life, Health, and Aging Project (NSHAP), I find that low income and African American older adults have more disordered living conditions, as do those with poorer physical and mental health. In addition, older adults who have a co-resident partner, more non-residential network ties, and more sources of instrumental support are exposed to fewer risky or harmful living conditions. This suggests that living conditions are an important, though overlooked, mechanism through which household composition, social networks, and social support affect health and well being in later life. PMID:25651314

  13. A relational perspective on autonomy for older adults residing in nursing homes

    PubMed Central

    Sherwin, Susan; Winsby, Meghan

    2011-01-01

    Abstract Aim  To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Background  Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. Methods  We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. Conclusion  We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent’s deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population. PMID:21029285

  14. Facility Focus: Residence Halls.

    ERIC Educational Resources Information Center

    College Planning & Management, 2002

    2002-01-01

    Describes residence halls seeking to meet needs beyond traditional mass housing for the 18- to 22-year-old students: Whittemore Hall at the Tuck School of Business at Dartmouth College (for older students); Small Group Housing at Washington University (grouping students with common interests); and the renovation of the residence hall at Boston's…

  15. Correlates of lifetime alcohol misuse among older community residents in Brazil

    PubMed Central

    Blay, Sergio Luis; Fillenbaum, Gerda G.; Andreoli, Sergio Baxter; Gastal, Fabio Leite

    2009-01-01

    Background Little is known about the sociodemographic correlates and health effects associated with lifetime alcohol misuse in community resident elderly in Brazil. Method Data came from a representative sample of 6961 residents aged 60+ in the State of Rio Grande do Sul, Brazil. The structured interview included a five-item lifetime alcohol use questionnaire addressing abuse and dependence, and enquiry regarding sociodemographic characteristics, lifestyle and social support, and health conditions. Results Of the sample, 10.6% (25.3% men, 2.9% women) endorsed at least one lifetime alcohol misuse question. Controlled analyses comparing a gradient of alcohol misuse (none, one, more than one item endorsed), found that men, people age 60–69 (compared to older persons), and tobacco users were more likely to endorse alcohol misuse items. Persons reporting lower income, and of nonWhite race/ethnicity did not differ from their comparison groups with respect to endorsing one item, but they were more likely to endorse two or more items. Endorsing more than one item was associated with impaired activities of daily living, the presence of respiratory problems and psychiatric disorder, but was protective against vascular conditions. Conclusions Major lifetime alcohol misuse (defined as endorsing more than one of five items reflecting alcohol abuse or dependence) is more common in certain sociodemographic groups (men, younger elderly, lower income, nonWhites). With the exception of vascular conditions, it is associated with smoking, poorer functional status, respiratory problems, and psychiatric disorder. Endorsing only one item has a reduced association, significant only for male gender, smoking, and psychiatric disorder. PMID:19141169

  16. Staff perspectives on the provision of end-of-life care in a community residence for older adults with developmental disabilities.

    PubMed

    Kirkendall, Abbie M; Waldrop, Deborah

    2013-09-01

    The purpose of the study was to describe the perceptions of community residence (CR) staff who have cared for older adults with developmental disabilities (ADDs) that are at the end of life. This exploratory, descriptive study utilized qualitative methods that involved semistructured interviews with CR staff members. The setting was a CR that was also an intermediate care facility (ICF) that provided 24-hour residential treatment for medical and/or behavioral needs. At least one registered nurse was present at all times. A CR with at least one resident who was over the age of 40 and had a diagnosis of a life-limiting illness was chosen. Participants included three frontline workers, four managers, and one registered nurse. In-person interviews included open-ended questions about end-of-life care for older ADDs. Demographics such as age, length of time working with ADDs, and education were analyzed using descriptive statistics. Descriptive statistics were used to analyze demographics such as age, and length of time working with ADDs. Interviews were digitally recorded, transcribed, and analyzed using grounded theory techniques. Four themes illuminated unique elements of the provision of end-of-life care in a CR: (1) influence of relationships, (2) expression of individuality, (3) contribution of hospice, (4) grief and bereavement, and (5) challenges to end-of-life care. The results provided insight into the unique needs of older ADDs at the end of life and how this influences their care. Emphasis was also placed on the importance of specialized care that involved collaborations with hospice for older ADDs who remain in a CR at the end of life.

  17. Preventive care in general practice among healthy older New South Wales residents.

    PubMed

    Harris, Mark F; Islam, Fakhrul Md; Jalaludin, Bin; Chen, Jack; Bauman, Adrian E; Comino, Elizabeth J

    2013-06-16

    Despite being at high risk, disadvantaged patients may be less likely to receive preventive care in general practice. This study aimed to explore self-reported preventive care received from general practitioners and the factors associated with this by healthy New South Wales (NSW) residents aged 45-74 years. A self-completed questionnaire was sent to 100,000 NSW residents in the 45 and Up cohort study. There was a 60% response rate. After exclusions there were 39,964 participants aged 45-74 years who did not report cardiovascular disease or diabetes. Dichotomised outcome variables were participant report of having had a clinical assessment of their blood pressure (BP), blood cholesterol (BC) or blood glucose (BG), or received advice to eat less high fat food, eat more fruit and vegetables or be more physically active from their GP in the last 12 months. Independent variables included socio-demographic, lifestyle risk factors, health status, access to health care and confidence in self-management. Most respondents reported having had their BP (90.6%), BC (73.9%) or BG (69.4%) assessed. Fewer reported being given health advice to (a)eat less high fat food (26.6%), (b) eat more fruit and vegetables (15.5%) or (c) do more physical activity (19.9%). The patterns of association were consistent with recognised need: participants who were older, less well educated or overweight were more likely to report clinical assessments; participants who were overseas born, of lower educational attainment, less confident in their own self-management, reported insufficient physical activity or were overweight were more likely to report receiving advice. However current smokers were less likely to report clinical assessments; and rural and older participants were less likely to receive diet or physical activity advice. This study demonstrated a gap between reported clinical assessments and preventive advice. There was evidence for inverse care for rural participants and smokers, who

  18. The basic data for residents aged 16 years or older who received a comprehensive health check examinations in 2011-2012 as a part of the Fukushima Health Management Survey after the great East Japan earthquake.

    PubMed

    Kawasaki, Yukihiko; Hosoya, Mitsuaki; Yasumura, Seiji; Ohira, Tetsuya; Satoh, Hiroaki; Suzuki, Hitoshi; Sakai, Akira; Ohtsuru, Akira; Takahashi, Atsushi; Ozasa, Kotaro; Kobashi, Gen; Kamiya, Kenji; Yamashita, Shunichi; Abe, Masafumi

    2014-01-01

    To assist in the long-term health management of residents and evaluate health impacts after the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant accident in Fukushima Prefecture, the Fukushima prefectural government decided to conduct the Fukushima Health Management Survey. This report describes the results for residents aged 16 years or older who received the health check examinations and evaluates the data obtained from 2011 and 2012. The target group consisted of residents aged 16 years or older who had lived in the evacuation zone. The health check examinations were performed on receipt of an application for a health check examination from any of the residents. The examinations, including measurements of height, weight, abdominal circumference/body mass index (BMI), blood pressure, biochemical laboratory findings, and peripheral blood findings, were performed as required. 1) A total of 56,399 (30.9%) and 47,009 (25.4%) residents aged 16 years or older received health checks in 2011 and 2012, respectively. 2) In both years, a number of male and female residents in the 16-39 year age group were found to suffer obesity, hyperlipidemia, hyperuricemia, or liver dysfunction, and the prevalence of obesity and hyperlipidemia among residents increased with age. Furthermore, the proportion of residents with hypertension, glucose metabolic abnormalities or renal dysfunction was higher in those aged 40 years or older. 3) The frequencies of obesity, hypertension and hyperlipidemia among residents in 2012 were lower than those in 2011. However, the prevalence of liver dysfunction, hyperuricemia, glucose metabolic abnormalities and renal dysfunction among residents was higher in 2012 than in 2011. These results suggested the number of residents who had lived in the evacuation zone with obesity, hyperlipidemia, hyperuricemia, liver dysfunction, hypertension, glucose metabolic abnormalities, or renal dysfunction increased with age in all age groups

  19. Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older.

    PubMed

    Álvarez Barbosa, Francisco; Del Pozo-Cruz, Borja; Del Pozo-Cruz, Jesús; Alfonso-Rosa, Rosa M; Sañudo Corrales, Borja; Rogers, Michael E

    2016-01-01

    Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. Cross-sectional study. Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall. Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome. Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls. © 2015 Association of Rehabilitation Nurses.

  20. Perceptions of tap water temperatures, scald risk and prevention among parents and older people in social housing: a qualitative study.

    PubMed

    Durand, Mary Alison; Green, Judith; Edwards, Phil; Milton, Sarah; Lutchmun, Suzanne

    2012-06-01

    Young children and older people are particularly vulnerable to tap water scalding. For children, there are also socio-economic inequalities in risk. Evidence suggests that reducing tap water temperatures in social (public) housing through 'passive' means is effective in reducing risk. However, little is known about parents' or older people's perceptions of scald risk and prevention. This study aimed to document the views of parents and older residents in social housing in an inner-London borough about their tap water temperature, perceived scalding risk and scald prevention strategies. Analysis of twenty in-depth interviews with 11 parents and 10 people aged 65 years or older. Tap water was described as very hot, but participants did not consider themselves at risk, viewing scald prevention as a personal responsibility achieved with a range of everyday, routine strategies. Very hot water was preferred for health- and convenience-related reasons. However, it was felt that others, particularly children, could be scalded, and some concern was expressed about the environmental and financial impacts of excessively hot water. Those seeking to introduce engineering-based scald prevention interventions in social housing should emphasise the potential environmental and financial impacts of water temperature reduction, in addition to promoting safety benefits for vulnerable others. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  1. Mental health among younger and older caregivers of dementia patients.

    PubMed

    Koyama, Asuka; Matsushita, Masateru; Hashimoto, Mamoru; Fujise, Noboru; Ishikawa, Tomohisa; Tanaka, Hibiki; Hatada, Yutaka; Miyagawa, Yusuke; Hotta, Maki; Ikeda, Manabu

    2017-03-01

    Caregiver burden in dementia is an important issue, but few studies have examined the mental health of younger and older family caregivers by comparing them with age- and gender-matched community residents. We aimed to compare the mental health of dementia caregivers with that of community residents and to clarify factors related to mental health problems in younger and older caregivers. We studied 104 dementia caregivers; 46 were younger (<65 years) and 58 were older (≥65 years). A total of 104 community residents who were matched for age and gender were selected. We compared depression (Center for Epidemiologic Studies Depression Scale for younger participants; Geriatric Depression Scale for older participants), health-related quality of life (QOL) short-form health survey (SF-8), sleep problems, and suicidal ideation between the caregivers and community residents by age. Behavioural and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL were assessed among patients with dementia using the Neuropsychiatric Inventory, Physical Self-Maintenance Scale, and Lawton Instrumental ADL Scale, respectively. According to SF-8 results, both younger and older caregivers had significantly worse mental QOL than community residents (younger caregivers: 46.3 vs community residents: 49.7, P = 0.017; older caregivers: 48.2 vs community residents: 51.1, P = 0.024) but were not more depressive. Sleep problems were significantly more frequent in younger caregivers (39.1%) than in community residents (17.0%) (P = 0.017). Multiple regression analysis revealed that caregivers' deteriorated mental QOL was associated with patients' behavioural and psychological symptoms of dementia in younger caregivers and with dementia patients' instrumental ADL and female gender in older caregivers. Dementia caregivers had a lower mental QOL than community residents. To maintain caregivers' mental QOL, it is necessary to provide younger

  2. Individual and contextual characteristics of indoor and outdoor falls in older residents of São Paulo, Brazil.

    PubMed

    do Nascimento, Carla Ferreira; Duarte, Yeda Aparecida Oliveira; Lebrão, Maria Lúcia; Chiavegatto Filho, Alexandre Dias Porto

    To analyze a representative sample of older individuals of São Paulo, Brazil, according to outdoor fallers, indoor fallers and non-fallers, and to identify biological and socioeconomic (individual and contextual) factors associated with the occurrence and place of falls. A cross-sectional study was conducted using data (n = 1345) from the 2010 wave of the Health, Wellbeing and Aging (SABE) Study, a representative sample of older residents (60 years and older) of São Paulo, Brazil. Multinomial logistic analysis was performed to identify individual factors associated with the occurrence and place of falls, and multilevel multinomial analysis to identify contextual effects (green areas, violence, presence of slums and income inequality). 29% had a fall in the last 12 months, with 59% occurring in indoor spaces. Individuals who had outdoor falls were overall not statistically different from non-fallers; on the other hand, those who had the last fall indoor had worse health status. Moderate homicide rate was a factor associated with increased presence of indoor falls, compared with non-fallers. Our results describe the importance of falls, a common problem in active and community-dwelling older adults of São Paulo, Brazil. Transforming outdoor spaces into walk-friendly areas is essential to allow socialization and autonomy with safety. Creating strategies that take into account the most vulnerable populations, as those who live in violent areas and the oldest older adults, will be a growing challenge among developing countries. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Fasting Periods in Older Patients Attending a South London Emergency Department

    PubMed Central

    2013-01-01

    There is increasing recognition of the deleterious effects of poor nutrition on health care outcomes. Older patients appear particularly vulnerable to the effects of undernutrition. This includes both low intake as patients and chronic preadmission undernutrition. This study investigates nutrition during a critical intervening period when patients present to a hospital emergency department (ED) in the first half of the day. One third of observed patients sustained periadmission fasts in excess of 18 hours. This fasting period showed significant positive correlation to age (correlation coefficient = 0.34, P < 0.05). Analysis of the results by gender showed that men who were older than the average cohort age of 53.6 years fasted for a significantly longer period in the hospital than their younger counterparts (P < 0.02). This comparison did not reach significant levels for female patients (P > 0.05). This study raises the question as to whether food should be routinely provided in the ED unless there is reason to withhold it. Particular care should be taken to avoid unnecessary delays in offering food to older patients. There may also be a need to ensure that geriatric care indicators are considered individually for each gender. PMID:23451846

  4. Staff Member Reactions to Same-Gender, Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities.

    PubMed

    Ahrendt, Andrew; Sprankle, Eric; Kuka, Alex; McPherson, Keagan

    2017-01-01

    The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers' approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults' perception of caregiver bias, as well as further investigation of caregivers' perceptions of older adults' sexual activity.

  5. "It's Somebody else's responsibility" - perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study.

    PubMed

    Close, Helen; Hancock, Helen; Mason, James M; Murphy, Jerry J; Fuat, Ahmet; de Belder, Mark; Hungin, A Pali S

    2013-07-05

    Older people in care-facilities may be less likely to access gold standard diagnosis and treatment for heart failure (HF) than non residents; little is understood about the factors that influence this variability. This study aimed to examine the experiences and expectations of clinicians, care-facility staff and residents in interpreting suspected symptoms of HF and deciding whether and how to intervene. This was a nested qualitative study using in-depth interviews with older residents with a diagnosis of heart failure (n=17), care-facility staff (n=8), HF nurses (n=3) and general practitioners (n=5). Participants identified a lack of clear lines of responsibility in providing HF care in care-facilities. Many clinical staff expressed negative assumptions about the acceptability and utility of interventions, and inappropriately moderated residents' access to HF diagnosis and treatment. Care-facility staff and residents welcomed intervention but experienced a lack of opportunity for dialogue about the balance of risks and benefits. Most residents wanted to be involved in healthcare decisions but physical, social and organisational barriers precluded this. An onsite HF service offered a potential solution and proved to be acceptable to residents and care-facility staff. HF diagnosis and management is of variable quality in long-term care. Conflicting expectations and a lack of co-ordinated responsibility for care, contribute to a culture of benign neglect that excludes the wishes and needs of residents. A greater focus on rights, responsibilities and co-ordination may improve healthcare quality for older people in care. ISRCTN19781227.

  6. An E-learning Module on Chronic Low Back Pain in Older Adults: Effect on Medical Resident Attitudes, Confidence, Knowledge, and Clinical Skills.

    PubMed

    Jacobs, Zachary G; Elnicki, D Michael; Perera, Subashan; Weiner, Debra K

    2018-01-05

    To determine 1) the feasibility of implementing an e-learning module on chronic low back pain (CLBP) in an older adult into an existing internal medicine residency curriculum and 2) the impact of this module on resident attitudes, confidence, knowledge, and clinical skills relating to CLBP. Participants were assigned to complete either the online module (N = 73) or the Yale Office-based curriculum on CLBP (N = 70). Attitudes, confidence, and knowledge were evaluated pre- and postintervention via survey. A retrospective blinded chart review of resident clinic encounters was conducted, wherein diagnosis codes and physical exam documentation were rated as basic or advanced. There was no improvement in overall knowledge scores in either group (60% average on both metrics). There were tendencies for greater improvements in the intervention group compared with controls for confidence in managing fibromyalgia (2.4 to 2.9 vs 2.5 to 2.5, P = 0.06) and leg length discrepancy (1.8 to 2.5 vs 1.5 to 1.9, P = 0.05). Those exposed to the online module also showed an increase in the percentage of physical exam documentation rated as advanced following the intervention (13% to 32%, P = 0.006), whereas the control group showed no change (14% to 12%, P = 0.68). An online module on CLBP in the older adult was a feasible addition to an existing curriculum for internal medicine residents. The module positively and substantively impacted resident clinical behaviors, as evidenced by enhanced sophistication in physical exam documentation; it also was associated with improved confidence in certain aspects of chronic pain management. © 2018 American Academy of Pain Medicine. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  7. Non-London electrodynamics in a multiband London model: Anisotropy-induced nonlocalities and multiple magnetic field penetration lengths

    NASA Astrophysics Data System (ADS)

    Silaev, Mihail; Winyard, Thomas; Babaev, Egor

    2018-05-01

    The London model describes strongly type-2 superconductors as massive vector field theories, where the magnetic field decays exponentially at the length scale of the London penetration length. This also holds for isotropic multiband extensions, where the presence of multiple bands merely renormalizes the London penetration length. We show that, by contrast, the magnetic properties of anisotropic multiband London models are not this simple, and the anisotropy leads to the interband phase differences becoming coupled to the magnetic field. This results in the magnetic field in such systems having N +1 penetration lengths, where N is the number of field components or bands. That is, in a given direction, the magnetic field decay is described by N +1 modes with different amplitudes and different decay length scales. For certain anisotropies we obtain magnetic modes with complex masses. That means that magnetic field decay is not described by a monotonic exponential increment set by a real penetration length but instead is oscillating. Some of the penetration lengths are shown to diverge away from the superconducting phase transition when the mass of the phase-difference mode vanishes. Finally the anisotropy-driven hybridization of the London mode with the Leggett modes can provide an effectively nonlocal magnetic response in the nominally local London model. Focusing on the two-component model, we discuss the magnetic field inversion that results from the effective nonlocality, both near the surface of the superconductor and around vortices. In the regime where the magnetic field decay becomes nonmonotonic, the multiband London superconductor is shown to form weakly-bound states of vortices.

  8. Age and Sex Variation In Prevalence Of Chronic Medical Conditions In Older Residents of U.S. Nursing Homes

    PubMed Central

    Moore, Kelly L.; Boscardin, W. John; Steinman, Michael A.; Schwartz, Janice B.

    2012-01-01

    OBJECTIVES To investigate patterns in prevalences of chronic medical conditions over the agespan of long-term stay nursing home residents and between the sexes with data from the 2004 National Nursing Home Survey (NNHS). DESIGN Retrospective, cross-sectional study. SETTING U.S. nursing homes. PARTICIPANTS Nationally representative sample comprising 11,788 long-term stay residents (3003 (25%) men and 8785 women) aged 65 years or older. MEASUREMENTS Clinical Classifications Software (CCS) was used to group ICD-9 codes to identify the 20 most prevalent chronic medical conditions. SAS survey procedures were used to account for design effects of stratification and clustering to generate nationally representative estimates of prevalences of medical conditions. RESULTS Average age was 84 y, with women older than men (85 vs. 81, p=0.02) with 67% of women ages 80–95. Women required more ADL assistance. The most frequent chronic medical conditions were hypertension (53, 56%: men, women), dementia (45, 52%), depression (31, 37%), arthritis (26, 35%), diabetes mellitus (26, 23%), gastrointestinal reflux -GERD (23, 23%), atherosclerosis (24, 20%), congestive heart failure -CHF (18, 21%), cerebrovascular disease (24, 19%) and anemia (17, 20%). Sex differences in prevalences existed for all but constipation, GERD, and hypertension. Diabetes, cerebrovascular disease, and lipid disorders decreased with age in men and women. Atrial fibrillation, anemia, arthritis, CHF, and dementia, and thyroid disease increased with age in both men and women. Age-related patterns differed between the sexes for diabetes, hypertension, and Parkinson’s disease. CONCLUSION The profile of chronic medical conditions varies over the agespan of nursing home residents and differs between men and women. This knowledge should guide educational and care efforts in long-term care. PMID:22463062

  9. The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto.

    PubMed

    Mendes, Ana; Papoila, Ana Luísa; Carreiro-Martins, Pedro; Bonassi, Stefano; Caires, Iolanda; Palmeiro, Teresa; Aguiar, Lívia; Pereira, Cristiana; Neves, Paula; Mendes, Diana; Botelho, Maria Amália Silveira; Neuparth, Nuno; Teixeira, João Paulo

    2016-01-01

    persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. to evaluate the influence of indoor air quality and contaminants on older people's respiratory health. cross-sectional study. 21 long-term care residences (LTC) in the city of Porto, Portugal. older people living in LTC with ≥65 years old. the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (22%) the main self-reported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1-7.2). high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Socioeconomic and ethnic inequalities in exposure to air and noise pollution in London.

    PubMed

    Tonne, Cathryn; Milà, Carles; Fecht, Daniela; Alvarez, Mar; Gulliver, John; Smith, James; Beevers, Sean; Ross Anderson, H; Kelly, Frank

    2018-06-01

    Transport-related air and noise pollution, exposures linked to adverse health outcomes, varies within cities potentially resulting in exposure inequalities. Relatively little is known regarding inequalities in personal exposure to air pollution or transport-related noise. Our objectives were to quantify socioeconomic and ethnic inequalities in London in 1) air pollution exposure at residence compared to personal exposure; and 2) transport-related noise at residence from different sources. We used individual-level data from the London Travel Demand Survey (n = 45,079) between 2006 and 2010. We modeled residential (CMAQ-urban) and personal (London Hybrid Exposure Model) particulate matter <2.5 μm and nitrogen dioxide (NO 2 ), road-traffic noise at residence (TRANEX) and identified those within 50 dB noise contours of railways and Heathrow airport. We analyzed relationships between household income, area-level income deprivation and ethnicity with air and noise pollution using quantile and logistic regression. We observed inverse patterns in inequalities in air pollution when estimated at residence versus personal exposure with respect to household income (categorical, 8 groups). Compared to the lowest income group (<£10,000), the highest group (>£75,000) had lower residential NO 2 (-1.3 (95% CI -2.1, -0.6) μg/m 3 in the 95th exposure quantile) but higher personal NO 2 exposure (1.9 (95% CI 1.6, 2.3) μg/m 3 in the 95th quantile), which was driven largely by transport mode and duration. Inequalities in residential exposure to NO 2 with respect to area-level deprivation were larger at lower exposure quantiles (e.g. estimate for NO 2 5.1 (95% CI 4.6, 5.5) at quantile 0.15 versus 1.9 (95% CI 1.1, 2.6) at quantile 0.95), reflecting low-deprivation, high residential NO 2 areas in the city centre. Air pollution exposure at residence consistently overestimated personal exposure; this overestimation varied with age, household income, and area-level income

  11. Non-verbal communication of the residents living in homes for the older people in Slovenia.

    PubMed

    Zaletel, Marija; Kovacev, Asja Nina; Sustersic, Olga; Kragelj, Lijana Zaletel

    2010-09-01

    Aging of the population is a growing problem in all developed societies. The older people need more health and social services, and their life quality in there is getting more and more important. The study aimed at determining the characteristics of non-verbal communication of the older people living in old people's homes (OPH). The sample consisted of 267 residents of the OPH, aged 65-96 years, and 267 caregivers from randomly selected twenty-seven OPH. Three types of non-verbal communication were observed and analysed using univariate and multivariate statistical methods. In face expressions and head movements about 75% older people looked at the eyes of their caregivers, and about 60% were looking around, while laughing or pressing the lips together was rarely noticed. The differences between genders were not statistically significant while statistically significant differences among different age groups was observed in dropping the eyes (p = 0.004) and smiling (0.008). In hand gestures and trunk movements, majority of older people most often moved forwards and clenched fingers, while most rarely they stroked and caressed their caregivers. The differences between genders were statistically significant in leaning on the table (p = 0.001), and changing the position on the chair (0.013). Statistically significant differences among age groups were registered in leaning forwards (p = 0.006) and pointing to the others (p = 0.036). In different modes of speaking and paralinguistic signs almost 75% older people spoke normally, about 70% kept silent, while they rarely quarrelled. The differences between genders were not statistically significant while statistically significant differences among age groups was observed in persuasive speaking (p = 0.007). The present study showed that older people in OPH in Slovenia communicated significantly less frequently with hand gestures and trunk movements than with face expressions and head movements or different modes of speaking

  12. Chief Resident Immersion Training in the Care of Older Adults: A Successful National Replication of an Interspecialty Educational Intervention.

    PubMed

    Levine, Sharon A; Chao, Serena H; Caruso, Lisa B; Jackson, Angela H; Russell, Matthew L; Young, Megan E; Brett, Belle

    2018-06-05

    Nongeriatricians must acquire skills and knowledge in geriatric medicine to ensure coordinated care of older adults' complex conditions by interspecialty and interprofessional teams. Chief residents (CRs) are an ideal target for an educational intervention. This study examined whether the Boston Medical Center (BMC) Chief Resident Immersion Training (CRIT) in the Care of Older Adults was replicable at diverse medical institutions. Between 2008 and 2010, 12 institutions in 11 states received funding, technical support, and a common program model. Each implemented 2.5-day CRITs, consisting of a patient case, geriatrics-related lectures, CR leadership sessions, action project planning, and networking time. Site faculty conducted 21 CRITs for 295 CRs representing 28 specialties. CRs completed knowledge pre- and post-tests, and self-report baseline and 6-month follow-up surveys. Outcome measures were change in pre- and post-test score; and change from baseline to six-months in self-reported surveys. Response rate for CRs was 99% (n = 293) for the pre-post tests and 78% (n = 231) for matchable baseline and six-month follow-up surveys. Participants' knowledge increased from 6.32 to 8.39 (P < .001) averaged from 12 questions. CRs' self-reported ability to apply clinical problem-solving skills to older patients (P < .001), number of geriatrics topics taught (P < .001), frequency of geriatrician consultations s (P = .017), confidence in leadership skills (P < .001), and confidence to conduct CR work (P < .001) increased from baseline to follow-up. CRIT is an innovative way to give non-geriatricians knowledge and skills to treat complex older patients.Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a "work of the United States Government" for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of

  13. Slow Gait Speed and Risk of Long-Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures.

    PubMed

    Lyons, Jennifer G; Ensrud, Kristine E; Schousboe, John T; McCulloch, Charles E; Taylor, Brent C; Heeren, Timothy C; Stuver, Sherri O; Fredman, Lisa

    2016-12-01

    To determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown. Longitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk. Community-based prospective cohort study. Older women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755). Gait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care. Participants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant. Older community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  14. Epidemiology of internal contamination with polonium-210 in the London incident, 2006.

    PubMed

    Fraser, G; Giraudon, I; Cohuet, S; Bishop, L; Maguire, H; Thomas, H L; Mandal, S; Anders, K; Sanchez-Padilla, E; Charlett, A; Evans, B; Gross, R

    2012-02-01

    More than 700 UK residents were tested for possible contamination with polonium-210 ((210)Po) following the alleged poisoning of Mr Alexander Litvinenko in London in November 2006. This paper describes the epidemiology of internal contamination with the radionuclide in this group. 11 locations in London had been identified as sufficiently environmentally contaminated with (210)Po to present a health risk to people associated with them. Public health consultant teams identified individuals at risk and offered 24-h urine testing for (210)Po excretion. Prevalence of internal contamination was estimated, and a retrospective cohort analysis was completed for each location. Overall 139 individuals (prevalence 0.19 (95% CI 0.13 to 0.27)) showed evidence of internal contamination with (210)Po, although none with uptakes likely to cause adverse health effects. Substantial prevalence was seen among specific hotel service staff, customers, staff and other users of a hotel bar, office and hospital staff, staff of one restaurant and residents of and visitors to the family home. Increased risks of contamination were seen for a hotel bar in association with occupational, behavioural and temporal factors. Occupational and guest exposure to contaminated areas of hotels were also associated with increased contamination risk. Nurses were more likely to become contaminated than other staff involved in direct patient care. Uptake of trace amounts of radionuclide in this incident was frequent. Occupational, behavioural and temporal gradients in contamination risk were mostly consistent with a priori site risk assessments. Utility of the investigation methods and findings for future accidental or deliberate environmental contamination incidents are discussed.

  15. Provision and perceived quality of mental health services for older care home residents in England: a national survey.

    PubMed

    Stewart, Karen; Hargreaves, Claire; Jasper, Rowan; Challis, David; Tucker, Sue; Wilberforce, Mark

    2018-02-01

    This study examined the nature, extent and perceived quality of the support provided by community mental health teams for older people (CMHTsOP) to care home residents. A postal survey was sent to all CMHTsOP in England. Information was collected about teams' staffing and their involvement in case finding, assessment, medication reviews, care planning and training as well as team managers' rating of the perceived quality of the service they provided for care home residents. Data were analysed using chi-squared tests of association and ordinal regression. Responses were received from 225 (54%) CMHTsOP. Only 18 per cent of these teams contained staff with allocated time for care home work. Services for care home residents varied considerably between teams. Two-fifths of teams provided formal training to care home staff. Team managers were more likely to perceive the quality of their service to care homes as good if they had a systematic process in place for reviewing antipsychotic drugs or routine mental health reviews, including contact with a GP. The findings suggested that more evidence is needed on the best approach for supporting care home residents with mental health needs. Areas to consider are the potential benefits of training to care home staff and regular mental health reviews, utilising links between GPs and CMHTsOP. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  16. London International Youth Science Forum

    ERIC Educational Resources Information Center

    Auty, Geoff

    2010-01-01

    In this article, the author discusses the 2010 London International Youth Science Forum (LIYSF) and shares his experience in attending the forum. Unlike the Harry Messel event in Sydney, which takes place every two years, LIYSF is an annual event. Before moving to Imperial College London, LIYSF was held at the Institute of Electrical Engineers and…

  17. London: An Art Teacher's Inspiration

    ERIC Educational Resources Information Center

    Guhin, Paula

    2012-01-01

    Often overshadowed in people's minds by Paris, London is truly an artist's jewel. The art and architecture, history, gardens and museums are inspiring, yes, but there's so much more to this ancient city. The performances, attractions and markets are a boon to the creative soul. London can be surprisingly inexpensive to visit. Gazing at statues,…

  18. A Community-Based Exergaming Physical Activity Program Improves Readiness-to-Change and Self-Efficacy Among Rural-Residing Older Adults.

    PubMed

    Sowle, Ashleigh J; Francis, Sarah L; Margrett, Jennifer A; Shelley, Mack C; Franke, Warren D

    2017-07-01

    Rural-residing older adults (OA) are not meeting physical activity (PA) recommendations, such that identifying methods of increasing PA among OA remains an ongoing challenge. This study evaluated the effect of a community-based exergaming program on PA readiness-to-change and self-efficacy among rural-residing OA (n = 265). There was a significant (p = .008) increase in readiness-to-change classification from PRE to POST. Significant increases in self-efficacy, or confidence in their ability to be physically active for a prescribed period of time, were detected for 35 (p = .011) and 40 min (p = .035) of continuous PA. PA self-efficacy change for 35 min of continuous PA (F [3,137] = 3.973, p = .010) and 40 min of continuous PA (F [3,137) = 2.893, p = .038) were influenced by the interaction between PRE self-reported health and PRE PA readiness-to-change levels. Results suggest that an exergaming-themed PA intervention is effective at increasing PA participation and self-efficacy for PA among rural-residing OA.

  19. Worry in Older Community-Residing Adults

    ERIC Educational Resources Information Center

    Brock, Kaye; Clemson, Lindy; Cant, Rosemary; Ke, Liang; Cumming, Robert G.; Kendig, Hal; Mathews, Mark

    2011-01-01

    With rising longevity, increasing numbers of older people are experiencing changes in their everyday family and social life, changes in their financial status, and a greater number of chronic conditions affecting their health. We took the opportunity to explore these relationships with worry in a group of volunteer community-living elderly (n =…

  20. Protocol for a process-oriented qualitative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme using the Researcher-in-Residence model

    PubMed Central

    Eyre, Laura; George, Bethan; Marshall, Martin

    2015-01-01

    Introduction The integration of health and social care in England is widely accepted as the answer to fragmentation, financial concerns and system inefficiencies, in the context of growing and ageing populations with increasingly complex needs. Despite an expanding body of literature, there is little evidence yet to suggest that integrated care can achieve the benefits that its advocates claim for it. Researchers have often adopted rationalist and technocratic approaches to evaluation, treating integration as an intervention rather than a process. Results have usually been of limited use to practitioners responsible for health and social care integration. There is, therefore, a need to broaden the evidence base, exploring not only what works but also how integrated care can most successfully be implemented and delivered. For this reason, we are carrying out a formative evaluation of the Waltham Forest and East London Collaborative (WELC) integrated care pioneer programme. Our expectation is that this will add value to the literature by focusing on the processes by which the vision and objectives of integrated care are translated through phases of development, implementation and delivery from a central to a local perspective, and from a strategic to an operational perspective. Methods and analysis The qualitative and process-oriented evaluation uses an innovative participative approach—the Researcher-in-Residence model. The evaluation is underpinned by a critical ontology, an interpretive epistemology and a critical discourse analysis methodology. Data will be generated using interviews, observations and documentary gathering. Ethics and dissemination Emerging findings will be interpreted and disseminated collaboratively with stakeholders, to enable the research to influence and optimise the effective implementation of integrated care across WELC. Presentations and publications will ensure that learning is shared as widely as possible. The study has received

  1. Association of β-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction.

    PubMed

    Steinman, Michael A; Zullo, Andrew R; Lee, Yoojin; Daiello, Lori A; Boscardin, W John; Dore, David D; Gan, Siqi; Fung, Kathy; Lee, Sei J; Komaiko, Kiya D R; Mor, Vincent

    2017-02-01

    Although β-blockers are a mainstay of treatment after acute myocardial infarction (AMI), these medications are commonly not prescribed for older nursing home residents after AMI, in part owing to concerns about potential functional harms and uncertainty of benefit. To study the association of β-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. This cohort study of nursing home residents with AMI from May 1, 2007, to March 31, 2010, used national data from the Minimum Data Set, version 2.0, and Medicare Parts A and D. Individuals with β-blocker use before AMI were excluded. Propensity score-based methods were used to compare outcomes in people who did vs did not initiate β-blocker therapy after AMI hospitalization. Functional decline, death, and rehospitalization in the first 90 days after AMI. Functional status was measured using the Morris scale of independence in activities of daily living. The initial cohort of 15 720 patients (11 140 women [70.9%] and 4580 men [29.1%]; mean [SD] age, 83 [8] years) included 8953 new β-blocker users and 6767 nonusers. The propensity-matched cohort included 5496 new users of β-blockers and an equal number of nonusers for a total cohort of 10 992 participants (7788 women [70.9%]; 3204 men [29.1%]; mean [SD] age, 84 [8] years). Users of β-blockers were more likely than nonusers to experience functional decline (odds ratio [OR], 1.14; 95% CI, 1.02-1.28), with a number needed to harm of 52 (95% CI, 32-141). Conversely, β-blocker users were less likely than nonusers to die (hazard ratio [HR], 0.74; 95% CI, 0.67-0.83) and had similar rates of rehospitalization (HR, 1.06; 95% CI, 0.98-1.14). Nursing home residents with moderate or severe cognitive impairment or severe functional dependency were particularly likely to experience functional decline from β-blockers (OR, 1.34; 95% CI, 1.11-1.61 and OR, 1.32; 95% CI, 1.10-1.59, respectively

  2. London, England

    NASA Image and Video Library

    2003-01-18

    For almost 2,000 years, the River Thames has served as the life force of London, capital of the United Kingdom and one of the world's most famous cities. In AD 43 the Romans established the trading settlement of Londinium at a favorable crossing point on the river. The Romans remained until the 5th century, when the city came under Saxon control. The early 17th century saw enormous growth, but the deadly plague of 1664 and 1665 ravaged the population, and in the following year the Great Fire, which burned for four days, destroyed most of the city. A public transportation system and other city services in the early 19th century eased many of the increasing urban problems of the burgeoning capital of the wealthy British Empire. After coping with the devastating effects of bombing during World War II and the gradual dismantling of the empire, London today thrives as a vital modern metropolis. London is one of 100 cities being studied using ASTER data to map and monitor urban use patterns and growth. This image was acquired on October 12, 2001 by the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) on NASA's Terra satellite. With its 14 spectral bands from the visible to the thermal infrared wavelength region, and its high spatial resolution of 15 to 90 meters (about 50 to 300 feet), ASTER images Earth to map and monitor the changing surface of our planet. http://photojournal.jpl.nasa.gov/catalog/PIA04301

  3. Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing.

    PubMed

    Petroka, Katherine; Campbell-Bussiere, Rania; Dychtwald, Dan K; Milliron, Brandy-Joe

    2017-09-01

    As adults transition into older ages, meeting age-specific dietary recommendations can become increasingly challenging, especially for low-income seniors who reside in publicly subsidized rental housing. The primary objectives of this study were to: 1) identify barriers and facilitators to healthy eating and self-management of nutrition-related chronic illnesses experienced by low-income seniors residing in a subsidized housing setting; and 2) assess the interest in community nutrition programming among low-income seniors residing in a subsidized housing setting. A qualitative study design, using food focus groups and food pantry observations, was used. Participants included 24 male and female senior adults, between 65 and 75 years of age, residing in a subsidized housing community in Philadelphia, PA. This setting also included the unique features of a community garden and food pantry. Data were manually analyzed using a content analysis approach, which included familiarization, identification of themes, categorization and interpretation; and verified using NVivo 10. Personal barriers, including food cost and accessibility, physical limitations, desire for convenience, and low self-efficacy to change dietary habits, inhibited motivation to change. External barriers in the food environment, including lack of transportation and distance of markets to access fresh produce, were commonly cited; as well as negative influences of the internal environment, such as the presence of vending machines, common cultural cooking and eating practices, and the lack of social cohesion. Facilitators focused on food preparation and recipe adaptation. Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.

  4. Factors associated with travel to non-local genitourinary medicine clinics for gonorrhoea: an analysis of patients diagnosed in London, 2009-10.

    PubMed

    Le Polain de Waroux, Olivier; Hughes, Gwenda; Maguire, Helen; Crook, Paul D

    2014-03-01

    We analysed factors associated with travelling to non-local genitourinary medicine clinics for gonorrhoea care in London. We used surveillance data on London residents attending genitourinary medicine clinics in 2009-10 and calculated distances between patients' areas of residence and both the nearest genitourinary medicine clinic and the clinic attended. Non-local clinics were attended by 5408 (46.7%) patients. Men having sex with men attended non-local services more than heterosexuals (OR 3.83, p < 0.001). Among heterosexual men, black Africans and black Caribbeans were more likely, and South Asians less likely, to attend non-local services compared to whites (OR [95%CI] 1.33 [1.04-1.72], 1.36 [1.11-1.67] and 0.46 [0.31-0.70] respectively). Similar associations, although not statistically significant, were found in women. People were more likely to attend local services if their local clinic provided walk-in and young people's services, weekend consultations and long opening hours. These findings could help design services meeting local population needs and facilitate prompt and equitable access to care.

  5. Role of income in intergenerational co-residence: Evidence from selected African and Asian countries.

    PubMed

    Aziz, Nusrate; Hossain, Belayet; Emran, Masum

    2018-06-01

    The study investigates the macroeconomic determinants of co-residing arrangement between generations in selected developing countries with a focus on examining the effect of changing income level of the working generation. A reduced form model is specified for co-residence between the older generation and altruistic working generation. The fixed- and random-effects models are applied in two waves of data for 22 countries. Estimated results indicate that the income of the altruistic working generation has a negative effect on co-residence, suggesting that if the income of the working generation increases, co-residence decreases. This decrease is greater for older men compared with their female counterparts. Life expectancy, literacy and culture also have significant influences on co-residence. Co-residence is expected to fall in developing countries with economic growth over time. Consequently, a higher proportion of older citizens will be vulnerable in the future. Hence, governments of developing countries will face increasing pressure from their older people to provide appropriate planning and strategy to face this challenge. © 2018 AJA Inc.

  6. Institutional profile: the London Centre for Nanotechnology.

    PubMed

    Weston, David; Bontoux, Thierry

    2009-12-01

    Located in the London neighborhoods of Bloomsbury and South Kensington, the London Centre for Nanotechnology is a UK-based multidisciplinary research center that operates at the forefront of science and technology. It is a joint venture between two of the world's leading institutions, UCL and Imperial College London, uniting their strong capabilities in the disciplines that underpin nanotechnology: engineering, the physical sciences and biomedicine. The London Centre for Nanotechnology has a unique operating model that accesses and focuses the combined skills of the Departments of Chemistry, Physics, Materials, Medicine, Electrical and Electronic Engineering, Mechanical Engineering, Chemical Engineering, Biochemical Engineering and Earth Sciences across the two universities. It aims to provide the nanoscience and nanotechnology required to solve major problems in healthcare, information processing, energy and the environment.

  7. Inequalities in usage of a public bicycle sharing scheme: socio-demographic predictors of uptake and usage of the London (UK) cycle hire scheme.

    PubMed

    Ogilvie, F; Goodman, A

    2012-07-01

    Cycling confers individual and population-level health benefits, but uptake is not always equitable across socio-demographic groups. We sought to examine inequalities in uptake and usage of London's Barclays Cycle Hire (BCH) scheme. We obtained complete BCH registration data, and compared users with the general population. We examined usage levels by explanatory variables including gender, small-area income-deprivation and local cycling prevalence. 100,801 registered individuals made 2.5 million trips between July 2010 and March 2011. Compared with residents and workers in the central London area served by the scheme, registered individuals were more likely to be male and to live in areas of low deprivation and high cycling prevalence. Among those registered, females made 1.63 (95%CI 1.53, 1.74) fewer trips per month than males, and made under a fifth of all trips. Adjusting for the fact that deprived areas were less likely to be close to BCH docking stations, users in the most deprived areas made 0.85 (95%CI 0.63,1.07) more trips per month than those in the least deprived areas. Females and residents in deprived areas are underrepresented among users of London's public bicycle sharing scheme. The scheme's planned expansion into more deprived areas has, however, the potential to create a more equitable uptake of cycling. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Reasons for living, meaning in life, and suicide ideation: investigating the roles of key positive psychological factors in reducing suicide risk in community-residing older adults.

    PubMed

    Heisel, Marnin J; Neufeld, Eva; Flett, Gordon L

    2016-01-01

    To investigate the roles of reasons for living (RFL) and meaning in life (MIL) in potentially promoting mental health and well-being and protecting against suicide ideation among community-residing older adults and to investigate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA). Of 173 older adults initially recruited into a longitudinal study on late-life suicide ideation, 109 completed the RFL-OA and measures of cognitive and physical functioning and positive and negative psychological factors at a two-year follow-up assessment. We tested a model in which RFL and MIL protect against suicide ideation, controlling for demographic and clinical factors. We also assessed the psychometric properties of the RFL-OA in community-residing older adults, investigating its internal consistency and its convergent (MIL, perceived social support, and life satisfaction), divergent (loneliness, depressive symptom severity, and suicide ideation), and discriminant validity (cognitive and physical functioning). RFL-OA scores explained significant variance in suicide ideation, controlling for age, sex, depressive symptom severity, and loneliness. MIL explained significant unique variance in suicide ideation, controlling for these factors and RFL, and MIL significantly mediated the association between RFL and suicide ideation. Psychometric analyses indicated strong internal consistency (α = .94), convergent, divergent, and discriminant validity for the RFL-OA relative to positive and negative psychological factors and cognitive and physical functioning. These findings add to a growing body of literature suggesting merit in investigating positive psychological factors together with negative factors when assessing suicide risk and planning psychological services for older adults.

  9. London's Jewish Communities and State Education

    ERIC Educational Resources Information Center

    Martin, Jane

    2012-01-01

    The Inner London education authority was a notable example of a radical and powerful local government body from which the fight for the comprehensive principle in English secondary education emerged. Building on previous work of women's contribution to state education in London, this articles focuses on Anglo-Jewish educator activists who helped…

  10. Improving the knowledge base in older people's care.

    PubMed

    Lomas, Clare

    2016-02-01

    The UK has a rapidly ageing population, and the number of people aged over 75 is projected to double in the next 30 years. In November 2014, King's College London introduced the Older Person's Nurse Fellowship, a pioneering programme designed to give senior nurses the knowledge and skills to optimise quality of life for older people, and lead the way in transforming care and services. This article examines the fellowship programme, its aims and intended effect on practice. It also highlights a series of case study articles by four of the first cohort of fellows beginning in the March issue of Nursing Older People, which will show how the programme is helping senior nurses to improve care in a variety of settings.

  11. Language Acculturation among Older Vietnamese Refugee Adults.

    ERIC Educational Resources Information Center

    Tran, Thanh V.

    1990-01-01

    Examined English language acculturation among older Vietnamese refugees (aged 40 and older). Found that age, sex, education in Vietnam, health, and length of residence in United States had some significant relationships with language acculturation. Older Vietnamese people had more problems with language acculturation than younger counterparts, and…

  12. The 'other' London effect: the diversification of London's suburban grammar schools and the rise of hyper-selective elite state schools.

    PubMed

    Gamsu, Sol

    2018-03-30

    This paper examines the rise of a new elite of 'super-state' schools in London, revealing a growing divide within the state sector which problematizes claims that the capital is a 'hotspot' for social mobility (Social Mobility Commission ). Although recent research has revealed a 'London effect' in which students in the capital on Free School Meals outperform their peers in other regions (Greaves, Macmillan and Sibieta ), inequalities between London's schools in access to elite universities have been overlooked. Drawing on a case study of a suburban London grammar school, 'King Henry's School', I show how ethnic-minority suburbanization has combined with an institutional strategy to compete with elite private schools. Strategies of selection have been mobilized alongside elements of elite 'gentlemanly' educational culture in order to reposition the school within the hierarchy of London's schools. The result is a hyper-selective school which provides a conduit to elite universities for upwardly mobile British-Asian students. I show that this strategy has strong parallels with the school's attempts in the early twentieth century to compete with London's fee-paying 'public' schools. The continuing symbolic value of 'traditional' forms of elite educational culture to a school seeking to reposition itself within the field reflects deep structural patterns of inequality in English education. To understand how apparent improvements in social mobility can sit alongside deepening inequalities between state schools, there is a need for a historical sociological approach that takes account of long-term processes of institutional change (Savage ; Inglis ). © London School of Economics and Political Science 2018.

  13. “It’s Somebody else’s responsibility” - perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study

    PubMed Central

    2013-01-01

    Background Older people in care-facilities may be less likely to access gold standard diagnosis and treatment for heart failure (HF) than non residents; little is understood about the factors that influence this variability. This study aimed to examine the experiences and expectations of clinicians, care-facility staff and residents in interpreting suspected symptoms of HF and deciding whether and how to intervene. Methods This was a nested qualitative study using in-depth interviews with older residents with a diagnosis of heart failure (n=17), care-facility staff (n=8), HF nurses (n=3) and general practitioners (n=5). Results Participants identified a lack of clear lines of responsibility in providing HF care in care-facilities. Many clinical staff expressed negative assumptions about the acceptability and utility of interventions, and inappropriately moderated residents’ access to HF diagnosis and treatment. Care-facility staff and residents welcomed intervention but experienced a lack of opportunity for dialogue about the balance of risks and benefits. Most residents wanted to be involved in healthcare decisions but physical, social and organisational barriers precluded this. An onsite HF service offered a potential solution and proved to be acceptable to residents and care-facility staff. Conclusions HF diagnosis and management is of variable quality in long-term care. Conflicting expectations and a lack of co-ordinated responsibility for care, contribute to a culture of benign neglect that excludes the wishes and needs of residents. A greater focus on rights, responsibilities and co-ordination may improve healthcare quality for older people in care. Trial registration ISRCTN: ISRCTN19781227 PMID:23829674

  14. The frequency of and reasons for acute hospital transfers of older nursing home residents.

    PubMed

    Kirsebom, Marie; Hedström, Mariann; Wadensten, Barbro; Pöder, Ulrika

    2014-01-01

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M=1.37 each). 63% resulted in hospitalization (M=7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/bed and was higher for the private for-profit providers than for public/private non-profit providers. One-fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Good oral health, adequate nutrient consumption and family support are associated with a reduced risk of being underweight amongst older Malaysian residents of publicly funded shelter homes.

    PubMed

    Visvanathan, Renuka; Ahmad, Zaiton

    2006-01-01

    A low body mass index in older people has been associated with increased mortality. The main objective of this study was to identify factors associated with low body mass indices [ BMIs] (< 18.5 kg/m2) in older residents of shelter care facilities in Peninsular Malaysia. 1081 elderly people (59% M) over the age of 60 years were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well being. Body mass index was also determined. Subjects were recruited from publicly funded shelter homes in Peninsular Malaysia. 14.3% of residents had BMIs < 18.5 kg/m2. Multivariate analyses (adjusted for age and sex) revealed that having no family (RR 1.98[95%CI 1.40-2.82], p<0.001) and negative responses to statement 3 [I eat few fruits or vegetables or milk products] (RR 0.62 [95% CI 0.42-0.90]; P= 0.013) and statement 5 [I have tooth or mouth problems that make it hard for me to eat] (RR 0.69 [95%CI 0.50-0.96]; P= 0.023) of the ' Determine Your Nutritional Health Checklist' were independently associated with low BMIs (<18.5 kg/m2). Older people with no family support were at risk of becoming underweight. Older people who consumed fruits, vegetables or milk or had good oral health were less likely to be underweight. Nutrient intake, oral health and social support were important in ensuring healthy body weight in older Malaysians.

  16. Sexual behaviour of institutionalised residents with dementia--a qualitative study.

    PubMed

    Tzeng, Yu-Ling; Lin, Li-Chan; Shyr, Yea-Ing Lotus; Wen, Jung-Kwang

    2009-04-01

    The purpose of this study was to explore the characteristics of and the contexts related to sexual behaviours among institutionalised residents with dementia. Institutionalised residents with dementia are frequently unable to manage their sexual needs properly resulting in caregivers having a more conservative and passive attitude toward residents with dementia than those with higher cognitive status. A grounded theory study. The participants in this study were institutionalised older people with dementia and their formal caregivers. Data were collected using in-depth, face-to-face interviews of 12 formal caregivers and by observing 12 institutional older people with dementia for three days. All observations were recorded and interview data were tape recorded and transcribed verbatim. The results indicated that the predisposing factors included having opportunity, presence of a cooperative target and personal space without privacy. The sexual expressions of institutionalised older people with dementia included: physically intimate touch, sexual expression without touching others and sexual talk. Responses by individuals to sexual behaviour from another resident included neutral response, negative response and positive response. To provide better care, it is recommended that an inventory regarding sexual expression for clinical and research usage be constructed from the research results. The findings of this study can provide the basis to develop on-the-job training programmes for sexual education of residents with dementia in institutions. Regular seminars on sexual care for the residents with dementia might be beneficial for managing sexual issues among residents and to decrease caregivers' burden.

  17. Living Arrangements of Ever-Married Older Lebanese Women: Is Living with Married Children Advantageous?

    PubMed Central

    Mehio-Sibai, Abla; Tohme, Rania A.

    2016-01-01

    In many Middle Eastern countries including Lebanon, the family as a social institution is greatly valued and local norms regarding family ties and living arrangements are especially important for older adults, in particular older women. While the presence of an adult child is often seen as responsive to the financial, health and social needs of older parents, it is not clear whether co-residence with married children offers a similar advantage as in the case of co-residence with unmarried children. Using data from a national Population and Housing Survey, this study examines associations of co-residence with adult children among ever-married women aged 65 years and older in Lebanon. Results showed a considerable proportion of elderly women who were living alone (18%) at the time of the survey. Co-residence was more frequent with unmarried than married children, but the gender ratio of the co-residing child varied with the marital status of both the older woman and the child. Moreover, among those co-residing with married children, results indicate a greater likelihood of co-residence with married sons over married daughters. Co-residence with an adult child associated positively with the availability of surviving children and negatively with the socioeconomic status of the woman and her spouse. Compared to other living arrangements, co-residence with a married child entailed the least advantageous Household Socioeconomic Status (HSES) score in terms of housing characteristics, infrastructure, and material possessions, for both married and unmarried women. PMID:18283537

  18. Sexuality and intimacy among care home residents.

    PubMed

    Simpson, Paul; Horne, Maria; Brown, Laura J E; Dickinson, Tommy; Wilson, Christine Brown

    Discussing sexuality and intimacy with older people can be problematic, so it is not uncommon that their needs go unrecognised. This article identifies barriers to addressing sexuality and intimacy needs, and outlines some simple strategies to raise awareness of them among older care home residents and staff, thereby facilitating a discussion to enable such needs to be met.

  19. Improving Health Care for Assisted Living Residents

    ERIC Educational Resources Information Center

    Kane, Robert L.; Mach, John R., Jr.

    2007-01-01

    Purpose: The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. Design and Methods: We present a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary…

  20. Bacterial Pneumonia in Older Adults.

    PubMed

    Henig, Oryan; Kaye, Keith S

    2017-12-01

    The incidence of pneumonia increases with age, and is particularly high in patients who reside in long-term care facilities (LTCFs). Mortality rates for pneumonia in older adults are high and have not decreased in the last decade. Atypical symptoms and exacerbation of underlying illnesses should trigger clinical suspicion of pneumonia. Risk factors for multidrug-resistant organisms are more common in older adults, particularly among LTCF residents, and should be considered when making empiric treatment decisions. Monitoring of clinical stability and underlying comorbid conditions, potential drug-drug interactions, and drug-related adverse events are important factors in managing elderly patients with pneumonia. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Recognising and Developing Urban Teachers: Chartered London Teacher Status

    ERIC Educational Resources Information Center

    Bubb, Sara; Porritt, Vivienne

    2008-01-01

    Chartered London Teacher (CLT) status is a unique scheme designed by London Challenge to recognise and reward teachers' achievements and provide a framework for professional development. As well as having the prestige of being a Chartered London Teacher for life, educators receive a one-time payment of 1,000 British pounds from the school budget…

  2. Effect of a Community-Based Service Learning Experience in Geriatrics on Internal Medicine Residents and Community Participants.

    PubMed

    Miller, Rachel K; Michener, Jennifer; Yang, Phyllis; Goldstein, Karen; Groce-Martin, Jennine; True, Gala; Johnson, Jerry

    2017-09-01

    Community-based service learning (CBSL) provides an opportunity to teach internal medicine residents the social context of aging and clinical concepts. The objectives of the current study were to demonstrate the feasibility of a CBSL program targeting internal medicine residents and to assess its effect on medical residents and community participants. internal medicine residents participated in a CBSL experience for half a day during ambulatory blocks from 2011 to 2014. Residents attended a senior housing unit or center, delivered a presentation about a geriatric health topic, toured the facility, and received information about local older adult resources. Residents evaluated the experience. Postgraduate Year 3 internal medicine residents (n = 71) delivered 64 sessions. Residents felt that the experience increased their ability to communicate effectively with older adults (mean 3.91 ± 0.73 on a Likert scale with 5 = strongly agree), increased their knowledge of resources (4.09 ± 1.01), expanded their knowledge of a health topic pertinent to aging (3.48 ± 1.09), and contributed to their capacity to evaluate and care for older adults (3.84 ± 0.67). Free-text responses demonstrated that residents thought that this program would change their practice. Of 815 older adults surveyed from 36 discrete teaching sessions, 461 (56%) thought that the medical residents delivered health information clearly (4.55 ± 0.88) and that the health topics were relevant (4.26 ± 0.92). Free-text responses showed that the program helped them understand their health concerns. This CBSL program is a feasible and effective tool for teaching internal medicine residents and older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. Traffic safety facts 1996 : older population

    DOT National Transportation Integrated Search

    1997-01-01

    There are approximately 24 million people age 70 years and older in the United States. In 1996, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1986. From 1986 to 1996, this older segment of the popu...

  4. Traffic safety facts 1998 : older population

    DOT National Transportation Integrated Search

    1999-01-01

    There are nearly 25 million people age 70 years and older in the United : States. In 1998, this age group made up 9 percent of the total U.S. : resident population, compared with 8 percent in 1988. From 1988 to : 1998, this older segment of the popul...

  5. [Four cholera epidemics in nineteenth-century London].

    PubMed

    Tynkkynen, K

    1995-01-01

    Asiatic cholera originated in India and spread to Europe in the early years of the nineteenth-century. In Britain the first cases were diagnosed late in 1831. The epidemic, reached London in February 1832. The authorities were poorly prepared for the invasion of a new epidemic and the doctors disagreed bitterly on the measures to be taken. There was little co-operation between the authorities, and the fact that the urban poor mistrusted the medical profession did not improve the situation. All this resulted in several cholera riots. These riots were not, however, as violent as those in several other cities in Europe. The 1832-33 cholera epidemic claimed 4,000 to 7,000 victims in London. It seems probable that several isolated cases of cholera occurred in London in 1852. It was not, however, until September 1853 that it was officially announced by the British authorities that a cholera epidemic was claiming victims not only in London but also in other parts of the country. During this epidemic numerous Londoners lodged complaints against nuisances in the metropolis. Yet, in most cases, the fines imposed on offenders were rather slight, since the authorities were extremely reluctant to interfere with anyone's trade or business. It was during this epidemic that John Snow, a London doctor, succeeded in tracing the epidemic to a single water pump on Broad Street in the Golden Square area. Snow did not, however, succeed in convincing the majority of his colleagues regarding the erroneous nature of the miasma theory during the epidemic of 1853/54, which cost the lives of some 12,000 people in the city area....

  6. The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis.

    PubMed

    Crocker, Tom; Young, John; Forster, Anne; Brown, Lesley; Ozer, Seline; Greenwood, Darren C

    2013-11-01

    the worldwide population is ageing. One expected consequence of this is an increase in morbidity and an associated increased demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects in residents of long-term care facilities. to examine the effects of physical rehabilitation on activities of daily living (ADL) in elderly residents of long-term care facilities. systematic review with meta-analysis of randomised controlled trials. We included studies that compared the effect of a physical rehabilitation intervention on independence in ADL with either no intervention or an alternative intervention in older people (over 60 years) living in long-term care facilities. We searched 19 databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, Web of Knowledge and Google Scholar. Two researchers independently screened papers and extracted data. Outcomes of included studies were combined in a standardised mean difference random-effects meta-analysis. thirteen of 14 studies identified were included in the meta-analysis. Independence in ADL was improved by 0.24 standard units (95% CI: 0.11-0.38; P = 0.0005). This is equivalent to 1.3 points on the Barthel Index (0-20 scale). No significant differences in effect were found based on participant or intervention characteristics. Larger sample size and low attrition were associated with smaller estimates of effect. All studies were assessed to be at risk of bias. physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.

  7. Traffic safety facts 1995 : older population

    DOT National Transportation Integrated Search

    1996-01-01

    There are approximately 23.6 million people age 70 years and older in the United States. In 1995, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1985. From 1985 to 1995, this older segment of the po...

  8. Traffic safety facts 1993 : older population

    DOT National Transportation Integrated Search

    1994-01-01

    There are almost 23 million people age 70 years and older in the United States. In 1993, this age group made up 8.8 percent of the total U.S. resident population, compared with 7.8 percent in 1983. From 1983 to 1993, this older segment of the populat...

  9. Traffic safety facts 1999 : older population

    DOT National Transportation Integrated Search

    2000-01-01

    There are more than 25 million people age 70 years and older in the United States. In 1999, this age group made up 9 percent of the total U.S. resident population, compared with 8 percent in 1989. From 1989 to 1999, this older segment of the populati...

  10. School Improvement in London: A Global Perspective

    ERIC Educational Resources Information Center

    McAleavy, Tony; Elwick, Alex

    2016-01-01

    This report considers how successful London's schools have been over the past decade and identifies potentially transferable components of the success story. There is much to be learned from the transformation undergone in London that is relevant to policymakers and educationalists worldwide, working in both high-income and low-income countries.…

  11. Report of Charrette : re-connect New London 2010.

    DOT National Transportation Integrated Search

    2011-03-01

    "Members of Re-New London Council Board informally met with Dr. Norman Garrick in November 2009. A lively discussion regarding the : New London landscape in general and leverage points for revitalization ensued. Norman related his observations as he ...

  12. Use of Osteoporosis Medications in Older Nursing Facility Residents

    PubMed Central

    Wright, Rollin M.

    2007-01-01

    Introduction Epidemiologic studies demonstrated that 70 – 85% of nursing home residents have osteoporosis. Few studies report comprehensive information about treatment of osteoporosis in nursing facilities. Objective To determine the prevalence osteoporosis treatment and identify resident characteristics associated with the use of anti-resorptive medications or supplements indicated to treat osteoporosis in nursing homes. Methods The study design was cross-sectional. The Systematic Assessment of Geriatric Drug Use via Epidemiology database provided the data. From this database, 186,221 residents were identified as newly admitted to nursing facilities in Kansas, Maine, Missouri, Ohio, and South Dakota between 1998 and 2000. The outcome measure was the use of anti-resorptive medications (alendronate, risedronate, calcitonin, estrogen, raloxifene) or supplements (calcium with vitamin D) indicated for treatment of osteoporosis. The independent variables included demographic, health status and fracture risk factors. Results Of the overall sample, 9.1% received anti-resorptive medications and/or supplements indicated for osteoporosis treatment. The most commonly used treatment was the combination of calcium and vitamin D (5.0%). Calcitonin (2.5%) use exceeded that of any other anti-resorptive. Multivariable logistic regression analyses revealed that a diagnosis of osteoporosis and female gender were strongly associated with being more likely to receive an osteoporosis treatment (OR 6.34 with 95% CI 6.11–6.64 and OR 2.67 with 95% CI 2.53–2.83 respectively). The number of medications residents received was also strongly associated with receiving osteoporosis treatment. Being black and having four or more active diagnoses were strongly associated with lower odds of receiving treatment (OR 0.63 with 95% CI 0.57–0.68 and OR 0.71 with 95% CI 0.68–0.74 for 4 to 6 diagnoses). Discussion Newly admitted nursing facility residents infrequently received an indicated

  13. Traffic safety facts 1994 : older population

    DOT National Transportation Integrated Search

    1995-01-01

    There are more than 23.2 million people age 70 years and older in the United States. In 1994, this age group made up 8.9 percent of the total U.S. resident population, compared with 7.9 percent in 1984. From 1984 to 1994, this older segment of the po...

  14. Traffic safety facts 2000 : older population

    DOT National Transportation Integrated Search

    2001-01-01

    There are more than 25 million people age 70 years and older in the United States. In 2000, this age group made up 9.2 percent of the total U.S. resident population, compared with 8.5 percent in 1990. From 1990 to 2000, this older segment of the popu...

  15. Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study.

    PubMed

    Hansell, Anna L; Blangiardo, Marta; Fortunato, Lea; Floud, Sarah; de Hoogh, Kees; Fecht, Daniela; Ghosh, Rebecca E; Laszlo, Helga E; Pearson, Clare; Beale, Linda; Beevers, Sean; Gulliver, John; Best, Nicky; Richardson, Sylvia; Elliott, Paul

    2013-10-08

    To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population. Small area study. 12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London. About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants). Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05. Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, L(Aeq),16 h) and night time (11 pm to 7 am, Lnight) aircraft noise. When areas experiencing the highest levels of daytime aircraft noise were compared with those experiencing the lowest levels (>63 dB v ≤ 51 dB), the relative risk of hospital admissions for stroke was 1.24 (95% confidence interval 1.08 to 1.43), for coronary heart disease was 1.21 (1.12 to 1.31), and for cardiovascular disease was 1.14 (1.08 to 1.20) adjusted for age, sex, ethnicity, deprivation, and a smoking proxy (lung cancer mortality) using a Poisson regression model including a random effect term to account for residual heterogeneity. Corresponding relative risks for mortality were of similar magnitude, although with wider confidence limits. Admissions for coronary heart disease and cardiovascular disease were particularly affected by adjustment for South Asian ethnicity, which needs to be considered in interpretation. All results were robust to adjustment for particulate matter (PM10) air pollution, and road traffic noise, possible for London boroughs (population about 2.6 million). We could not distinguish between the effects of daytime or night time

  16. Life stage differences in resident coping with restart of the Three Mile Island nuclear generating facility.

    PubMed

    Prince-Embury, S; Rooney, J F

    1990-12-01

    A study of residents who remained in the vicinity of Three Mile Island (TMI) immediately following the restart of the nuclear generating plant revealed that older residents employed a more emotion-focused coping style in the face of this event than did younger residents. Coping style was, however, unrelated to the level of psychological symptoms for these older residents, whereas demographic variables were related. Among younger residents, on the other hand, coping style was related to the level of psychological symptoms, whereas demographic variables were not. Among younger residents, emotion-focused coping was associated with more symptoms and problem-focused coping was associated with fewer symptoms, contradicting previous findings among TMI area residents.

  17. Report of Charrette re-connect New London 2010.

    DOT National Transportation Integrated Search

    2011-03-01

    Members of Re-New London Council Board informally met with Dr. Norman Garrick in November 2009. A lively discussion regarding the : New London landscape in general and leverage points for revitalization ensued. Norman related his observations as he e...

  18. Older Adult Participation in Higher Education. New Roles for Older Arkansans as Students and Educational Resources.

    ERIC Educational Resources Information Center

    Graham, Lou; And Others

    A random sample survey of people aged 50 and older was conducted to study the educational interests of older residents of Pulaski County, Arkansas. Telephone surveys were completed for 346 individuals. Findings showed that almost 85 percent of the respondents indicated an interest in education. Two-thirds of the respondents were women; 62 percent…

  19. 32. VIEW OF PHOTO CAPTIONED 'SUBMARINE BASE, NEW LONDON, CONN. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    32. VIEW OF PHOTO CAPTIONED 'SUBMARINE BASE, NEW LONDON, CONN. OCTOBER 3, 1932. COMPLETION OF ERECTION OF STEELWORK FOR ELEVATOR. LOOKING NORTH. CONTRACT NO. Y-1539-ELEVATOR, SUBMARINE ESCAPE TANK.' - U.S. Naval Submarine Base, New London Submarine Escape Training Tank, Albacore & Darter Roads, Groton, New London County, CT

  20. Managing Malnutrition in Older Persons Residing in Care Homes: Nutritional and Clinical Outcomes Following a Screening and Intervention Program.

    PubMed

    Mountford, Christopher G; Okonkwo, Arthur C O; Hart, Kathryn; Thompson, Nick P

    2016-01-01

    This study aimed to establish prevalence of malnutrition in older adult care home residents and investigate whether a nutritional screening and intervention program could improve nutritional and clinical outcomes. A community-based cohort study was conducted in five Newcastle care homes. 205 participants entered; 175 were followed up. Residents already taking oral nutritional supplements (ONS) were excluded from interventions. Those with Malnutrition Universal Screening Tool (MUST) score of 1 received dietetic advice and ≥2 received dietetic advice and were prescribed ONS (220 ml, 1.5 kcal/ml) twice daily for 12 weeks. Body mass index (BMI), MUST, mini nutritional assessment score (MNA)®, mid upper arm muscle circumference (MAMC), and Geriatric Depression Scale (GDS) were recorded at baseline and 12 weeks. Malnutrition prevalence was 36.6% ± 6.6 (95% CI). A higher MUST was associated with greater mortality (p = 0.004). Type of intervention received was significantly associated with change in MUST score (p < 0.001); dietetic advice resulting in the greatest improvement. There were no significant changes in BMI (p = 0.445), MAMC (p = 0.256), or GDS (p = 0.385) following the interventions. Dietitian advice may slow the progression of nutritional decline. In this study oral nutritional supplements over a 3-month period did not significantly improve nutritional status in malnourished care home residents.

  1. Epidemiology of multiple sclerosis in London and Middlesex County, Ontario, Canada.

    PubMed

    Hader, W J; Elliot, M; Ebers, G C

    1988-04-01

    A case-controlled epidemiologic study of multiple sclerosis (MS) was carried out in London, Ontario, and its surrounding Middlesex County for the period 1974-1983. The prevalence rates for clinically definite/probable MS on January 1, 1984 were 94/100,000 for the city and 91/100,000 for the county. The estimated annual incidence rate for the decade 1974-83 was 3.4/100,000. The female-to-male sex ratio was 2.5:1. A familial history of MS was recorded in 14.4% of close relatives and a total of 17% when distant relatives are included. The MS group is predominantly of British (70%) and European (23%) origin. The urban-rural residence pattern analysis indicates no significant regional influence on the risk of developing MS.

  2. Pan-London tuberculosis services: a service evaluation

    PubMed Central

    2012-01-01

    Background London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London’s TB services’ organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently. Methods Objectives were: 1) To establish how London’s TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London’s five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2). Results Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals’ interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for

  3. Social Capital and Suicidal Ideation in Community-Dwelling Older Residents: A Multilevel Analysis of 10,094 Subjects in Japan.

    PubMed

    Noguchi, Masayuki; Kobayashi, Tomoko; Iwase, Toshihide; Suzuki, Etsuji; Kawachi, Ichiro; Takao, Soshi

    2017-01-01

    Social capital, the collective resources of groups including perceptions of trust and reciprocity, is recognized as an important contributor to suicide. We examined the association of individual- and community-level social capital with suicidal ideation after adjusting for social support among older adults living in the community. In August 2010 we sent questionnaires to all residents aged 65 years and older living in 3 rural municipalities (N = 21,232) in Okayama Prefecture, Japan; 13,919 questionnaires were returned (response rate: 65.6%). The final analysis included 10,094 participants. The outcome variable was suicidal ideation. Exposure variables were individual-level mistrust and lack of reciprocity (level 1), and the aggregated responses of these variables from 35 communities in the municipalities (level 2). Covariates included age, sex, educational attainment, marital status, the number of cohabitants, years of residence, self-rated socioeconomic status, disability, social support, and psychological distress. Multilevel logistic regression analysis was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). After adjusting for social support and psychological distress, we found that mistrust and lack of reciprocity were only associated with suicidal ideation at the individual level. Stratified analysis showed that among subjects with psychological distress, mistrust was associated with suicidal ideation at individual (OR: 1.88; 95% CI: 1.42-2.51) and community levels (OR: 1.98; 95% CI: 1.02-3.81). Our findings show that individual- and community-level social capital is a possible protective factor for suicidal ideation, particularly for people with psychological distress. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. The effect of garden designs on mood and heart output in older adults residing in an assisted living facility.

    PubMed

    Goto, Seiko; Park, Bum-Jin; Tsunetsugu, Yuko; Herrup, Karl; Miyazaki, Yoshifumi

    2013-01-01

    The objective of this study is to trace short-term changes in mood and heart function in elderly individuals in response to exposure to different landscaped spaces. Nineteen elderly but cognitively intact residents of an assisted living facility participated in the study. They were exposed to three landscaped spaces: a Japanese style garden, an herb garden, and a simple landscaped area planted with a single tree. To assess the effect of different landscaped spaces on older adults, individuals were monitored for mood and cardiac function in response to short exposures to spaces. Mood state was assessed using Profile of Mood States (POMS) before and after viewing the spaces. Cardiac output was assessed using a portable electrocardiograph monitor before and during the viewing. We found that the structured gardens evoked greater responses in all outcome measures. Scores on the POMS improved after observation of the two organized gardens compared to responses to the simple landscaped space with a single tree. During the observation period, heart rate was significantly lower in the Japanese garden than in the other environments, and sympathetic function was significantly lower as well. We conclude that exposure to organized gardens can affect both the mood and cardiac physiology of elderly individuals. Our data further suggest that these effects can differ depending on the types of landscape to which an individual is exposed. Elderly, Japanese garden, herb garden, heart rate, mood, healing environmentPreferred Citation: Goto, S., Park, B-J., Tsunetsugu, Y., Herrup, K., & Miyazaki, Y. (2013). The effect of garden designs on mood and heart output in older adults residing in an assisted living facility. Health Environments Research & Design Journal 6(2), pp 27-42.

  5. What Makes Residents Interested in Geriatric Psychiatry? A Pan-Canadian Online Survey of Psychiatry Residents.

    PubMed

    Rej, Soham; Laliberté, Vincent; Rapoport, Mark J; Seitz, Dallas; Andrew, Melissa; Davidson, Marla

    2015-07-01

    In spite of a rapidly increasing need, there remains a shortage of geriatric psychiatrists in North America. The factors associated with psychiatric residents' interest in geriatric psychiatry have not yet been examined in a nationally representative sample. Cross-sectional study. Web-based online survey of Canadian psychiatry residents. 207 psychiatry residents (24.3% response rate). The main outcome was interest in becoming a geriatric psychiatrist. Bivariate and multivariate analyses were performed to better understand what demographic, educational, and vocational variables were associated with interest in becoming a geriatric psychiatrist. A number of respondents had an interest in becoming a geriatric psychiatrist (29.0%, N = 60); in doing a geriatric psychiatry fellowship (20.3%, N = 42); or an interest in doing geriatric psychiatry as a part of the clinical practice (60.0%, N = 124). Demographic characteristics (age, gender, ethnicity) did not correlate with interest in geriatric psychiatry. The variables most robustly associated with interest in geriatric psychiatry were: 1) completion of geriatric psychiatry rotation(s) before the third year of residency (OR: 5.13, 95% CI: 1.23-21.4); 2) comfort working with geriatric patients and their families (OR: 18.6, 95% CI: 2.09-165.3); 3) positive experiences caring for older adults prior to medical school (OR: 12.4, 95% CI: 1.07-144.5); and 4) the presence of annual conferences in the resident's field of interest (OR: 4.50, 95% CI: 1.12-18.2). Exposing medical students and junior psychiatry residents to clinical geriatric psychiatry rotations that increase comfort in working with older adults may be potential future strategies to improve recruitment of geriatric psychiatrists. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  6. Sustainability Literacy of Older People in Retirement Villages

    PubMed Central

    Xia, Bo; Zuo, Jian; Skitmore, Martin; Buys, Laurie; Hu, Xin

    2014-01-01

    With many developed countries experiencing the aging of the population, older people play a large role in contributing to environmental problems but also to environmental solutions. The purpose of this research is to understand the awareness and behavior of current older people living in retirement villages towards sustainability development. To achieve this, a sustainability literacy survey was conducted with 65 older residents of a private retirement village located 10 Km outside the Brisbane, Australia's central business district (CBD). Most of residents recognized the importance of environment protection and would like to lead a more environmentally friendly lifestyle. In addition, the majority were willing to pay higher prices for a living environment with sustainable features. The importance of positive social communications was emphasized with most residents having established good relationships with others in the village. The findings provide an important insight into consumer perspectives regarding the sustainable features that should and can be incorporated into the village planning and development. PMID:25587448

  7. Participation of surgical residents in operations: challenging a common classification.

    PubMed

    Bezemer, Jeff; Cope, Alexandra; Faiz, Omar; Kneebone, Roger

    2012-09-01

    One important form of surgical training for residents is their participation in actual operations, for instance as an assistant or supervised surgeon. The aim of this study was to explore what participation in operations entails and how it might be described and analyzed. A qualitative study was undertaken in a major teaching hospital in London. A total of 122 general surgical operations were observed. A subsample of 14 laparoscopic cholecystectomies involving one or more residents was analyzed in detail. Audio and video recordings of eight operations were transcribed and analyzed linguistically. The degree of participation of trainees frequently shifted as the operation progressed to the next stage. Participation also varied within each stage. When trainees operated under supervision, the supervisors constantly adjusted their degree of control over the resident's operative maneuvers. Classifications such as "assistant" and "supervised surgeon" describing a trainee's overall participation in an operation potentially misrepresent the varying involvement of resident and supervisor. Video recordings provide a useful alternative for documenting and analyzing actual participation in operations.

  8. Memory performance and affect: are there gender differences in community-residing older adults?

    PubMed

    McDougall, Graham Joseph; Pituch, Keenan A; Stanton, Marietta P; Chang, Wanchen

    2014-08-01

    After age 65, the incidence of episodic memory decline in males is greater than in females. We explored the influence of anxiety and depression on objective and subjective memory performance in a diverse sample of community-residing older adults. The study was a secondary analysis of data on three samples of adults from two states, Ohio and Texas: a community sample (n = 177); a retirement community sample (n = 97); and the SeniorWISE Study (n = 265). The sample of 529 adults was 74% female, the average age was 76.58 years (range = 59-100 years), and educational attainment was 13.12 years (±3.68); 68% were Caucasian, and 17% had depressive symptoms. We found no memory performance differences by gender. Males and females were similarly classified into the four memory performance groups, with almost half of each gender in the poor memory category. Even though males had greater years of education, they used fewer compensatory memory strategies. The observed gender differences in memory were subjective evaluations, specifically metamemory. Age was not a significant predictor of cognition or memory performance, nor did males have greater memory impairment than females.

  9. Taylor Elected to Royal Society of London

    Science.gov Websites

    SLAC, 28 May 1997 Taylor Elected to Royal Society of London Richard Taylor, physics professor at statements must be verified by facts. Taylor will travel to London in the near future for his induction, part Isaac Newton and Michael Faraday. Taylor, a Canadian citizen, received his Ph.D. at Stanford in 1962 and

  10. Daily life after moving into a care home--experiences from older people, relatives and contact persons.

    PubMed

    Andersson, Ingegerd; Pettersson, Elisabet; Sidenvall, Birgitta

    2007-09-01

    To describe older people's experiences of daily life at the care home after admittance with respect to their perceptions of participation in the decision to move. Furthermore, the aim was to study the experiences of their relatives and contact persons with respect to the daily life of the same residents. When older persons move into a care home, the whole family often play an important part. Thus, it is interesting to study how newly admitted older people, their relatives and staff members experience daily life in a modern care home. Qualitative design. The participants comprised a purposive sample of 13 residents, recently admitted to a care home, 69-90 years old, both single living and married, both moving from their own homes and from different institutions. Interviews were carried out with the older people (n = 13), their relatives (n = 10) and contact persons (n = 11). The majority of the residents reported satisfaction with care home living. The relatives were also satisfied, secure and appreciated the privacy and homely atmosphere of the flat. The disadvantage of one-room flats was that the residents might have felt lonely. The relatives felt that the residents were bored, but few residents desired more activities, even if some of them longed for people to socialize with. For many older people, perhaps talking is the most important 'activity' at care homes. Concerning self-determination, some residents did not find it satisfactory. Staff members must pay attention to residents' need to talk with people. For many older people, talking is perhaps the most important 'activity' at care homes. Nurses must safeguard residents' self-determination. When residents are in control of their lives, they may become satisfied with time.

  11. 30. VIEW OF PHOTO CAPTIONED 'SUBMARINE BASE, NEW LONDON, CONNECTICUT. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    30. VIEW OF PHOTO CAPTIONED 'SUBMARINE BASE, NEW LONDON, CONNECTICUT. 2 JUNE 1930. SUBMARINE TRAINING TANK - STEELWORK 98% COMPLETE; BRICKWORK 95% COMPLETE, PIPING 10% IN PLACE. LOOKING NORTH. CONTRACT NO. Y-1539-ELEVATOR, SUBMARINE ESCAPE TANK.' - U.S. Naval Submarine Base, New London Submarine Escape Training Tank, Albacore & Darter Roads, Groton, New London County, CT

  12. Perceptions of exercise screening among older adults.

    PubMed

    Stathokostas, Liza; Petrella, Andrea F M; Blunt, Wendy; Petrella, Robert J

    2018-06-01

    Prephysical activity screening is important for older adults' participating in physical activity. Unfortunately, many older adults face barriers to exercise participation and thus, may not complete proper physical activity screening. The purpose of this project was to conduct a thematic analysis of perceptions and experiences of community-dwelling older adults regarding prephysical activity screening (i.e., Get Active Questionnaire (GAQ) and a standardized exercise stress test). A convenience sample of adults (male n = 58, female n = 54) aged 75 ± 7 years living in the City of London, Ontario, Canada, was used. Participants completed a treadmill stress test and the GAQ at a research laboratory for community-based referrals. One week later, participants completed the GAQ again and were asked questions by a research assistant about their perceptions of the screening process. Thematic analysis of the responses was conducted. The results indicated that older adults view physical activity screening as acceptable, but not always necessary. Also, the experiences expressed by this sample of older adults indicated that physical activity screening can contribute to continued confidence (through reassurance) and can contribute to increased motivation (through yearly fitness results) in exercise participation. In conclusion, older adults may perceive screening as supportive in exercise adoption, if screening is simple, convenient, and supports older adults' motivation and confidence to exercise.

  13. Gonorrhoea in inner London: results of a cross sectional study.

    PubMed Central

    Low, N.; Daker-White, G.; Barlow, D.; Pozniak, A. L.

    1997-01-01

    OBJECTIVES: To estimate population based incidence rates of gonorrhoea in an inner London area and examine relations with age, ethnic group, and socioeconomic deprivation. DESIGN: Cross sectional study. SETTING: 11 departments of genitourinary medicine in south and central London. SUBJECTS: 1978 first episodes of gonorrhoea diagnosed in 1994 and 1995 in residents of 73 electoral wards in the boroughs of Lambeth, Southwark, and Lewisham who attended any of the departments of genitourinary medicine. MAIN OUTCOME MEASURES: Yearly age, sex, and ethnic group specific rates of gonorrhoea per 100,000 population aged 15-59 years; rate ratios for the effects of age and ethnic group on gonorrhoea rates in women and men before and after adjustment for confounding factors. RESULTS: Overall incidence rates of gonorrhoea in residents of Lambeth, Southwark, and Lewisham were 138.3 cases yearly per 100,000 women and 291.9 cases yearly per 100,000 men aged 15-59 years. At all ages gonorrhoea rates were higher in non-white minority ethnic groups. Rate ratios for the effect of age adjusted for ethnic group and underprivilege were 15.2 (95% confidence interval 11.6 to 19.7) for women and 2.0 (1.7 to 2.5) for men aged 15-19 years compared with those over 30. After deprivation score and age were taken into account, women from black minority groups were 10.5 (8.6 to 12.8) times as likely and men 11.0 (9.7 to 12.6) times as likely as white people to experience gonorrhoea. CONCLUSIONS: Gonorrhoea rates in Lambeth, Southwark, and Lewisham in 1994-5 were six to seven times higher than for England and Wales one year earlier. The presentation of national trends thus hides the disproportionate contribution of ongoing endemic transmission in the study area. Teenage women and young adult men, particularly those from black minority ethnic groups, are the most heavily affected, even when socioeconomic underprivilege is taken into account. There is urgent need for resources for culturally

  14. Experiential Approaches to the Global City: London as Social Laboratory

    ERIC Educational Resources Information Center

    Gristwood, Anthony; Woolf, Michael

    2011-01-01

    London is the paramount example of a city that is not bounded by its geography and cannot be grasped in isolation. The U.K.'s national capital and the prime focus for business, finance and creative industries, London also transcends the U.K.'s borders as a hub of the world economy. This paper argues that London, a city riddled by the socioeconomic…

  15. Joseph Clover and the cobra: a tale of snake envenomation and attempted resuscitation with bellows in London, 1852.

    PubMed

    Ball, C

    2010-07-01

    The Industrial Revolution saw the creation of many new jobs, but probably none more curious than that of zookeeper. The London Zoological Gardens, established for members in 1828, was opened to the general public in 1847. In 1852 the "Head Keeper in the Serpent Room", Edward Horatio Girling, spent a night farewelling a friend departing for Australia. He arrived at work in an inebriated state and was bitten on the face by a cobra that he was handling in a less than sensible manner. He was taken by cab to University College Hospital where he was resuscitated by a number of doctors, including Joseph Clover then the resident medical officer to the hospital and later to become the leading anaesthetist in London. Clover recorded this event in his diary along with the resuscitation method used. The patient eventually died but his treatment created a flurry of correspondence in the medical and lay press. Interestingly, the attempted resuscitation was with bellows, which had been abandoned by the Royal Humane Society twenty years earlier Clover records other cases of resuscitation with bellows at University College Hospital during his time as a resident medical officer there (1848 to 1853). There is a casebook belonging to Joseph Clover in the Geoffrey Kaye Museum, in Melbourne. This story is one of the many interesting stories uncovered during a study of this book and Clover's other personal papers.

  16. Mapping the evolution of 'food deserts' in a Canadian city: Supermarket accessibility in London, Ontario, 1961–2005

    PubMed Central

    Larsen, Kristian; Gilliland, Jason

    2008-01-01

    Background A growing body of research suggests that the suburbanization of food retailers in North America and the United Kingdom in recent decades has contributed to the emergence of urban 'food deserts', or disadvantaged areas of cities with relatively poor access to healthy and affordable food. This paper explores the evolution of food deserts in a mid-sized Canadian city (London, Ontario) by using a geographic information system (GIS) to map the precise locations of supermarkets in 1961 and 2005; multiple techniques of network analysis were used to assess changing levels of supermarket access in relation to neighbourhood location, socioeconomic characteristics, and access to public transit. Results The findings indicate that residents of inner-city neighbourhoods of low socioeconomic status have the poorest access to supermarkets. Furthermore, spatial inequalities in access to supermarkets have increased over time, particularly in the inner-city neighbourhoods of Central and East London, where distinct urban food deserts now exist. Conclusion Contrary to recent findings in larger Canadian cities, we conclude that urban food deserts exist in London, Ontario. Policies aimed at improving public health must also recognize the spatial, as well as socioeconomic, inequities with respect to access to healthy and affordable food. Additional research is necessary to better understand how supermarket access influences dietary behaviours and related health outcomes. PMID:18423005

  17. Suicide on the London Underground System.

    PubMed

    Farmer, R; O'Donnell, I; Tranah, T

    1991-09-01

    Over the past 50 years there has been an increase in the numbers of people jumping/falling in front of trains on the London Underground system. Case-fatality rates have fallen from 70% in the 1950s to 55% today. The proportion certified as suicide has fallen while the proportions certified as accidents or open verdicts have risen. There is unusual clustering of events at some stations which are adjacent to psychiatric units. The hypothesis that ease of access to London Underground stations may sometimes be a determinant of suicide is investigated.

  18. Older people's involvement in activities related to meals in nursing homes.

    PubMed

    Grøndahl, Vigdis Abrahamsen; Aagaard, Heidi

    2016-09-01

    To explore how residents in nursing homes perceive their participation in activities related to food and meals, and possible factors influencing their involvement. Eating and drinking are fundamental human needs and consequently essential parts of nursing and nursing care. Therefore and as part of nursing care, encouraging older people in nursing homes to engage in different mealtime activities could be one way to increase participation in activities of daily living and more optimal nutrition status among older people. A cross-sectional survey design was used. A total of 204 residents (88%) in one Norwegian county agreed to participate and completed a face-to-face interview questionnaire about food and meal experiences. Descriptive and comparative statistics was used. Close to 30% of the residents were vulnerable to malnourishment. None of the residents were involved in menu planning, and more than 90% did not participate in food preparation or setting/clearing tables. Ten per cent were able to choose where they could eat and 5% when they could eat. Older persons living in nursing homes with more than 80 residents and those younger than 65 years of age participated the most, while older people with poor appetites were able to choose more often where they wanted to eat, compared to those with a healthy appetite. The residents in this study appeared to be vulnerable to malnourishment. The results indicated that they only to a limited extent were involved in activities concerning food and meals at the nursing homes. Management and nurses should focus on residents' eating and drinking, which are essentials of nursing care. The residents should be asked whether they would like to participate in different mealtime activities. Further, a person-centred care approach that facilitates activities concerning food and meals should be promoted. © 2016 John Wiley & Sons Ltd.

  19. The Struggle to Study. Financial Implications for Adults Studying in London. A Research Report Funded by London's Four Open College Networks: ALFA, CAWLOC, GLEAN, and OCSL.

    ERIC Educational Resources Information Center

    Sims, Anne; Goddard, Ty

    The four Open College Networks in London assessed the climate in inner London for adult students who wished to return to education and training. The research focussed on: the extent to which recent legislative changes threatened adult participation in education and training; the abolition of the Inner London Education Authority (ILEA) and…

  20. The health of older Mexican Americans in the long run.

    PubMed

    González, Hector M; Ceballos, Miguel; Tarraf, Wassim; West, Brady T; Bowen, Mary E; Vega, William A

    2009-10-01

    We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Self-rated health, medical illnesses, and functional measures were examined in multivariate regression models that included nativity and years of US residency as key predictors. Self-rated health and medical illnesses of immigrant and US-born groups did not differ significantly. Immigrants with longer US residency had significantly higher cognitive functioning scores and fewer problems with functional activities after adjustment for predisposing and medical need factors. Among older Mexican Americans, immigrant health advantages over their US-born counterparts were not apparent. Immigrants had better health functioning with longer US residency that may derive from greater socioeconomic resources. Our findings suggest that the negative acculturation-health relationship found among younger immigrant adults may become a positive relationship in later life.

  1. Changing the Subject: English in London, 1945-1967

    ERIC Educational Resources Information Center

    Yandell, John

    2014-01-01

    Two recent books, "English Teachers in a Postwar Democracy: Emerging Choice in London Schools, 1945-1965" and "The London Association for the Teaching of English, 1947-67: A History," explore an important period in the development of English as a school subject and in the remaking of the professional identity of English…

  2. A Case Study Investigation into the Use of Multi-compartment Compliance Aids in Older People Resident in Very Sheltered Housing.

    PubMed

    MacLure, Katie; MacLeod, Joan; Forbes-McKay, Katrina; Paudyal, Vibhu; Cunningham, Scott; Strath, Alison; Lynch, Rory; Stewart, Derek

    2016-12-01

    Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines, heralded by some as a solution to non-adherence but with little evidence of benefit. The aim was to use a theoretical approach to describe the behavioural determinants impacting the use of MCAs in older people from the perspectives of the individual and health and social care providers. A case study investigation was conducted. The study took place in three very sheltered housing sites in North East Scotland. Twenty residents (≥65 years) using an MCA for at least 6 months and 34 members of their care team [17 formal carers, eight general practitioners (GPs), eight pharmacists, one family member]. Semi-structured, face-to-face interviews with items based on the Theoretical Domains Framework were conducted. Interviews were audio-recorded, transcribed and analysed thematically. Several behavioural determinants impacted the use of MCAs from the perspectives of the stakeholders involved. Goals of use related to promoting adherence and safety, with less emphasis on independence. Beliefs of consequences related to these goals and were considered of value, with additional consequences of concern around reduced awareness of medicines and complexities of changing medicines. There was a lack of clearly defined roles of professionals for all processes of MCA use, with evidence of blurring and gaps in roles. There were additional issues relating to capabilities of older people in using MCAs and capacity issues for pharmacy-supplied MCAs. Several behavioural determinants impacted the use of MCAs, and while MCAs were valued, there is a need to more clearly define, develop, implement and evaluate a model of care encompassing resident and medicines assessment, supply and ongoing review of MCAs.

  3. Training Older Adults to Access Health Information

    ERIC Educational Resources Information Center

    Bertera, Elizabeth M.; Bertera, Robert L.; Morgan, Russell; Wuertz, Ellen; Attey, Alfred M. O.

    2007-01-01

    Many older adults do not use health information available on the Internet. Older adults residing in affordable housing were taught to use the NIHSeniorHealth.gov Web site. Participants were predominantly African American women with limited education and income (N = 42). Outcomes included changes in computer and health Web site navigation skills.…

  4. Soybeans or Soybean Products Consumption and Depressive Symptoms in Older Residents in Rural Northeast China: A Cross-Sectional Study.

    PubMed

    Yu, S; Guo, X; Yang, H; Zheng, L; Sun, Y

    2015-11-01

    Depression is one of the most common mental disorders among elderly subjects. The purpose of this study is to estimate the prevalence of depressive symptoms and the association between soybeans consumption and depressive symptoms among older residents in rural Northeast China. Cross-sectional study. A representative sample of the rural Northeast residents. This survey was conducted from July 2012 to August 2013 which randomly selected and examined a total of 1717 residents aged ≥ 65 years from the rural Northeast China. All participants completed the Patient Health Questionnaire-9 (PHQ-9). Information on demographic and lifestyle characteristics and blood biochemical indexes were collected by well-trained personnel. The prevalence of depressive symptoms in the elderly was 8.9%. Women had significantly higher prevalence of depressive symptoms than men (13.3% vs.4.6%, P<0.001). Individuals consuming soybeans ≥4times/week had statically lower possibility to have depressive symptoms than those rarely consuming (3.6%vs. 12.5%, P<0.05). In addition to some conventional risk factors like sex, annual income, educational status, current smoking and chronic diseases status were associated with depressive symptoms, proper sleep duration (7-8h/d) [OR(95%CI):0.28(0.15,0.53)] and frequently consumption of soybeans or soybean products [OR (95%CI): 0.36 (0.15,0.87) for 2-3times/week and OR (95%CI):0.50 (0.34,0.74) for ≥4times/week] significantly decreased the risk of depressive symptoms among elderly in rural Northeast China. Women had significantly higher prevalence of depressive symptoms than men in rural China. Individuals who rarely consume soybeans or soybean products are more likely to suffer depressive symptoms. Rural elderly residents should be cautiously screened to prevent or treat depression.

  5. Why do some people look older than they should?

    PubMed

    Bulpitt, C J; Markowe, H L; Shipley, M J

    2001-09-01

    As a component of studies on biological age, the age of subjects from their appearance (perceived age) was estimated. To determine the factors associated with looking older. Cross sectional study of London civil servants (318 men, 129 women) in the Department of the Environment study. Perceived age was recorded by an observer and the difference between this age and chronological age was analysed according to 20 different variables. Men had an average perceived age of 0.37 years older than their actual age and women a perceived age of 0.54 years younger. In men, looking older was related to greying of the hair, grade of arcus senilis, and grade of baldness. Less expected, looking older was positively related to total serum cholesterol (p=0.03) and blood haemoglobin (p<0.01). In women, looking older was related to greying of the hair, positively to blood erythrocyte sedimentation rate (ESR), and negatively to serum bilirubin (p=0.01). Looking older was not related to alcohol consumption, employment grade, serum high density lipoprotein cholesterol, glucose, albumin, and calcium in either sex. The relationships between looking older and total cholesterol and haemoglobin in men and ESR and bilirubin in women, require further investigation.

  6. The Capacity to Consent to Research among Older Adults

    ERIC Educational Resources Information Center

    Lee, Minhong

    2010-01-01

    The aim of this study was to develop and validate an assessment tool for research consent competence in older participants. A four-item instrument was developed to assess the capacity of the older adults to consent to research. Data were obtained from 203 nursing home residents from two facilities and 201 community-dwelling older adults in a…

  7. 'A place for men to come and do their thing': constructing masculinities in betting shops in London.

    PubMed

    Cassidy, Rebecca

    2014-03-01

    During fieldwork conducted with workers and customers in betting shops in London research participants consistently conceptualized betting shops as masculine spaces in contrast to the femininity of other places including home and the bingo hall. According to this argument, betting on horses and dogs was 'men's business' and betting shops were 'men's worlds'. Two explanations were offered to account for this situation. The first suggested that betting was traditionally a pastime enjoyed by men rather than women. The second was that betting is intrinsically more appealing to men because it is based on calculation and measurement, and women prefer more intuitive, simpler challenges. I use interviews with older people to describe how the legalisation of betting in cash in 1961 changed the geography of betting. I then draw upon interviews with regular customers in order to show how knowledge about betting is shared within rather than between genders. Finally, I use my experience of training and working as a cashier to describe how the particular hegemonic masculinity found in betting shops in London is maintained through myriad everyday practices which reward certain kinds of gendered performances while at the same time suppressing alternatives. The article shows how particular spaces may become gendered as an unanticipated consequence of legislation and how contingent gendered associations are both naturalized and, at the same time, subjected to intense attention. © London School of Economics and Political Science 2013.

  8. Identification of depressive disorder among older people in care homes - a feasibility study.

    PubMed

    Morrell, C Jane; Curran, Stephen; Topping, Annie; Shaik, Kauserjan; Muthukrishnan, Venkatesh; Stephenson, John

    2011-07-01

    Depression is common among older people but more common among those living in care homes. Depression is not easily detected among older adults because of the presentation, and the tendency for older people not to complain of depression, particularly those living in care homes. In general, care home staff have limited training in recognising depression. Depression is undertreated and residents may not receive a therapeutic dose of antidepressant. The true prevalence of depression among care home residents is uncertain. This feasibility study aimed to explore the level of depression among older people in care homes by comparing the outcome of an assessment by care home staff with the outcome of a diagnostic clinical interview, using ICD-10 criteria and the 30-item Geriatric Depression Scale (GDS), conducted by a psychiatrist. In all, 47 older people from four care homes were interviewed by a psychiatrist. Of them, 39.1% (18/46) of residents were prescribed an antidepressant and were no longer depressed; 8.7% (4/46) were prescribed an antidepressant and remained depressed; and 6.5% (3/46) of residents assessed as being depressed, had not been prescribed an antidepressant. That is, 54% (25/46) of residents had been or were currently depressed. Using ICD-10 criteria, the sensitivity of the GDS at a threshold of 10 and 11 was 100%. In total, 89.4% of residents received a correct diagnosis (presence or absence of depression) using the GDS at the 11 threshold. The prevalence of depression in these homes was 54%. Of the residents with depression, 72% (18/25) were managed with an antidepressant and 28% (7/25) were receiving ineffective or no treatment. The 30-item GDS can provide more useful information than a home care staff assessment for identifying depression. More research should explore the value of training home care staff to administer the 30-item GDS to optimise the management of depression in older people in care homes.

  9. Utilization of the emergency department by older residents in Kuala Lumpur, Malaysia.

    PubMed

    Mohd Mokhtar, Mohd Amin; Pin, Tan Maw; Zakaria, Mohd Idzwan; Hairi, Noran Naqiah; Kamaruzzaman, Shahrul Bahiyah; Vyrn, Chin Ai; Hua, Philip Poi Jun

    2015-08-01

    To determine the pattern of utilization of emergency department (ED) services by older patients in Kuala Lumpur, Malaysia, compared with younger patients in the same setting. The sociodemographics, clinical characteristics and resource utilization of consecutive patients attending the adult ED at the University Malaya Medical Center were recorded during a typical week. A total of 1649 patients were included in the study; 422/1649 (25.6%) were aged ≥60 years and 1077 (74.4%) were aged <60 years. Older adult patients were more likely to be diagnosed with ischemic heart disease (12.6% vs 2.5%, P < 0.001), and more likely to require investigations such as electrocardiogram (68.1% vs 16.6%, P < 0.001) or chest X-rays (67.6% vs 24.0%, P < 0.001) than their younger counterparts. Logistic regression methods showed that older adults remained an independent predictor of hospital admission (OR 2.75, 95% CI 2.11-3.57). The ratio of older adult patients attending our ED over the proportion of older people in the general population was 26:6, which is far higher than reported in previous published studies carried out in other countries. Older ED attenders are also more likely to require investigations, procedures and hospital admissions. With the rapidly aging population in Malaysia, reconfiguration of resources will need to occur at a compatible rate in order to ensure that the healthcare needs of our older adults are met. © 2014 Japan Geriatrics Society.

  10. Senior residents' perceived need of and preferences for "smart home" sensor technologies.

    PubMed

    Demiris, George; Hensel, Brian K; Skubic, Marjorie; Rantz, Marilyn

    2008-01-01

    The goal of meeting the desire of older adults to remain independent in their home setting while controlling healthcare costs has led to the conceptualization of "smart homes." A smart home is a residence equipped with technology that enhances safety of residents and monitors their health conditions. The study aim is to assess older adults' perceptions of specific smart home technologies (i.e., a bed sensor, gait monitor, stove sensor, motion sensor, and video sensor). The study setting is TigerPlace, a retirement community designed according to the Aging in Place model. Focus group sessions with fourteen residents were conducted to assess perceived advantages and concerns associated with specific applications, and preferences for recipients of sensor-generated information pertaining to residents' activity levels, sleep patterns and potential emergencies. Sessions were audio-taped; tapes were transcribed, and a content analysis was performed. A total of fourteen older adults over the age of 65 participated in three focus group sessions Most applications were perceived as useful, and participants would agree to their installation in their own home. Preference for specific sensors related to sensors' appearance and residents' own level of frailty and perceived need. Specific concerns about privacy were raised. The findings indicate an overall positive attitude toward sensor technologies for nonobtrusive monitoring. Researchers and practitioners are called upon to address ethical and technical challenges in this emerging domain.

  11. Teaching the History of Astronomy On Site in London

    NASA Astrophysics Data System (ADS)

    French, Linda M.

    2016-01-01

    In the autumn of 2014, the author had the opportunity to teach a class on the history of astronomy in England as part of a study abroad experience for students at Illinois Wesleyan University. The philosophy of the program is to use the rich cultural environment of London as a setting for active learning. In the classroom, students read and discussed selected works by Ptolemy, Copernicus, Kepler, Galileo, and Herschel. We visited Stonehenge, the Royal Greenwich Observatory, the London Science Museum, the London Monument, and the library of the Royal Astronomical Society. Lessons learned from the experience will be shared.

  12. The role of community nursing in providing integrated care for older people with alcohol misuse.

    PubMed

    Rao, Tony

    2014-02-01

    Alcohol misuse in older people is a growing problem for health and social care providers, but remains largely hidden from public view and therefore largely overlooked by commissioners. Many older people with alcohol misuse have a 'dual diagnosis' (alcohol misuse accompanying other mental disorders) rather than alcohol misuse alone, which requires specialist nursing expertise. Over the past 10 years, assessment of and interventions for the detection of alcohol misuse in older people have been developed within one London borough. This article details the background, strategy and outcomes of this service, which provides integrated care in a multi-disciplinary community mental health team covering an inner-city area with a high prevalence of alcohol misuse and dual diagnosis in older people.

  13. What's different about older people.

    PubMed

    Crome, Peter

    2003-10-01

    Older people can be regarded as a marginalised group within society from a number of perspectives including that of health. When it comes to the use of medication older people have suffered from a double whammy. Not only are they more at risk from the adverse effects of drugs but also their involvement in clinical trials has been limited so that rational prescribing both to maximise benefit and to reduce risk has been problematic. Their special problems have been recognised formerly by the Department of Health in its NSF for Older People [National Service Framework for Older People. Department of Health, London (2001a)], [Medicines and Older People. Implementing medicines-related aspects of the NSF for Older People. Department of Health (2001b)]. Early studies focussed on compliance, the avoidance of poly-pharmacy and the high prevalence of adverse effects of drugs and the reasons for this. Studies in long-stay patients showed dramatic differences in pharmacokinetics between such older people and young healthy volunteers. Initially such differences were ascribed to age alone and the overall message became "start low and go slow". Studies in healthy older people then revealed that age differences in drug metabolism were, as a rule, not so marked although clearance of renally excreted drugs was reduced in line with the age associated decline in renal function. Including older people in clinical trials poses challenges. Many traditional trialists do not have ready access to older people, co-morbidity and poly-pharmacy are common and most people feel reluctant to ask older people to take part in complex and potentially hazardous trials. Concern about compliance is unwarranted. Adverse events may be more serious. Thus in a younger patient postural hypotension may make a subject unsteady but in an older subject the unsteadiness may lead to a fall, the fall to a fracture, and the fracture to poor recovery. The choice of end-points is crucial. Although reduction of

  14. The epidemiology of injuries at the London 2012 Paralympic Games.

    PubMed

    Willick, Stuart E; Webborn, Nick; Emery, Carolyn; Blauwet, Cheri A; Pit-Grosheide, Pia; Stomphorst, Jaap; Van de Vliet, Peter; Patino Marques, Norma Angelica; Martinez-Ferrer, J Oriol; Jordaan, Esmè; Derman, Wayne; Schwellnus, Martin

    2013-05-01

    The characteristics and incidence of injuries at the Summer Paralympic Games have not previously been reported. A better understanding of injuries improves the medical care of athletes and informs future injury prevention strategies. The objective of this prospective cohort study was to characterise the incidence and nature of injuries during the London 2012 Summer Paralympic Games. Injury information was obtained from two databases. One database was populated from medical encounter forms completed by providers at the time of assessment in one of the medical stations operated by the Organising Committee. The second database was populated daily with information provided by team medical personnel who completed a comprehensive, web-based injury survey. The overall injury incidence rate was 12.7 injuries/1000 athlete-days. Injury rates were similar in male and female athletes. The precompetition injury rates in women were higher than those in the competition period. Higher injury rates were found in older athletes and certain sports such as football 5-a-side (22.4 injuries/1000 athlete-days). Overall, 51.5% of injuries were new onset acute traumatic injuries. The most commonly injured region (percentage of all injuries) was the shoulder (17.7%), followed by the wrist/hand (11.4%), elbow (8.8%) and knee (7.9%). This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.

  15. Police deaths in New York and London during the twentieth century

    PubMed Central

    Kyriacou, D N; Monkkonen, E H; Peek‐Asa, C; Lucke, R E; Labbett, S; Pearlman, K S; Hutson, H R

    2006-01-01

    Objectives To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century. To assess the relation between overall societal violence and violence directed toward police officers in these metropolitan areas. Design and setting Ecological study of New York and London from 1900 through 1999. Main outcome measures Intentional and unintentional occupational police mortality rates for New York and London were estimated for each decade. The general population homicide rates of both New York and London were assessed for their correlation with their respective intentional occupational police mortality rates. Results During the 20th century, 585 police officers in New York and 160 police officers in London died while participating in law enforcement activities. New York had markedly greater intentional police mortality rates compared to London throughout most of the 20th century, but these differences decreased significantly by the end of the century. Intentional gunshot wounds comprised 290 police deaths in New York, but only 14 police deaths in London. In New York, gun shot wounds (both intentional and unintentional) accounted for more occupational police deaths (51.6%) than did all other injury mechanisms combined. In London, motor vehicle collision was the most common cause (47.5%) of occupational police death. There were no apparent correlations between the general population homicide rates and intentional police mortality rates in either New York (r2 = 0.05, 95% CI −0.77 to 0.81) or London (r2 = 0.34, 95% CI −0.61 to 0.89). Conclusions During the 20th century, both intentional and unintentional occupational police mortality rates were significantly greater in New York compared to London. These differences are likely from several socioeconomic, cultural, and occupational factors. The declines in police deaths in New York during the latter part of

  16. Digital London: Creating a Searchable Web of Interlinked Sources on Eighteenth Century London

    ERIC Educational Resources Information Center

    Shoemaker, Robert

    2005-01-01

    Purpose: To outline the conceptual and technical difficulties encountered, as well as the opportunities created, when developing an interlinked collection of web-based digitised primary sources on eighteenth century London. Design/methodology/approach: As a pilot study for a larger project, a variety of primary sources, including the "Old…

  17. The Influence of Green Infrastructure on Urban Resilience in Greater London

    NASA Astrophysics Data System (ADS)

    Oh, Yukyung

    2017-04-01

    High population densities and diverse economic activities in urban areas create social issues as well as a range of environmental impacts including air pollution, soil contamination, loss of biodiversity and health problems (Alberti et al., 2003; Dobbs, Escobedo, & Zipperer, 2011; Grimm et al., 2008). The concept of urban resilience has been used for increasing the capacity of the entities and players to adapt to rapid changes, and urban green spaces play a crucial role in increasing urban resilience. Greater London has a good case for increasing urban green spaces and resilience under the London Plan. The relevance of urban open spaces and several socioeconomic indicators would provide researchers and policy makers with the information for managing green coverage. The correlation analysis of two quantitative data such as open space and socioeconomic data of Greater London was conducted with SPSS. The data for open spaces in Greater London was gained through Greenspace Information for Greater London. The data was converted from vector to raster in Geographic Information System (GIS), so as to calculate landscape metrics for open spaces in Greater London through a spatial pattern analysis program, FRAGSTATS 4.2. The socioeconomic data was obtained from "London Borough Profile", London Datastore. In addition, data on total carbon emissions from Industry and Commercial, Domestic, Transport, LULUCF Net Emissions, and per capita emissions were gained from UK local authority and regional carbon dioxide emissions national statistics: 2005-2014 released from Department of Energy and Climate Change. The indicators from open spaces are total area of open space and patch density or contagion of open spaces. The latter indicator allows to figure out the level of fragmentation of open spaces. The socioeconomic indicators cover number of jobs by workplace, jobs density, crime rates per thousand population, and several wellbeing indicators such as life satisfaction

  18. Clean Air for London (CLEARFLO) Final Campaign Summary

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Worsnop, D. R.; Williams, L. R.; Herndon, S. C.

    This field campaign funded the participation of scientists from seven different research groups and operated over thirty instruments during the Winter Intensive Operating Period (January-February 2012) of the Clean Air for London (ClearfLo) campaign. The campaign took place at a rural site in Detling, UK, 45 kilometers southeast of central London. The primary science questions for the ClearfLo winter IOP (intensive operational periods) were: 1) “what is the urban increment of particulate matter (PM) and other pollutants in the greater London area?” and 2) “what is the contribution of solid fuel use for home heating to wintertime PM?” An additionalmore » motivation for the Detling measurements was the question of whether coatings on black carbon particles enhance absorption.« less

  19. 33 CFR 110.52 - Thames River, New London, Conn.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Thames River, New London, Conn. 110.52 Section 110.52 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY ANCHORAGES ANCHORAGE REGULATIONS Special Anchorage Areas § 110.52 Thames River, New London, Conn. (a) Area No...

  20. 33 CFR 110.52 - Thames River, New London, Conn.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Thames River, New London, Conn. 110.52 Section 110.52 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY ANCHORAGES ANCHORAGE REGULATIONS Special Anchorage Areas § 110.52 Thames River, New London, Conn. (a) Area No...

  1. 33 CFR 110.52 - Thames River, New London, Conn.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Thames River, New London, Conn. 110.52 Section 110.52 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY ANCHORAGES ANCHORAGE REGULATIONS Special Anchorage Areas § 110.52 Thames River, New London, Conn. (a) Area No...

  2. 33 CFR 110.52 - Thames River, New London, Conn.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Thames River, New London, Conn. 110.52 Section 110.52 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY ANCHORAGES ANCHORAGE REGULATIONS Special Anchorage Areas § 110.52 Thames River, New London, Conn. (a) Area No...

  3. 33 CFR 110.52 - Thames River, New London, Conn.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Thames River, New London, Conn. 110.52 Section 110.52 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY ANCHORAGES ANCHORAGE REGULATIONS Special Anchorage Areas § 110.52 Thames River, New London, Conn. (a) Area No...

  4. Health-related profile and quality of life among nursing home residents: does pain matter?

    PubMed

    Tse, Mimi M Y; Wan, Vanessa T C; Vong, Sinfia K S

    2013-12-01

    The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. Older Americans. Datatrack 9.

    ERIC Educational Resources Information Center

    American Council of Life Insurance, Washington, DC.

    Ninth in a series of reports which compile and interpret statistical information of direct concern to life insurance executives, this report deals with senior citizens, defined as persons 65 years and over. Examined are social and economic characteristics. Trends in the older population's growth, morality, educational attainment, residence, living…

  6. Establishing community wound prevalence within an inner London borough: exploring the complexities.

    PubMed

    Hopkins, Alison; Worboys, Fran

    2014-11-01

    The academic literature reveals a dearth of evidence regarding the wound prevalence across a community setting, despite the need for both clinicians and commissioners to understand local need. To support the commissioning process, a wound prevalence audit was undertaken across all community services in an inner London borough in 2012 as part of a local needs analysis and to identify where resources were required. Within a population of 254,000, 272 residents had a total of 325 wounds, giving a mean of 1.19 wounds and a community wound prevalence of 1.07 per 1000 residents. The majority were male (51%) and the age range was 9-96 years. Acute and traumatic wounds accounted for 44% followed by foot and leg ulcers at 41%, pressure ulcers at 13% and other wound types at 2.6%. Of the lower leg ulceration group, 34 patients had venous ulceration, giving a prevalence of 0.13 per 1000. The difficulties in establishing a comprehensive wound prevalence that includes acute services are discussed in addition to the significance of the findings in the context of a deprived ethnically diverse borough with a younger population. The number of residents with any wound type was lower than other reported studies with similar methodologies. This paper presents the view that, despite the deprivation of the borough, the combined factors of age, ethnicity and early access to specialist expertise appear to deliver a lower community wound prevalence. Copyright © 2014 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  7. Nutritional status and health outcomes for older people with dementia living in institutions.

    PubMed

    Lou, Meei-Fang; Dai, Yu-Tzu; Huang, Guey-Shiun; Yu, Po-Jui

    2007-12-01

    This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. Eighteen percent of the residents were under-nourished (body mass index <18.5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia.

  8. THE LONDON EXTERNAL DEGREE SYSTEM, ORIGINS AND PRESENT PROBLEMS.

    ERIC Educational Resources Information Center

    CHARNLEY, A.H.

    FORMAL RESPONSIBILITY FOR BRITISH ADULTS PURSUING DEGREE COURSES BY HOME STUDY RESTS LARGELY WITH THE UNIVERSITY OF LONDON. ALTHOUGH ABOUT 1,000 STUDENTS ARE BEING TAUGHT AT INSTITUTIONS COOPERATING WITH THE UNIVERSITY OF LONDON, THE MAJOR GROUPS ARE THE HOME STUDENTS (OVER 20,000) AND THE OVERSEAS STUDENTS (OVER 4,000). BRITISH EXTERNAL STUDENTS…

  9. Fear of Crime among Elderly Jews in Boston and London.

    ERIC Educational Resources Information Center

    Ginsberg, Yona

    1985-01-01

    Examines the impact of fear of crime on the daily behavior of elderly Jews in racially mixed, deteriorating neighborhoods in Boston and London. Results showed the Boston elderly retreated behind locked doors, while the London elderly continued their daily routine. (JAC)

  10. Disturbed social recognition and impaired risk judgement in older residents with mild cognitive impairment after the Great East Japan Earthquake of 2011: the Tome Project.

    PubMed

    Akanuma, Kyoko; Nakamura, Kei; Meguro, Kenichi; Chiba, Masanori; Gutiérrez Ubeda, Sergio Ramón; Kumai, Keiichi; Kato, Yuka; Oonuma, Jiro; Kasai, Mari; Nakatsuka, Masahiro; Seki, Takashi; Tomita, Hiroaki

    2016-11-01

    After the Great East Japan Earthquake of 2011, we investigated the safety of residents in the affected communities. Most of the people requiring help were elderly and had previously been assessed as Clinical Dementia Rating (CDR) 0.5 (i.e. as having mild cognitive impairment (MCI)). We examined how well they understood the television news and whether they could make appropriate decisions. This community-based study of dementia and difficulties following a disaster started in Tome, northern Japan. The subjects were 188 randomly selected older residents who underwent CDR, blood tests, magnetic resonance imaging, and cognitive tests, including an original visual risk cognition task. They were shown NHK news broadcasts from the day of the earthquake to determine whether they could understand the content. Neither the CDR 0 (healthy) nor the CDR 0.5 (MCI) subjects fully understood the television news. Some subjects did not recognize the danger of aftershocks and engaged in risky behaviour. CDR 0.5 subjects who exhibited such behaviour scored lower on the visual risk cognition task. It is noteworthy that television news is difficult to understand, even for healthy older adults. We found that MCI subjects had particular difficulties due to the disaster and suggest that risk cognition could be evaluated using visually presented materials. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.

  11. The role of exercise in fall prevention for older adults.

    PubMed

    Rose, Debra J; Hernandez, Danielle

    2010-11-01

    This article reviews the evidence for the effectiveness of stand-alone exercise interventions and multifactorial intervention strategies that include exercise in lowering fall incidence rates and/or fall risk among older adults residing in the community, acute, subacute, and long-term care settings. Stand-alone exercise programs that emphasize multiple exercise categories are effective in reducing fall rates and fall risk in community-residing older adults, and may also be effective when conducted for a sufficient duration with older adult patients in subacute settings. In contrast, multifactorial fall risk reduction programs that include exercise as a component and are delivered by a multidisciplinary team are more effective in lowering fall rates in long-term care settings. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Art in wartime: The First Wounded, London Hospital, August 1914.

    PubMed

    Park, M P; Park, R H R

    2011-06-01

    John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

  13. Chinese health beliefs of older Chinese in Canada.

    PubMed

    Lai, Daniel W L; Surood, Shireen

    2009-02-01

    Objectives. This study examines the cultural health beliefs held by older Chinese in Canada. Methods. Chinese surnames are randomly selected from the local Chinese telephone directories. Telephone screening is then conducted to identify eligible Chinese people 55 years of age or older to take part in a face-to-face interview to complete a structured survey questionnaire. Results. The results of exploratory factor analysis indicate that the health beliefs of the older Chinese are loaded onto three factors related to beliefs about traditional health practices, beliefs about traditional Chinese medicine, and beliefs about preventive diet. Education, religion, country of origin, length of residency in Canada, and city of residency are the major correlates of the various Chinese health beliefs scales. Discussion. The findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intragroup sociocultural diversity that health practitioners should acknowledge in their practice.

  14. Time to and predictors of dual incontinence in older nursing home admissions.

    PubMed

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

    2018-01-01

    There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

  15. Inner London's Education Authority: Reflections on ILEA Twenty-Five Years after Closure

    ERIC Educational Resources Information Center

    Mitchell, Peter

    2015-01-01

    It is 25 years since the Inner London Education Authority (ILEA) was abolished and management of education in central London transferred to 13 London boroughs. The author reflects on the experience of being an ex-ILEA head teacher, and of managing one of the new local education authorities in the immediate post-ILEA period. He begins by commenting…

  16. London Challenge: Surveys of Pupils and Teachers, 2005. Research Report RR718

    ERIC Educational Resources Information Center

    Ridley, Kate; Knight, Sarah; Scott, Emma; Benton, Tom; Woodthorpe, Adrian

    2006-01-01

    The London Challenge is a Department for Education and Skills (DfES) initiative, which aims to raise levels of attainment in London secondary schools and to create a world class education system in the capital. In 2005, London Challenge commissioned the National Foundation for Educational Research (NFER) to carry out a survey of Year 7 pupils,…

  17. Factors associated with general surgery residents' desire to leave residency programs: a multi-institutional study.

    PubMed

    Gifford, Edward; Galante, Joseph; Kaji, Amy H; Nguyen, Virginia; Nelson, M Timothy; Sidwell, Richard A; Hartranft, Thomas; Jarman, Benjamin; Melcher, Marc; Reeves, Mark; Reid, Christopher; Jacobsen, Garth R; Thompson, Jonathan; Are, Chandrakanth; Smith, Brian; Arnell, Tracey; Hines, Oscar J; de Virgilio, Christian

    2014-09-01

    General surgical residency continues to experience attrition. To date, work hour amendments have not changed the annual rate of attrition. To determine how often categorical general surgery residents seriously consider leaving residency. At 13 residency programs, an anonymous survey of 371 categorical general surgery residents and 10-year attrition rates for each program. Responses from those who seriously considered leaving surgical residency were compared with those who did not. Factors associated with the desire to leave residency. The survey response rate was 77.6%. Overall, 58.0% seriously considered leaving training. The most frequent reasons for wanting to leave were sleep deprivation on a specific rotation (50.0%), an undesirable future lifestyle (47.0%), and excessive work hours on a specific rotation (41.4%). Factors most often cited that kept residents from leaving were support from family or significant others (65.0%), support from other residents (63.5%), and perception of being better rested (58.9%). On univariate analysis, older age, female sex, postgraduate year, training in a university program, the presence of a faculty mentor, and lack of Alpha Omega Alpha status were associated with serious thoughts of leaving surgical residency. On multivariate analysis, only female sex was significantly associated with serious thoughts of leaving residency (odds ratio, 1.2; 95% CI, 1.1-1.3; P = .003). Eighty-six respondents were from historically high-attrition programs, and 202 respondents were from historically low-attrition programs (27.8% vs 8.4% 10-year attrition rate, P = .04). Residents from high-attrition programs were more likely to seriously consider leaving residency (odds ratio, 1.8; 95% CI, 1.0-3.0; P = .03). A majority of categorical general surgery residents seriously consider leaving residency. Female residents are more likely to consider leaving. Thoughts of leaving seem to be associated with work conditions on specific rotations

  18. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association.

    PubMed

    Napolitano, Lena M; Savarise, Mark; Paramo, Juan C; Soot, Laurel C; Todd, S Rob; Gregory, Jay; Timmerman, Gary L; Cioffi, William G; Davis, Elisabeth; Sachdeva, Ajit K

    2014-05-01

    General surgery residency training has changed with adoption of the 80-hour work week, patient expectations, and the malpractice environment, resulting in decreased resident autonomy during the chief resident year. There is considerable concern that graduating residents are not prepared for independent surgical practice. Two online surveys were developed, one for "young surgeons" (American College of Surgeons [ACS] Fellows 45 years of age and younger) and one for "older surgeons" (ACS Fellows older than 45 years of age). The surveys were distributed by email to 2,939 young and 9,800 older surgeons. The last question was open-ended with a request to provide comments. A qualitative and quantitative analysis of all comments was performed. The response rate was 9.6% (282 of 2,939) of young and 10% (978 of 9,800) of older surgeons. The majority of young surgeons (94% [58.7% strongly agree, 34.9% agree]) stated they had adequate surgical training and were prepared for transition to the surgery attending role (91% [49.6% strongly agree, 41.1% agree]). In contrast, considerably fewer older surgeons believed that there was adequate surgical training (59% [18.7% strongly agree, 40.2% agree]) or adequate preparation for transition to the surgery attending role (53% [16.93% strongly agree, 36.13% agree]). The 2 groups' responses were significantly different, chi-square test of association (3) = 15.73, p = 0.0012. Older surgeons focused considerably more on residency issues (60% vs 42%, respectively), and young surgeons focused considerably more on business and practice issues (30% vs 14%, respectively). Young and older surgeons' perceptions of general surgery residents' readiness to practice independently after completion of general surgery residency differ significantly. Future work should focus on determination of specific efforts to improve the transition to independent surgery practice for the general surgery resident. Copyright © 2014 American College of Surgeons

  19. Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians.

    PubMed Central

    Strachan, D. P.; Powell, K. J.; Thaker, A.; Millard, F. J.; Maxwell, J. D.

    1995-01-01

    BACKGROUND--In a previous retrospective study of tuberculosis in south London among Asian immigrants from the Indian subcontinent Hindu Asians were found to have a significantly increased risk for tuberculosis compared with Muslims. This finding has been further investigated by examining the role of socioeconomic and lifestyle variables, including diet, as risk factors for tuberculosis in Asian immigrants from the Indian subcontinent resident in south London. METHODS--Using a case-control study technique Asian immigrants from the Indian subcontinent diagnosed with tuberculosis during the past 10 years and two Asian control groups (community and outpatient clinic controls) from the Indian subcontinent were investigated. Cases and community controls were approached by letter. A structured questionnaire concerning a range of demographic, migration, socioeconomic, dietary, and health topics was administered by a single trained interviewer to subjects (56 cases and 100 controls) who agreed to participate. RESULTS--The results confirmed earlier findings that Hindu Asians had an increased risk of tuberculosis compared with Muslims. However, further analysis revealed that religion had no independent influence after adjustment for vegetarianism (common among Hindu Asians). Unadjusted odds ratios for tuberculosis among vegetarians were 2.7 (95% CI 1.1 to 6.4) using community controls, and 4.3 (95% CI 1.8 to 10.4) using clinic controls. There was a trend of increasing risk of tuberculosis with decreasing frequency of meat or fish consumption. Lactovegetarians had an 8.5 fold risk (95% CI 1.6 to 45.4) compared with daily meat/fish eaters. Adjustment for a range of other socioeconomic, migration, and lifestyle variables made little difference to the relative risks derived using either community or clinic controls. CONCLUSIONS--These results indicate that a vegetarian diet is an independent risk factor for tuberculosis in immigrant Asians. The mechanism is unexplained. However

  20. Comparison of safety equipment between London underground and Beijing subway

    NASA Astrophysics Data System (ADS)

    Chen, T.; Zhang, S. Y.; Zhao, L. Z.; Xia, J. J.; Fu, X. C.; Bao, Z. M.; Chen, Y.; Zhang, X. Z.; Wang, R. J.; Hu, C.; Jing, L. S.; Wang, Y.

    2017-06-01

    The purpose of this paper was to improve the safety equipment’s effectiveness through the comparison. Firstly, the history and safety accident of London Underground and Beijing Subway were shown. Secondly, fire equipment between these two cities was compared including station’s hardware installations and carriage’s hardware installations. Thirdly, the relative software installations were also compared such as emergency drills. The results showed that Beijing Subway’s hardware installations were better than London. However, London Underground’s some installations were more effective than Beijing. Both cities would pay more attention on anti-terrorist in tunnel.

  1. Companionship in the neighborhood context: older adults' living arrangements and perceptions of social cohesion.

    PubMed

    Bromell, Lea; Cagney, Kathleen A

    2014-03-01

    This study investigated the impact of neighborhood social cohesion on the perceived companionship of nearly 1,500 community-dwelling older adults from the Neighborhood, Organization, Aging and Health project (NOAH), a Chicago-based study of older adult well-being in the neighborhood context. We hypothesized that the relationship between neighborhood-level social cohesion and individual residents' reports of companionship would be more pronounced among those who lived alone than those who resided with others. Controlling for age, gender, education, race, marital status, length of neighborhood residence, and self-rated health, neighborhood social cohesion predicted companionship among those who lived alone; for a one-unit increase in neighborhood social cohesion, the odds of reporting companionship increased by half. In contrast, social cohesion did not predict the companionship of those who resided with others. The results suggest that older adults who live alone particularly profit from the benefits of socially cohesive neighborhood environments. © The Author(s) 2013.

  2. The epidemiology of suicide on the London Underground.

    PubMed

    O'Donnell, I; Farmer, R D

    1994-02-01

    A database containing details of every incident of suicidal behaviour on the London Underground railway system between 1940 and 1990 was assembled from the records of London Underground Ltd and the British Transport Police. The total number of cases was 3240. The mean annual number of suicidal acts on the London Underground system increased from 36.1 (1940-1949) to 94.1 (1980-1989). There were significantly fewer incidents on Sundays than on the other days of the week and the daily rate was highest in the spring. 64% of incidents involved males and the peak age group for both sexes was 25-34 yr. Suicide verdicts were returned for a greater proportion of women than men. Overall case fatality was 55%. However, case fatality rates differed between stations, environmental factors appearing to influence survival. Possible strategies to prevent railway suicides and reduce the lethality of this method are discussed.

  3. Effects of Air Pollution and the Introduction of the London Low Emission Zone on the Prevalence of Respiratory and Allergic Symptoms in Schoolchildren in East London: A Sequential Cross-Sectional Study.

    PubMed

    Wood, Helen E; Marlin, Nadine; Mudway, Ian S; Bremner, Stephen A; Cross, Louise; Dundas, Isobel; Grieve, Andrew; Grigg, Jonathan; Jamaludin, Jeenath B; Kelly, Frank J; Lee, Tak; Sheikh, Aziz; Walton, Robert; Griffiths, Christopher J

    2015-01-01

    The adverse effects of traffic-related air pollution on children's respiratory health have been widely reported, but few studies have evaluated the impact of traffic-control policies designed to reduce urban air pollution. We assessed associations between traffic-related air pollutants and respiratory/allergic symptoms amongst 8-9 year-old schoolchildren living within the London Low Emission Zone (LEZ). Information on respiratory/allergic symptoms was obtained using a parent-completed questionnaire and linked to modelled annual air pollutant concentrations based on the residential address of each child, using a multivariable mixed effects logistic regression analysis. Exposure to traffic-related air pollutants was associated with current rhinitis: NOx (OR 1.01, 95% CI 1.00-1.02), NO2 (1.03, 1.00-1.06), PM10 (1.16, 1.04-1.28) and PM2.5 (1.38, 1.08-1.78), all per μg/m3 of pollutant, but not with other respiratory/allergic symptoms. The LEZ did not reduce ambient air pollution levels, or affect the prevalence of respiratory/allergic symptoms over the period studied. These data confirm the previous association between traffic-related air pollutant exposures and symptoms of current rhinitis. Importantly, the London LEZ has not significantly improved air quality within the city, or the respiratory health of the resident population in its first three years of operation. This highlights the need for more robust measures to reduce traffic emissions.

  4. Voting suffrage and the political budget cycle: Evidence from the London Metropolitan Boroughs 1902-1937.

    PubMed

    Aidt, Toke S; Mooney, Graham

    2014-04-01

    We study the opportunistic political budget cycle in the London Metropolitan Boroughs between 1902 and 1937 under two different suffrage regimes: taxpayer suffrage (1902-1914) and universal suffrage (1921-1937). We argue and find supporting evidence that the political budget cycle operates differently under the two types of suffrage. Taxpayer suffrage, where the right to vote and the obligation to pay local taxes are linked, encourages demands for retrenchment and the political budget cycle manifests itself in election year tax cuts and savings on administration costs. Universal suffrage, where all adult residents can vote irrespective of their taxpayer status, creates demands for productive public services and the political budget cycle manifests itself in election year hikes in capital spending and a reduction in current spending.

  5. Educational interventions to empower nursing home residents: a systematic literature review

    PubMed Central

    Schoberer, Daniela; Leino-Kilpi, Helena; Breimaier, Helga E; Halfens, Ruud JG; Lohrmann, Christa

    2016-01-01

    Purpose of the study Health education is essential to improve health care behavior and self-management. However, educating frail, older nursing home residents about their health is challenging. Focusing on empowerment may be the key to educating nursing home residents effectively. This paper examines educational interventions that can be used to empower nursing home residents. Methods A systematic literature search was performed of the databases PubMed, CINAHL, CENTRAL, PsycINFO, and Embase, screening for clinical trials that dealt with resident education and outcomes in terms of their ability to empower residents. An additional, manual search of the reference lists and searches with SIGLE and Google Scholar were conducted to identify gray literature. Two authors independently appraised the quality of the studies found and assigned levels to the evidence reported. The results of the studies were grouped according to their main empowering outcomes and described narratively. Results Out of 427 identified articles, ten intervention studies that addressed the research question were identified. The main educational interventions used were group education sessions, motivational and encouragement strategies, goal setting with residents, and the development of plans to meet defined goals. Significant effects on self-efficacy and self-care behavior were reported as a result of the interventions, which included group education and individual counseling based on resident needs and preferences. In addition, self-care behavior was observed to significantly increase in response to function-focused care and reasoning exercises. Perceptions and expectations were not improved by using educational interventions with older nursing home residents. Conclusion Individually tailored, interactive, continuously applied, and structured educational strategies, including motivational and encouraging techniques, are promising interventions that can help nursing home residents become more

  6. Educational interventions to empower nursing home residents: a systematic literature review.

    PubMed

    Schoberer, Daniela; Leino-Kilpi, Helena; Breimaier, Helga E; Halfens, Ruud Jg; Lohrmann, Christa

    2016-01-01

    Health education is essential to improve health care behavior and self-management. However, educating frail, older nursing home residents about their health is challenging. Focusing on empowerment may be the key to educating nursing home residents effectively. This paper examines educational interventions that can be used to empower nursing home residents. A systematic literature search was performed of the databases PubMed, CINAHL, CENTRAL, PsycINFO, and Embase, screening for clinical trials that dealt with resident education and outcomes in terms of their ability to empower residents. An additional, manual search of the reference lists and searches with SIGLE and Google Scholar were conducted to identify gray literature. Two authors independently appraised the quality of the studies found and assigned levels to the evidence reported. The results of the studies were grouped according to their main empowering outcomes and described narratively. Out of 427 identified articles, ten intervention studies that addressed the research question were identified. The main educational interventions used were group education sessions, motivational and encouragement strategies, goal setting with residents, and the development of plans to meet defined goals. Significant effects on self-efficacy and self-care behavior were reported as a result of the interventions, which included group education and individual counseling based on resident needs and preferences. In addition, self-care behavior was observed to significantly increase in response to function-focused care and reasoning exercises. Perceptions and expectations were not improved by using educational interventions with older nursing home residents. Individually tailored, interactive, continuously applied, and structured educational strategies, including motivational and encouraging techniques, are promising interventions that can help nursing home residents become more empowered. Empowering strategies used by nurses can

  7. The pleasurable recreational activities among community-dwelling older adults.

    PubMed

    Onishi, Joji; Masuda, Yuichiro; Suzuki, Yusuke; Gotoh, Tadao; Kawamura, Takashi; Iguchi, Akihisa

    2006-01-01

    This study aimed to clarify what pleasurable recreational activities older adults like to participate in, and to investigate the relationship between those activities and quality of life (QOL). Questionnaires were delivered to older residents (65 years and above) in a Japanese rural area. The residents' background information, the amount of pleasure for various activities, and the QOL were surveyed. The QOL was evaluated by the revised Philadelphia Geriatric Center (PGC) morale scale. The amount of pleasure taken in a majority of the activities, such as conversation with family or neighbors showed a significant association with the happiness score, but only a few activities showed significant association between the revised PGC morale scale and the amount of pleasure. The multiple regression analyses indicated that the amount of pleasure in exercise, the difficulty in managing finances, and amount of pleasure taken in watching TV were significant variables for predicting the happiness score. The results indicated that the amount of pleasure older adults experienced when engaging in activities such as conversation with family or neighbors showed significant association with the older adults' happiness. These results may be helpful in understanding contributions of various activities to the perception of pleasure in older adults.

  8. Quality of residential care for older people: does education for healthcare assistants make a difference?

    PubMed

    Smith, Barbara; Kerse, Ngaire; Parsons, Matthew

    2005-05-06

    To determine the impact of a healthcare assistant education programme on the quality of care for older people living in a residential home in Auckland, New Zealand. A pre- and post-intervention evaluation study was undertaken within a residential home for older people. Quality of care was established by two periods of non-participant time-sampling observation of residents, separated by a programme of 10 interactive teaching sessions for healthcare assistants. Informed consent was gained from all observed residents and staff. Using the Quality Assessment Project (QAP) quality measure, the non-participant time-sampling observation data identified a 12.5% increase in resident care that was considered appropriate and adequate (chi-squared=12.05) and an 11.53% decrease in resident care that was considered inappropriate and inadequate (chi-squared=11.43). The intermediate grades did not alter significantly. Residents with low functional activity scores (Barthel Index) received better care after the education intervention (chi-squared=32.99), as did residents with moderate cognitive impairment (Abbreviated Mental Test Score [AMTS]<8/10). Healthcare assistant education can positively impact on the quality of care given to older people in residential care.

  9. Wealth, health and frailty in industrial-era London.

    PubMed

    DeWitte, Sharon N; Hughes-Morey, Gail; Bekvalac, Jelena; Karsten, Jordan

    2016-05-01

    Socioeconomic status is a powerful predictor of mortality in living populations, as status affects exposure or access to a variety of factors that impact health and survival, such as diet, healthcare, infectious disease and pollution. This study examines the effect of socioeconomic status on mortality and survival in London during a period spanning the early 18th through mid-19th centuries. During this period, London experienced rapid industrialization and heightened class distinctions. This study examines whether low-socioeconomic status was associated with reduced survival at a time when the distinctions between social strata were peaking. The samples for this study are drawn from three skeletal assemblages in London that represent lower and higher social strata. The upper socioeconomic status sample (n = 394) is from Chelsea Old Church and St Bride's Fleet Street (crypt assemblage). The low socioeconomic status sample (n = 474) is from St. Bride's Lower Churchyard (also known as St Bride's Farringdon Street). The effect of status on mortality and survival is assessed using hazard analysis and Kaplan-Meier analysis. The results reveal elevated mortality and reduced survival for lower socioeconomic status children, but no strong effect of status on adult mortality or survival. These results might indicate strong selective mortality operating during childhood or the effects of migration in the industrial-era population of London.

  10. Factors related to attrition in surgery residency based on application data.

    PubMed

    Naylor, Rebekah A; Reisch, Joan S; Valentine, R James

    2008-07-01

    To determine whether variables in the surgery resident selection process will predict attrition or performance during residency training. Retrospective study. A university residency program. A total of 111 categorical surgery residents matched during a 10-year period (1991-2000). Satisfactory outcome included successful completion of training and the American Board of Surgery examinations on the first attempt. Participants with a satisfactory outcome were stratified into good or marginal performance based on adverse actions during residency. Of 111 residents studied, 28 (25.2%) had an unsatisfactory outcome; attrition occurred in 25 (22.5%). Univariate analysis identified the following variables as predictors of unsatisfactory outcome: age at entry older than 29 years (P = .005), female sex (P = .02), courses repeated (P = .01), "C" grades on transcript (P = .01), no participation in team sports (P = .02), and lack of superlative comments in the dean's letter (P = .03). The following variables were retained in the multivariate model: age older than 29 years (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.02-0.47; P = .003), summary comments in the dean's letter (OR, 4.57; 95% CI, 2.00-10.43; P < .001), participation in team sports (OR, 4.96; 95% CI, 1.36-18.05; P = .02), and merit scholarship in medical school (OR, 0.25; 95% CI, 0.08-0.78; P = .02). Attrition can be predicted from factors identified on residency applications, with nonacademic factors being more important. Among residents who completed the program, no predictors of performance were identified.

  11. Determinants of the use of specialist mental health services by nursing home residents.

    PubMed Central

    Shea, D G; Streit, A; Smyer, M A

    1994-01-01

    OBJECTIVE. This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals. DATA SOURCES/STUDY SETTING. The study uses data from the Institutional Population Component of the 1987 National Medical Expenditure Survey, a secondary data source containing data on 3,350 nursing home residents living in 810 nursing homes as of January 1, 1987. STUDY DESIGN. Andersen's health services use model (1968) is used to estimate a multivariate logistic equation for the effects of independent variables on the probability that a resident has received services from mental health professionals. Important variables include resident race, sex, and age; presence of several behaviors and reported mental illnesses; and facility ownership, facility size, and facility certification. DATA COLLECTION/EXTRACTION METHODS. Data on 188 residents were excluded from the sample because information was missing on several important variables. For some additional variables residents who had missing information were coded as negative responses. This left 3,162 observations for analysis in the logistic regressions. PRINCIPAL FINDINGS. Older residents and residents with more ADL limitations are much less likely than other residents to have received treatment from a mental health professional. Residents with reported depression, schizophrenia, or psychoses, and residents who are agitated or hallucinating are more likely to have received treatment. Residents in government nursing homes, homes run by chains, and homes with low levels of certification are less likely to have received treatment. CONCLUSIONS. Few residents receive treatment from mental health professionals despite need. Older, physically disabled residents need special attention. Care in certain types of facilities requires further study. New regulations mandating treatment for mentally ill residents will demand increased attention from

  12. Fritz London and the scale of quantum mechanisms

    NASA Astrophysics Data System (ADS)

    Monaldi, Daniela

    2017-11-01

    Fritz London's seminal idea of ;quantum mechanisms of macroscopic scale;, first articulated in 1946, was the unanticipated result of two decades of research, during which London pursued quantum-mechanical explanations of various kinds of systems of particles at different scales. He started at the microphysical scale with the hydrogen molecule, generalized his approach to chemical bonds and intermolecular forces, then turned to macrophysical systems like superconductors and superfluid helium. Along this path, he formulated a set of concepts-the quantum mechanism of exchange, the rigidity of the wave function, the role of quantum statistics in multi-particle systems, the possibility of order in momentum space-that eventually coalesced into a new conception of systems of equal particles. In particular, it was London's clarification of Bose-Einstein condensation that enabled him to formulate the notion of superfluids, and led him to the recognition that quantum mechanics was not, as it was commonly assumed, relevant exclusively as a micromechanics.

  13. Effects of Nativity, Length of Residence, and County-Level Foreign-Born Density on Mental Health Among Older Adults in the U.S

    PubMed Central

    Choi, Sunha; Kim, Giyeon

    2016-01-01

    Using the 2004–2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals’ mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults’ immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.-born individuals (n = 24,225), earlier immigrants (≥15 years in the U.S.; n = 3866), and recent immigrants (<15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities. PMID:26910461

  14. Effects of Nativity, Length of Residence, and County-Level Foreign-Born Density on Mental Health Among Older Adults in the U.S.

    PubMed

    Choi, Sunha; Kim, Giyeon; Lee, Sungkyu

    2016-12-01

    Using the 2004-2007 Medical Expenditure Panel Survey data that are linked to county-level data from the Area Health Resources Files, this study examined whether the healthy immigrant effect applies to mental health of foreign-born older adults. Additionally, testing a protective ethnic density effect on older foreign-born individuals' mental health, this study examined how the percentage of foreign-born population in the county affected the relationship between older adults' immigration status (U.S.-nativity and length of residence in the U.S.) and their mental health status. The sample included 29,011 individuals (level-1) from 920 counties (level-2) across 50 states and D.C. Using the Mental Component Summary of the Short-Form 12, the Kessler Index (K-6), and the Patient Health Questionnaire (PHQ-2), U.S.-born individuals (n = 24,225), earlier immigrants (≥15 years in the U.S.; n = 3866), and recent immigrants (<15 years in the U.S.; n = 920) were compared. The results indicate that recent immigrants showed worse mental health on all three measures compared with U.S.-born individuals and on the K-6 and PHQ-2 compared with earlier immigrants. Higher county-level foreign-born densities were associated with worse mental health status of individuals. However, the significant interactions found in the full conditional multilevel models indicated that the high foreign-born density functioned as a risk factor for worse mental health only among recent immigrants but not among the U.S.-born. In conclusion, the results revealed the vulnerability of older recent immigrants, especially those living in the counties with high foreign-born densities.

  15. Practicing Reflexivity in the Study of Italian Migrants in London

    ERIC Educational Resources Information Center

    Seganti, Francesca Romana

    2010-01-01

    This article discusses the centrality of reflexivity in qualitative research through examples from my study on the role new media play in the lives of Italians in London. My hypothesis was that Italians were "in transit" in London and they were using new media to build "temporary" communities. I conducted in-depth interviews…

  16. Royal london hospital set P28 plans 30th anniversary reunion.

    PubMed

    Sibthorpe, Fran

    2013-04-03

    Members of Set P28 at the Royal London Hospital who began their training in February 1980 are planning a reunion on July 27 in London. The venue will be announced later. Email fran-joy@hotmail.com for details.

  17. Building a Hypertextual Digital Library in the Humanities: A Case Study on London.

    ERIC Educational Resources Information Center

    Crane, Gregory; Smith, David A.; Wulfman, Clifford E.

    This paper describes the creation of a new humanities digital library collection: 11,000,000 words and 10,000 images representing books, images, and maps on pre-twentieth century London and its environs. The London collection contained far more dense and precise information than the materials from the Greco-Roman world. The London collection thus…

  18. Is older adult care mediated by caregivers' cultural stereotypes? The role of competence and warmth attribution.

    PubMed

    Fernández-Ballesteros, Rocío; Bustillos, Antonio; Santacreu, Marta; Schettini, Rocio; Díaz-Veiga, Pura; Huici, Carmen

    2016-01-01

    The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers' cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers' cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents' functioning) were applied. Caregivers' cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. Our results underline the influence of caregivers' cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers' cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component.

  19. Alternative Spaces of Learning in East London: Opportunities and Challenges

    ERIC Educational Resources Information Center

    Sneddon, Raymonde; Martin, Peter

    2012-01-01

    This article emerges from an ongoing exploration into how British minority ethnic communities in the London area create spaces in community-based programs to maintain or develop their languages and literacies. In London, more than one-third of the 850,000 school children speak a language other than English at home (Baker & Eversley, 2000).…

  20. Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners

    PubMed Central

    Rubin, G James; Brewin, Chris R; Greenberg, Neil; Simpson, John; Wessely, Simon

    2005-01-01

    Objectives To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. Design A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. Setting Interviews took place between 18 and 20 July. Participants 1010 participants (10% of the eligible people we contacted) completed the interviews. Main outcome measures Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. Results 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. Conclusions Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners. PMID:16126821

  1. Multifractal to monofractal evolution of the London street network.

    PubMed

    Murcio, Roberto; Masucci, A Paolo; Arcaute, Elsa; Batty, Michael

    2015-12-01

    We perform a multifractal analysis of the evolution of London's street network from 1786 to 2010. First, we show that a single fractal dimension, commonly associated with the morphological description of cities, does not suffice to capture the dynamics of the system. Instead, for a proper characterization of such a dynamics, the multifractal spectrum needs to be considered. Our analysis reveals that London evolves from an inhomogeneous fractal structure, which can be described in terms of a multifractal, to a homogeneous one, which converges to monofractality. We argue that London's multifractal to monofractal evolution might be a special outcome of the constraint imposed on its growth by a green belt. Through a series of simulations, we show that multifractal objects, constructed through diffusion limited aggregation, evolve toward monofractality if their growth is constrained by a nonpermeable boundary.

  2. An oral health survey of vulnerable older people in Belgium.

    PubMed

    De Visschere, Luc; Janssens, Barbara; De Reu, Griet; Duyck, Joke; Vanobbergen, Jacques

    2016-11-01

    The aim of this study was to gain insight in the oral health of persons aged 65 years or more. Data were obtained from 652 vulnerable older persons (≥65) by means of a clinical oral examination. Additional demographic data were gathered including age, gender, residence, and care dependency. The mean age of the total study sample was 83 (7.7) years and 71 % was female. Nearly 33 % of the sample was living at home with support, and 67 % was residing in nursing homes. The number of occluding pairs was low and the proportion of edentulous people was highest among persons with the highest care dependency. The mean Decay-missing-filled teeth index (DMFT) was 20.3 (9.0). A prosthetic treatment need and inadequate oral hygiene levels were observed in 40 % and more than 60 % of the subjects, respectively. The highest treatment need was observed in the oldest age group and the highest mean dental plaque in older persons with the highest care dependency. The oral health in frail older people in Belgium is poor. The restorative and prosthetic treatment need is high and oral hygiene levels are problematic. Age, residence, and care dependency seemed to have some influence on oral health parameters. In the long term, the most important future challenge of oral health care policies is to identify older adults before they begin to manifest such oral health deterioration. Regular dental visits should be strongly promoted by all (oral) health care workers during the lifespan of all persons including older adults.

  3. Case studies of transport for London.

    DOT National Transportation Integrated Search

    2009-01-01

    This project was motivated by the election of Ken Livingston as Mayor of London in : 2000. Mayor Livingston campaigned on a platform of improving transportation service through : such innovative means as congestion pricing. Mayor Livingston relied on...

  4. Lay Meanings of Health among Rural Older Adults in Appalachia

    ERIC Educational Resources Information Center

    Goins, R. Turner; Spencer, S. Melinda; Williams, Kimberly

    2011-01-01

    Purpose: Self-perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define…

  5. Smoking prevalence differs by location of residence among Ghanaians in Africa and Europe: The RODAM study

    PubMed Central

    Brathwaite, Rachel; Addo, Juliet; Kunst, Anton E.; Agyemang, Charles; Owusu-Dabo, Ellis; de-Graft Aikins, Ama; Beune, Erik; Meeks, Karlijn; Klipstein-Grobusch, Kerstin; Bahendeka, Silver; Mockenhaupt, Frank P.; Amoah, Stephen; Galbete, Cecilia; Schulze, Matthias B.; Danquah, Ina; Smeeth, Liam

    2017-01-01

    Background Although the prevalence of smoking is low in Ghana, little is known about the effect of migration on smoking. Comparing Ghanaians living in their country of origin to those living in Europe offers an opportunity to investigate smoking by location of residence and the associations between smoking behaviours and migration-related factors. Methods Data on a relatively homogenous group of Ghanaians living in London (n = 949), Amsterdam (n = 1400), Berlin (n = 543), rural Ghana (n = 973) and urban Ghana (n = 1400) from the cross-sectional RODAM (Research on Obesity & Diabetes in African Migrants) study were used. Age-standardized prevalence rates of smoking by location of residence and factors associated with smoking among Ghanaian men were estimated using prevalence ratios (PR: 95% CIs). Results Current smoking was non-existent among women in rural and urban Ghana and London but was 3.2% and 3.3% in women in Amsterdam and Berlin, respectively. Smoking prevalence was higher in men in Europe (7.8%) than in both rural and urban Ghana (4.8%): PR 1.91: 95% CI 1.27, 2.88, adjusted for age, marital status, education and employment. Factors associated with a higher prevalence of smoking among Ghanaian men included European residence, being divorced or widowed, living alone, Islam religion, infrequent attendance at religious services, assimilation (cultural orientation), and low education. Conclusion Ghanaians living in Europe are more likely to smoke than their counterparts in Ghana, suggesting convergence to European populations, although prevalence rates are still far below those in the host populations. PMID:28475620

  6. Not ageing in place: Negotiating meanings of residency in age-related housing.

    PubMed

    Vasara, Paula

    2015-12-01

    This article explores the experience of residing in age-related housing. The focus is on the negotiations around the multiple meanings assigned to place of residency among older people - in a situation where the official policy objectives of growing old in one's own home are not achieved. Narrative analysis is employed to study the experiences of older people aged 75 or older living in special types of housing due to actual or anticipated difficulties associated with age. The interviews are part of a larger body of data gathered in MOVAGE Moving in Old Age: Transitions in Housing and Care research project. The storyworld was structured by the romantic canonical narrative associated with the policy of 'ageing in place'; growing old at home is idealised and moving is constructed as a disruption. This breach was resolved through explaining deviance from canonical expectations by causes constructed as legitimate, through encountering trouble by constructing oneself as a non-typical resident, and through creating counter stories of natural transitions and choices. As a result, despite the commonly negative meanings associated with the residency in age-related housing, positive storylines respecting values embedded in the canonical narratives of home and endurance were achieved. A living environment that is experienced as suitable, and that has adequate formal help available, supports and enables wellbeing and independence. This is true within age-related housing as well as in other forms. Thus, even though the important meaning of a long-term home should continue to be acknowledged, various other kinds of forms of housing should be made available in order to enhance older people's sense of security and feeling that they are autonomous, independent agents in their everyday life in accordance with their subjective life experiences. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Implementing the Namaste Care Program for residents with advanced dementia: exploring the perceptions of families and staff in UK care homes.

    PubMed

    Stacpoole, Min; Hockley, Jo; Thompsell, Amanda; Simard, Joyce; Volicer, Ladislav

    2017-10-01

    Increasing numbers of older people with advanced dementia are cared for in care homes. No cure is available, so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well. The Namaste Care programme is a multi-dimensional care program with sensory, psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia. The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes; and what effect Namaste Care has on the quality of life of residents with advanced dementia, their families and staff. This article explores the qualitative findings of the study, reporting the effect of the programme on the families of people with advanced dementia and care home staff, and presenting their perceptions of change in care. An organisational action research methodology was used. Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program. The researcher kept a reflective diary recording data on the process of change. A comments book was available to staff and relatives in each care home. Data was analysed thematically within each care home and then across all care homes. Six care homes were recruited in south London: one withdrew before the study was underway. Of the five remaining care homes, four achieved a full Namaste Care program. One care home did not achieve the full program during the study, and another discontinued Namaste Care when the study ended. Every home experienced management disruption during the study. Namaste Care challenged normal routinised care for older people with advanced dementia. The characteristics of care uncovered before Namaste was implemented were: chaos and confusion, rushing around, lack of trust, and rewarding care. After the programme was implemented these perceptions were transformed, and themes of calmness, reaching out to

  8. Geriatrics in family practice residency education: an unmet challenge.

    PubMed

    Gazewood, John D; Vanderhoff, Bruce; Ackermann, Richard; Cefalu, Charles

    2003-01-01

    The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

  9. Sarcopenia and mortality in older people living in a nursing home in Turkey.

    PubMed

    Yalcin, Ahmet; Aras, Sevgi; Atmis, Volkan; Cengiz, Ozlem Karaarslan; Cinar, Esat; Atli, Teslime; Varli, Murat

    2017-07-01

    The aim of the present study was to evaluate the relationship between mortality and sarcopenia defined by the criteria of the European Working Group on Sarcopenia in Older People in older nursing home residents in Turkey. This was an observational prospective study. Nursing home residents who were aged older than 65 years and living in the Seyranbagları Nursing Home and Rehabilitation Center (Ankara, Turkey) were recruited for the study. The main outcome measure was the relationship between sarcopenia and mortality. Diagnosis of sarcopenia was carried out according to the European Working Group on Sarcopenia in Older People criteria. Bioelectrical impedance analysis was used for skeletal muscle mass measurement. Muscle strength and muscle performance were evaluated by handgrip testing and gait speed, respectively. Mortality was assessed at the end of 2 years. The Kaplan-Meier method and Cox regression analysis were used to evaluate the relationship between sarcopenia and all-cause mortality. The prevalence of sarcopenia and severe sarcopenia were 29% and 25.4%, respectively. A total of 44% (18) of sarcopenic participants died, whereas 15% (15) of participants without sarcopenia died after 2 years of follow up (P < 0.001). After adjusting for confounding factors, sarcopenia was associated with all-cause mortality among older nursing home residents in Turkey (HR 2.38, 95% CI 1.04-5.46; P = 0.039). However, sarcopenia was not significantly related with mortality after adjustment of MNA score (HR 2.04, 95% CI 0.85-4.9; P = 0.1). Sarcopenia independently increases all-cause mortality in older nursing home residents in Turkey. Nutritional status plays a role in sarcopenia-related mortality. Geriatr Gerontol Int 2017; 17: 1118-1124. © 2016 Japan Geriatrics Society.

  10. Association between stairs in the home and instrumental activities of daily living among community-dwelling older adults.

    PubMed

    Tomioka, Kimiko; Kurumatani, Norio; Hosoi, Hiroshi

    2018-06-04

    There is insufficient evidence regarding the relationship of home environment with functional capacity among community-dwelling older people without disabilities. We conducted a population-based longitudinal cohort study and examined whether stairs in the home were associated with capability to perform instrumental activities of daily living (IADL) in community-dwelling high-functioning older adults. The target population was individuals aged 65 years or older living in two municipalities in Nara Prefecture in Japan. At the baseline survey, residents who were independent in IADL (n = 6722) were included as survey subjects. Subjects were divided into three groups according to their home type; one-storey residences, walk-up residences, or residences with an elevator. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regression analyses stratified by gender were used to calculate the odds ratio (OR) and a 95% confidence interval (CI) for a decline in IADL, with one-storey residences as a reference. Age, studied area, marital status, working status, self-perceived economic status, body mass index, chronic diseases, smoking, drinking, eating habits, basic activities of daily living, cognitive functioning, depression, self-rated health, and social participation were used as covariates. During the 3-year follow-up, 11.6% of the subjects showed a decline in IADL. After adjusting for covariates, women who lived in walk-up residences had a lower risk for IADL decline (adjusted OR = 0.72, 95% CI = 0.52-0.99), while living in a home with an elevator was not associated with IADL decline (adjusted OR = 0.94, 95% CI = 0.49-1.77). In contrast, there was no association between home type and IADL decline in men (walk-up residences, adjusted OR = 0.90, 95% CI = 0.71-1.14; residences with an elevator, adjusted OR = 0.82, 95% CI = 0.39-1.72). The presence of stairs in the home was

  11. Prevalence and potentially reversible factors associated with anorexia among older nursing home residents: results from the ULISSE project.

    PubMed

    Landi, Francesco; Lattanzio, Fabrizia; Dell'Aquila, Giuseppina; Eusebi, Paolo; Gasperini, Beatrice; Liperoti, Rosa; Belluigi, Andrea; Bernabei, Roberto; Cherubini, Antonio

    2013-02-01

    The principal aims of the present study were to explore the prevalence of anorexia and the factors correlated to anorexia in a large population of older people living in nursing home. Secondary, we evaluated the impact of anorexia on 1-year survival. Data are from baseline evaluation of 1904 participants enrolled in the Un Link Informatico sui Servizi Sanitari Esistenti per l'Anziano study, a project evaluating the quality of care for older persons living in an Italian nursing home. All participants underwent a standardized comprehensive evaluation using the Italian version of the inter Resident Assessment Instrument Minimum Data Set (version 2.0) for Nursing Home. We defined anorexia as the presence of lower food intake. The relationship between covariates and anorexia was estimated by deriving ORs and relative 95% CIs from multiple logistic regression models including anorexia as the dependent variable of interest. Hazard ratios and 95% CIs for mortality by anorexia were calculated. More than 12% (240 participants) of the study sample suffered from anorexia, as defined by the presence of decreased food intake or the presence of poor appetite. Participants with functional impairment, dementia, behavior problems, chewing problems, renal failure, constipation, and depression, those treated with proton pump inhibitors and opioids had a nearly 2-fold increased risk of anorexia compared with participants not affected by these syndromes. Furthermore, participants with anorexia had a higher risk of death for all causes compared with nonanorexic participants (hazard ratio 2.26, 95% CI: 2.14-2.38). The major finding is that potentially reversible causes, such as depression, pharmacologic therapies, and chewing problems, were strongly and independently associated with anorexia among frail older people living in nursing home. Furthermore, anorexia was associated with higher rate of mortality, independently of age and other clinical and functional variables. Copyright © 2013

  12. Gender differences in the predictors of physical activity among assisted living residents.

    PubMed

    Chen, Yuh-Min; Li, Yueh-Ping; Yen, Min-Ling

    2015-05-01

    To explore gender differences in the predictors of physical activity (PA) among assisted living residents. A cross-sectional design was adopted. A convenience sample of 304 older adults was recruited from four assisted living facilities in Taiwan. Two separate simultaneous multiple regression analyses were conducted to identify the predictors of PA for older men and women. Independent variables entered into the regression models were age, marital status, educational level, past regular exercise participation, number of chronic diseases, functional status, self-rated health, depression, and self-efficacy expectations. In older men, a junior high school or higher educational level, past regular exercise participation, better functional status, better self-rated health, and higher self-efficacy expectations predicted more PA, accounting for 61.3% of the total variance in PA. In older women, better self-rated health, lower depression, and higher self-efficacy expectations predicted more PA, accounting for 50% of the total variance in PA. Predictors of PA differed between the two genders. The results have crucial implications for developing gender-specific PA interventions. Through a clearer understanding of gender-specific predictors, healthcare providers can implement gender-sensitive PA-enhancing interventions to assist older residents in performing sufficient PA. © 2015 Sigma Theta Tau International.

  13. Importance of Thinking Locally for Mental Health: Data from Cross-Sectional Surveys Representing South East London and England

    PubMed Central

    Hatch, Stephani L.; Woodhead, Charlotte; Frissa, Souci; Fear, Nicola T.; Verdecchia, Maria; Stewart, Robert; Reichenberg, Abraham; Morgan, Craig; Bebbington, Paul; McManus, Sally; Brugha, Traolach; Kankulu, Bwalya; Clark, Jennifer L.; Gazard, Billy; Medcalf, Robert; Hotopf, Matthew

    2012-01-01

    Background Reliance on national figures may be underestimating the extent of mental ill health in urban communities. This study demonstrates the necessity for local information on common mental disorder (CMD) and substance use by comparing data from the South East London Community Health (SELCoH) study with those from a national study, the 2007 English Adult Psychiatric Morbidity Study (APMS). Methodology/Principal Findings Data were used from two cross-sectional surveys, 1698 men and women residing in south London and 7403 men and women in England. The main outcome, CMD, was indicated by a score of 12 or above on the Revised Clinical Interview Schedule. Secondary outcomes included hazardous alcohol use and illicit drug use. SELCoH sample prevalence estimates of CMD were nearly twice that of the APMS England sample estimates. There was a four-fold greater proportion of depressive episode in the SELCoH sample than the APMS sample. The prevalence of hazardous alcohol use was higher in the national sample. Illicit drug use in the past year was higher in the SELCoH sample, with cannabis and cocaine the illicit drugs reported most frequently in both samples. In comparisons of the SELCoH sample with the APMS England sample and the APMS sample from the Greater London area in combined datasets, these differences remained after adjusting for socio-demographic and socioeconomic indicators for all outcomes. Conclusions/Significance Local information for estimating the prevalence of CMD and substance use is essential for surveillance and service planning. There were similarities in the demographic and socioeconomic factors related to CMD and substance use across samples. PMID:23251330

  14. The social impact of dizziness in London and Siena.

    PubMed

    Bronstein, Adolfo M; Golding, John F; Gresty, Michael A; Mandalà, Marco; Nuti, Daniele; Shetye, Anu; Silove, Yvonne

    2010-02-01

    Although dizziness is a common presenting symptom in general and hospital practice, its social cost is not known. We assessed the social and work life impact of dizziness on patients in two contrasting European cities, Siena and London. First, we developed the 'Social life & Work Impact of Dizziness questionnaire' (SWID), which was validated by administering it to 43 patients with dizziness and 45 normal controls and by correlating the results with the EQ-5D (Europe quality of life) questionnaire. The SWID and EQ-5D scores were worse in patients than controls (p < 0.001) and the two correlated significantly (r = 0.50 p < 0.001). Then two hundred consecutive patients per city attending tertiary specialised 'dizzy patient' clinics, one in London led by a neurologist, one in Siena led by an ear, nose and throat specialist (ENT), were investigated with SWID. Amongst the 400 patients, 27% reported changing their jobs and 21% giving up work as a result of the dizziness. Over 50% of patients felt that their efficiency at work had dropped considerably. The mean number of days off work attributed to the dizziness in the previous 6 months was 7.15 days. Social life was disrupted in 57% of all 400 patients. Factor analysis identified that detrimental effects on work, travel, social and family life combine to create a single factor accounting for much of the overall impact of their dizziness. Significant differences in some measures of handicap between London and Siena emerged, with London patients often faring worse. Reasons for these location differences include, as expected, a higher proportion of neurological patients in London than in Siena. However, factors related to city demographics and social cohesion may also modulate the impact on quality of life and working practice. Regardless of inter-city differences, these findings highlight the high social and economic impact of dizziness.

  15. London, England

    NASA Technical Reports Server (NTRS)

    2003-01-01

    For almost 2,000 years, the River Thames has served as the life force of London, capital of the United Kingdom and one of the world's most famous cities. In AD 43 the Romans established the trading settlement of Londinium at a favorable crossing point on the river. The Romans remained until the 5th century, when the city came under Saxon control. The early 17th century saw enormous growth, but the deadly plague of 1664 and 1665 ravaged the population, and in the following year the Great Fire, which burned for four days, destroyed most of the city. A public transportation system and other city services in the early 19th century eased many of the increasing urban problems of the burgeoning capital of the wealthy British Empire. After coping with the devastating effects of bombing during World War II and the gradual dismantling of the empire, London today thrives as a vital modern metropolis. London is one of 100 cities being studied using ASTER data to map and monitor urban use patterns and growth.

    This image was acquired on October 12, 2001 by the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) on NASA's Terra satellite. With its 14 spectral bands from the visible to the thermal infrared wavelength region, and its high spatial resolution of 15 to 90 meters (about 50 to 300 feet), ASTER images Earth to map and monitor the changing surface of our planet.

    ASTER is one of five Earth-observing instruments launched December 18, 1999, on NASA's Terra satellite. The instrument was built by Japan's Ministry of Economy, Trade and Industry. A joint U.S./Japan science team is responsible for validation and calibration of the instrument and the data products.

    The broad spectral coverage and high spectral resolution of ASTER will provide scientists in numerous disciplines with critical information for surface mapping, and monitoring of dynamic conditions and temporal change. Example applications are: monitoring glacial advances and retreats

  16. Prevalence, correlates and patterns of waterpipe smoking among secondary school students in southeast London: a cross-sectional study.

    PubMed

    Jawad, Mohammed; Power, Gerald

    2016-02-01

    Waterpipe smoking is growing worldwide, but little is known of its epidemiology in the UK due to its absence from national health surveys. We sought to address this by calculating the prevalence of waterpipe smoking among secondary school students in southeast London. We conducted a pooled secondary analysis of routine health surveillance surveys among 11-17 year olds in convenience-sampled secondary schools from three ethnically-diverse areas of southeast London. We calculated ever (lifetime) waterpipe use, and compared its sociodemographic correlates to ever (lifetime) cigarette use. In one area we collected data on patterns of waterpipe use. Of 2,098 respondents (mean age 14.1 ± 1.7 years, 55.7 % male, 46.6 % of black ethnicity), ever waterpipe use was 39.6 % (95 % CI 37.6-41.7 %) and was higher than that for ever cigarette use (32.4 %; 95 % CI 30.5-34.4). While waterpipe users were significantly and independently more likely to be male and of non-white ethnicities, at least 30 % of all age, gender and ethnic sub-groups had tried waterpipe smoking. In contrast, cigarette users were more likely to be older and of white ethnicity. In one of the three areas, over a quarter of waterpipe users were occasional or regular waterpipe smokers, and most were introduced to and currently used waterpipe in waterpipe-serving premises or friends' homes. Waterpipe smoking prevalence was high in southeast London, and users exhibited a different sociodemographic profile to cigarette users. Waterpipe should be included in national health surveys of young people. National surveillance is warranted to help develop suitable interventions to prevent uptake and promote cessation.

  17. Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States.

    PubMed

    Burke, Robert E; Rooks, Sean P; Levy, Cari; Schwartz, Robert; Ginde, Adit A

    2015-05-01

    To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. Retrospective analysis of the 2005-2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) with those that led to admission (less likely preventable). Nationally representative sample of US EDs; federal hospitals and hospitals with fewer than 6 beds were excluded. Older (age ≥65 years) NH residents with an ED visit during this time period. Patient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. Older NH residents accounted for 3857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing before ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, P < .001), whereas infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). Computed tomography (CT) scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications before ED discharge in 9.4% of visits. This nationally representative sample of older NH residents

  18. The effects of small-scale, homelike facilities for older people with dementia on residents, family caregivers and staff: design of a longitudinal, quasi-experimental study.

    PubMed

    Verbeek, Hilde; van Rossum, Erik; Zwakhalen, Sandra M G; Ambergen, Ton; Kempen, Gertrudis I J M; Hamers, Jan P H

    2009-01-20

    Small-scale and homelike facilities for older people with dementia are rising in current dementia care. In these facilities, a small number of residents live together and form a household with staff. Normal, daily life and social participation are emphasized. It is expected that these facilities improve residents' quality of life. Moreover, it may have a positive influence on staff's job satisfaction and families involvement and satisfaction with care. However, effects of these small-scale and homelike facilities have hardly been investigated. Since the number of people with dementia increases, and institutional long-term care is more and more organized in small-scale and homelike facilities, more research into effects is necessary. This paper presents the design of a study investigating effects of small-scale living facilities in the Netherlands on residents, family caregivers and nursing staff. A longitudinal, quasi-experimental study is carried out, in which 2 dementia care settings are compared: small-scale living facilities and regular psychogeriatric wards in traditional nursing homes. Data is collected from residents, their family caregivers and nursing staff at baseline and after 6 and 12 months of follow-up. Approximately 2 weeks prior to baseline measurement, residents are screened on cognition and activities of daily living (ADL). Based on this screening profile, residents in psychogeriatric wards are matched to residents living in small-scale living facilities. The primary outcome measure for residents is quality of life. In addition, neuropsychiatric symptoms, depressive symptoms and social engagement are assessed. Involvement with care, perceived burden and satisfaction with care provision are primary outcome variables for family caregivers. The primary outcomes for nursing staff are job satisfaction and motivation. Furthermore, job characteristics social support, autonomy and workload are measured. A process evaluation is performed to investigate to

  19. Community Priorities for Healthy Eating in Older Adults.

    PubMed

    Jiang, Qianzhi; Cohen, Nancy L; Marra, Melissa Ventura; Woolf, Kathleen; Gilbride, Judith; Francis, Sarah L

    2017-01-01

    Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

  20. Social Support and Successful Aging in Assisted Living Residents

    ERIC Educational Resources Information Center

    Howie, Laura Odell; Troutman-Jordan, Meredith; Newman, Ann M.

    2014-01-01

    Successful aging has been associated with adequate social support. However, impaired functionality, increased dependence, multiple comorbidities, and reduced social interactions place older assisted living community (ALC) residents at risk for poorer social support and less successful aging. This cross-sectional descriptive study used the revised…

  1. [Comparing the Health Needs of Older Aboriginal and Older Ethnic Chinese Individuals in Taiwan].

    PubMed

    Lee, Ling-Ling; Lin, Shu-Shuan; Yen, Chia-Feng; Chuang, Jui-Ling

    2016-04-01

    Providing healthcare to older people is an essential policy in Taiwan. Previous studies have assessed the health needs of older people residing in urban areas. Evidence related to the differences in healthcare needs between older aboriginal and older ethnic Chinese people in Taiwan is insufficient. As both groups exhibit mutually distinct physical and socio-cultural attributes, understanding their different health needs is necessary to provide tailored and effective healthcare. To investigate the distinct health needs of older aboriginal and older ethnic Chinese using a comprehensive health-needs assessment tool. A cross-sectional study design was used. Older people aged 65 or over were proportionally sampled from communities. The Elderly Assessment System Care Standard instrument was used to collect data through interviews held in participant homes or in community activity centers between October 20th and December 20th, 2011. A total of 180 older people were recruited. A majority of participants had at least one chronic disease, disability, or frailty. Across a range of dimensions and categories of health needs, older aboriginal people had statistically significant higher health needs than non-aboriginal ones. However, older ethnic Chinese participants had higher levels of need in the domains of housing/financing and social participation/isolation. Regression analysis found that independence, risk of frailty, and risk of falls explained the majority of health needs, with R2 values of 64% and 69.6% for older aboriginal and older ethnic Chinese participants, respectively. However, the respective impact of these three categories on overall health needs varied between the two groups. Based on our findings, healthcare providers should focus on improving the self-care capabilities of older aboriginal people and on reducing the risk of breakdowns in care for older ethnic Chinese people in order to enhance the quality of elderly care in Taiwan.

  2. 'I don't think they knew we could do these sorts of things': social representations of community and participation in community arts by older people.

    PubMed

    Murray, Michael; Crummett, Amanda

    2010-07-01

    As people age the character of their social relationships change. There is evidence that older people who reside in disadvantaged communities often experience social isolation, which in turn has been found to be associated with a variety of health problems. This article reports the initial findings from a participatory arts project with a group of older residents of a disadvantaged urban community. It describes how the older residents represented their community and how they perceived the community arts intervention.

  3. Predictors of depressive symptoms in older adults living in care homes in Thailand.

    PubMed

    Tosangwarn, Suhathai; Clissett, Philip; Blake, Holly

    2018-02-01

    Thai culture traditionally abhors elders living in care homes due to the belief that this represents a dereliction of filial piety by their children, thus care homes are stigmatized as the domain of poor older adults with no family. This may impact negatively on psychological wellbeing of residents, although little is known about the key factors influencing depressive symptoms. Therefore, this study explores factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among older adults residing in care homes in Thailand. A cross-sectional questionnaire study was conducted with 128 older residents recruited from two care homes in Northeast Thailand. Data were collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and the Coping Strategies Inventory Short-Form. Depressive symptoms were significantly correlated with internalised stigma, self-esteem and social support (r=0.563, -0.574 and -0.333) (p<0.001), respectively. Perceived internalised stigma of living in a care home was the strongest predictor of care home residents reporting depressive symptoms (odds ratio=9.165). Older adults who perceived high internalised stigma of living in a care home were over nine times as likely to report experiencing depressive symptoms. Efforts to decrease or prevent perceived internalised stigma might help to reduce depressive symptoms. Interventions might include media collaboration, educational interventions in the care home setting and organising social activities for residents and their families. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Health in post-Black Death London (1350-1538): age patterns of periosteal new bone formation in a post-epidemic population.

    PubMed

    DeWitte, Sharon N

    2014-10-01

    Previous research has shown that the Black Death targeted older adults and individuals who had been previously exposed to physiological stressors. This project investigates whether this selectivity of the Black Death, combined with post-epidemic rising standards of living, led to significant improvements in patterns of skeletal stress markers, and by inference in health, among survivors and their descendants. Patterns of periosteal lesions (which have been previously shown, using hazard analysis, to be associated with elevated risks of mortality in medieval London) are compared between samples from pre-Black Death (c. 1,000-1,300, n = 464) and post-Black Death (c. 1,350-1,538, n = 133) London cemeteries. To avoid the assumptions that stress markers alone provide a direct measure of health and that a change in frequencies of the stress marker by itself indicates changes in health, this study assesses age-patterns of the stress marker to obtain a more nuanced understanding of the population-level effects of an epidemic disease. Age-at-death in these samples is estimated using transition analysis, which provides point estimates of age even for the oldest adults in these samples and thus allows for an examination of physiological stress across the lifespan. The frequency of lesions is significantly higher in the post-Black Death sample, which, at face value, might indicate a general decline in health. However, a significant positive association between age and periosteal lesions, as well as a significantly higher number of older adults in the post-Black Death sample more likely suggests improvements in health following the epidemic. © 2014 Wiley Periodicals, Inc.

  5. Managing the Environment for Older Students.

    ERIC Educational Resources Information Center

    Gelwicks, Louis E.; Weinstock, Ruth

    1980-01-01

    The environmental adjustments required to make campuses responsive to the needs of older persons are seen as tending to fall in the realm of environmental management. Security, orientation, sight, sound, ambient temperature, seating, time, transportation, lounges, and campus residence halls are some environmental needs which are discussed. (MLW)

  6. Retail clinic visits: are resident paneled patients more likely to make multiple visits?

    PubMed

    Angstman, Kurt B; Garrison, Gregory M; Rohrer, James E; Dupras, Denise M; O'Grady, Jason S

    2012-04-01

    Primary care resident physicians generally have significantly fewer hours in outpatient clinic per week than staff physicians. With the transient nature of a primary care resident's practice, do the patients of residents utilize the health care system differently? Our hypothesis was that patients paneled with a resident physician would be more likely to utilize retail clinics with repeat week day visits than those patients paneled with a staff primary care physician. A retrospective review of 16,318 retail clinic visits made in 2009 was studied. Since the patient making a repeat retail clinic visit had experience with the services available, they were making an informed decision on the type of care desired (their primary care provider or not). The patients who made repeat retail clinical visits were divided into groups by age, those younger than 18 years and those 18 years and older. Via multiple logistic regression, patients under 18 years demonstrated that a patient paneled with a resident physician was no more likely to have repeat visits to the retail clinic than a staff physician's patient, when controlling for all other variables. Similarly, those ages 18 years and older also demonstrated no differences in resident or staff paneled patients in utilization of retail clinics during the work day. Multivariate analysis found no difference in the utilization of repeat retail clinic visits during 2009 with resident paneled patients as compared to staff physician patients.

  7. Accelerated Innovation Deployment (AID) Demonstration : KYTC—Roundabout Installation Project in London, Kentucky.

    DOT National Transportation Integrated Search

    2017-11-01

    This document serves as the final report on the construction and opening of the Roundabout Project in London, Kentucky (Kentucky Item Number 11904.1). This project (hereafter referred to as the London Roundabout) was constructed on the authority o...

  8. [Discussion between informal and formal caregivers of community-dwelling older adults].

    PubMed

    Jacobs, M T; Broese van Groenou, M I; Deeg, D J H

    2014-04-01

    Current Dutch policy on long-term care is aimed at a stronger connection between formal home care and informal care. We examined if formal and informal caregivers of community-dwelling older adults discuss the care and whether this is related to characteristics of the older adult, the care network and the individual caregivers. Data are derived from 63 community-dwelling older adults, including their health, their perceived control of the care and their care network. In addition, 79 informal and 90 formal caregivers are interviewed on their motives and vision on caregiving. The 112 dyads between those formal and informal caregivers are the units of analysis in the current study. Bivariate analyses reveal that informal caregivers are more likely to discuss the care with formal caregivers when they are residing with the older adult, when they provide a lot of care and/or when they are strongly motivated to keep the older adult at home. This is particularly the case when the care demands are high. Characteristics of the formal caregivers were not important. In conclusion, discussion of care between non-resident informal caregivers and formal caregivers is not self-evident and requires more effort to be established.

  9. Regional differences in prescribing quality among elder veterans and the impact of rural residence

    PubMed Central

    Lund, BC; Charlton, ME; Steinman, MA; Kaboli, PJ

    2014-01-01

    Purpose Medication safety is a critical concern for older adults. Regional variation in potentially inappropriate prescribing practices may reflect important differences in health care quality. Therefore, the objectives of this study were to characterize prescribing quality variation among older adults across geographic region, and to compare prescribing quality across rural versus urban residence. Methods Cross-sectional study of 1,549,824 older adult veterans with regular Veterans Affairs (VA) primary care and medication use during fiscal year 2007. Prescribing quality was measured by 4 indicators of potentially inappropriate prescribing: Zhan criteria drugs to avoid, Fick criteria drugs to avoid, therapeutic duplication, and drug-drug interactions. Frequency differences across region and rural-urban residence were compared using adjusted odds-ratios. Findings Significant regional variation was observed for all indicators. Zhan criteria frequencies ranged from 13.2% in the Northeast to 21.2% in the South. Nationally, rural veterans had a significantly increased risk for inappropriate prescribing according to all quality indicators. However, regional analyses revealed this effect was limited to the South and Northeast, whereas rural residence was neutral in the Midwest and protective in the West. Conclusions Significant regional variation in prescribing quality was observed among older adult veterans, mirroring recent findings among Medicare beneficiaries. The association between rurality and prescribing quality is heterogeneous, and relying solely on national estimates may yield misleading conclusions. While we documented important variations in prescribing quality, the underlying factors driving these trends remain unknown, and they are a vital area for future research affecting older adults in both VA and non-VA health systems. PMID:23551647

  10. Sarcopenia prevalence and factors associated with sarcopenia in older people living in a nursing home in Ankara Turkey.

    PubMed

    Yalcin, Ahmet; Aras, Sevgi; Atmis, Volkan; Cengiz, Ozlem Karaarslan; Varli, Murat; Cinar, Esat; Atli, Teslime

    2016-08-01

    Sarcopenia is prevalent in older people, and is related to survival and disability. There are no data on sarcopenia evaluated according to European Working Group on Sarcopenia in Older People criteria for nursing home residents in Turkey. We aimed to evaluate the prevalence of sarcopenia according to European Working Group on Sarcopenia in Older People criteria and associated factors with sarcopenia among nursing home residents in Turkey. The study cohort consisted of individuals aged over 65 years and living in the Seyranbağları Nursing Home and Rehabilitation Center in Ankara, Turkey. Besides demographic and medical data, Mini-Mental State Examination, activities of daily living, Mini-Nutritional Assessment, body mass index, calf circumference, gait speed and handgrip strength were also investigated. Muscle mass was evaluated by bioelectrical impedance analysis. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criteria. A total of 141 older individuals were evaluated. Sarcopenia was found in 29% (n = 41) of the participants. Participants with sarcopenia were older and had low scores for activities of daily living, low body mass index, greater cognitive dysfunction, high malnutrition risk and low calf circumference. Body mass index and calf circumference were found to be associated with sarcopenia in multivariate logistic regression analysis. Almost one-third of older nursing home residents were diagnosed with sarcopenia according to European Working Group on Sarcopenia in Older People criteria in this study in Turkey. Calf circumference and body mass index were associated with increased risk of sarcopenia among nursing home residents. This is the first study evaluating sarcopenia using European Working Group on Sarcopenia in Older People criteria in Turkey. Geriatr Gerontol Int 2016; 16: 903-910. © 2015 Japan Geriatrics Society.

  11. Voting suffrage and the political budget cycle: Evidence from the London Metropolitan Boroughs 1902–1937

    PubMed Central

    Aidt, Toke S.; Mooney, Graham

    2014-01-01

    We study the opportunistic political budget cycle in the London Metropolitan Boroughs between 1902 and 1937 under two different suffrage regimes: taxpayer suffrage (1902–1914) and universal suffrage (1921–1937). We argue and find supporting evidence that the political budget cycle operates differently under the two types of suffrage. Taxpayer suffrage, where the right to vote and the obligation to pay local taxes are linked, encourages demands for retrenchment and the political budget cycle manifests itself in election year tax cuts and savings on administration costs. Universal suffrage, where all adult residents can vote irrespective of their taxpayer status, creates demands for productive public services and the political budget cycle manifests itself in election year hikes in capital spending and a reduction in current spending. PMID:25843984

  12. Companionship in the neighborhood context: Older adults’ living arrangements and perceptions of social cohesion

    PubMed Central

    Bromell, Lea; Cagney, Kathleen A.

    2014-01-01

    This study investigated the impact of neighborhood social cohesion on the perceived companionship of nearly 1,500 community-dwelling older adults from the Neighborhood, Organization, Aging and Health project (NOAH), a Chicago-based study of older adult well-being in the neighborhood context. We hypothesized that the relationship between neighborhood-level social cohesion and individual residents’ reports of companionship would be more pronounced among those who lived alone than those who resided with others. Controlling for age, gender, education, race, marital status, length of neighborhood residence, and self-rated health, neighborhood social cohesion predicted companionship among those who lived alone; for a one-unit increase in neighborhood social cohesion, the odds of reporting companionship increased by half. In contrast, social cohesion did not predict the companionship of those who resided with others. The results suggest that older adults who live alone particularly profit from the benefits of socially cohesive neighborhood environments. PMID:24860203

  13. HIV in East London: ethnicity, gender and risk. Design and methods.

    PubMed

    Elford, Jonathan; Anderson, Jane; Bukutu, Cecilia; Ibrahim, Fowzia

    2006-06-09

    While men who have sex with men remain the group at greatest risk of acquiring HIV infection in the UK, the number of new diagnoses among heterosexuals has risen steadily over the last five years. In the UK, three-quarters of heterosexual men and women diagnosed with HIV in 2004 probably acquired their infection in Africa. This changing epidemiological pattern is particularly pronounced in East London because of its ethnically diverse population. The objective of the study was to examine the social, economic and behavioural characteristics of patients with HIV infection currently receiving treatment and care in hospitals in East London. The research focused on ethnicity, gender, sexuality, education, employment, housing, HIV treatment, stigma, discrimination, religion, migration and sexual risk behaviour. People diagnosed with HIV infection attending outpatient treatment clinics at St Bartholomew's, the Royal London, Whipp's Cross, Homerton, Newham and Barking hospitals (all in East London) over a 4-6 month period were invited to participate in the study in 2004-2005. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire. During the study period, 2680 patients with HIV attended the outpatient clinics in the six participating hospitals, of whom 2299 were eligible for the study and 1687 completed a questionnaire. The response rate was 73% of eligible patients and 63% of all patients attending the clinics during the survey period. A clinic-based study has allowed us to survey nearly 1700 patients with HIV from diverse backgrounds receiving treatment and care in East London. The data collected in this study will provide valuable information for the planning and delivery of appropriate clinical care, social support and health promotion for people living with HIV not only in East London but in other parts of the capital as well as elsewhere in the UK.

  14. Evaluating methane inventories by isotopic analysis in the London region.

    PubMed

    Zazzeri, G; Lowry, D; Fisher, R E; France, J L; Lanoisellé, M; Grimmond, C S B; Nisbet, E G

    2017-07-07

    A thorough understanding of methane sources is necessary to accomplish methane reduction targets. Urban environments, where a large variety of methane sources coexist, are one of the most complex areas to investigate. Methane sources are characterised by specific δ 13 C-CH 4 signatures, so high precision stable isotope analysis of atmospheric methane can be used to give a better understanding of urban sources and their partition in a source mix. Diurnal measurements of methane and carbon dioxide mole fraction, and isotopic values at King's College London, enabled assessment of the isotopic signal of the source mix in central London. Surveys with a mobile measurement system in the London region were also carried out for detection of methane plumes at near ground level, in order to evaluate the spatial allocation of sources suggested by the inventories. The measured isotopic signal in central London (-45.7 ±0.5‰) was more than 2‰ higher than the isotopic value calculated using emission inventories and updated δ 13 C-CH 4 signatures. Besides, during the mobile surveys, many gas leaks were identified that are not included in the inventories. This suggests that a revision of the source distribution given by the emission inventories is needed.

  15. Older adults' perceptions of work.

    PubMed

    Bambrick, Patricia; Bonder, Bette

    2005-01-01

    Traditional definitions of work may not reflect the activities of older adults. A broader definition that incorporates non-economic as well as economic measures may better describe their participation in the labor force and the meanings they ascribe to these activities. Because productive activity has been linked to successful aging, it is important to understand how elders perceive work. Twenty-six community-residing older adults were interviewed over a two-year period. Participants were mostly female and represented diverse cultural, religious and educational backgrounds. All these individuals participated in some activities they perceived as work. Three themes emerged as describing their attributions of meaning or importance to productive activities: contribution to self-concept, giving back to community, and staying engaged. Findings suggest that the productive activities of older adults contribute to quality of life for them and have implications for society as well.

  16. City lights of London, England taken during Expedition Six

    NASA Image and Video Library

    2003-02-04

    ISS006-E-22939 (4 February 2003) --- City lights of London, England were captured with a digital still camera by one of the Expedition Six crewmembers on the International Space Station (ISS). This nighttime view of the British capital shows the city’;s urban density and infrastructure as highlighted by electrical lighting. Beyond lie isolated bright areas marking the numerous smaller cities and towns of the region and as far southeast as Hastings on the coast. London’;s two major airports, Heathrow and Gatwick, are visible to the south of the city.

  17. Fast-food, everyday life and health: A qualitative study of 'chicken shops' in East London.

    PubMed

    Thompson, Claire; Ponsford, Ruth; Lewis, Daniel; Cummins, Steven

    2018-05-26

    The higher prevalence of fast food outlets in deprived areas has been associated with the production and maintenance of geographical inequalities in diet. In the UK one type of fast food outlet - the 'chicken shop' - has been the focus of intense public health and media interest. Despite ongoing concerns and initiatives around regulating these establishments, the 'chicken shop' is both a commercially successful and ubiquitous feature of disadvantaged urban neighbourhoods. However, little is known about how they are perceived by local residents. We report data from a qualitative study of neighbourhood perceptions in a low SES urban setting. Narrative family interviews, go-along interviews and school video focus group workshops with 66 residents of East London were conducted over two waves. The topic of chicken shops was a prolific theme and a narrative analysis of these accounts revealed that local perceptions of chicken shops are complex and contradictory. Chicken shops were depicted as both potentially damaging for the health of local residents and, at the same time, as valued community spaces. This contradiction was discursively addressed in narrative via a series of rhetorical rebuttals that negated their potential to damage health on the grounds of concepts such as trust, choice, balance, food hygiene and compensatory physical activity. In some instances, chicken shops were described as 'healthy' and patronising them constructed as part of a healthy lifestyle. Chicken shops are embedded in the social fabric of neighbourhoods. Successful strategies to improve diet therefore requires context-sensitive environmental interventions. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. Michael Fisher at King's College London

    NASA Astrophysics Data System (ADS)

    Domb, Cyril

    1991-09-01

    Michael Fisher spent the first 16 years of his academic life in the Physics Department of King's College, London, starting as an undergraduate and ending as a full professor. A survey is undertaken of his activities and achievements during the various periods of this phase of his career.

  19. Michael Fisher at King's College London

    NASA Astrophysics Data System (ADS)

    Domb, Cyril

    Michael Fisher spent the first 16 years of his academic life in the Physics Department of King's College, London, starting as an undergraduate and ending as a full professor. A survey is undertaken of his activities and achievements during the various periods of this phase of his career.

  20. 75 FR 54024 - Drawbridge Operation Regulations; Shaw Cove, New London, CT, Maintenance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... Operation Regulations; Shaw Cove, New London, CT, Maintenance AGENCY: Coast Guard, DHS. ACTION: Notice of... temporary deviation from the regulation governing the operation of the Amtrak Bridge across Shaw Cove, mile...-9826. SUPPLEMENTARY INFORMATION: The Amtrak Bridge, across Shaw Cove at mile 0.0, at New London...

  1. The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease.

    PubMed

    Cott, Cheryl A; Dawson, Pamela; Sidani, Souraya; Wells, Donna

    2002-01-01

    The purpose of this study was to investigate the effects of a walking/talking program on residents' communication, ambulation, and level of function when there were two residents to one care provider (2:1). A randomized control trial design was used. Subjects were residents with Alzheimer disease in three geriatric long-term care facilities in Metropolitan Toronto. Residents who met the inclusion criteria were randomly assigned to one of three groups: walk-and-talk group (30 min, 5 times per week for 16 weeks, walking/talking in pairs), talk-only group (30 min, 5 times per week for 16 weeks, talk only in pairs), or no intervention. The outcome measures were the Functional Assessment of Communication Skills for Adults, the 2-min walk test, and London Psychogeriatric Rating Scale. Residents who received the walk-and-talk intervention did not demonstrate statistically significant differences in the outcome variables measured posttest when compared with residents who received the talk-only intervention or no intervention, even after controlling for individual differences. Variability in the outcomes measured posttest is explained by differences in the residents' level of cognitive impairment before the study rather than by study group membership. These findings are contradictory to those of previous studies.

  2. Droughts and Dragons: Geography, Rainfall, and Eighteenth-Century London's Water Systems.

    PubMed

    Van Lieshout, Carry

    By the end of the eighteenth century the majority of households in London received a piped water supply. This article examines the geographical, technological, and environmental challenges that London's private water companies faced as they created and expanded the large technological networks necessary to provide the growing city's water supply. It identifies geography and drought as the main drivers of innovation in London's water supply neworks, and argues that the main impediment to expansion for the majority of the water companies was overcoming the differences in elevation between their intake points and customer bases, with major improvements often made as a result of water shortages. The timing and the success or failure of a company's technological improvements proved pivotal in the subsequent development of the water market.

  3. Seasonal change of residence time in spring water and groundwater at a mountainous headwater catchment

    NASA Astrophysics Data System (ADS)

    Nagano, Kosuke; Tsujimura, Maki; Onda, Yuichi; Iwagami, Sho; Sakakibara, Koichi; Sato, Yutaro

    2017-04-01

    Determination of water age in headwater is important to consider water pathway, source and storage in the catchment. Previous studies showed that groundwater residence time changes seasonally. These studies reported that mean residence time of water in dry season tends to be longer than that in rainy season, and it becomes shorter as precipitation and discharge amount increases. However, there are few studies to clarify factors causing seasonal change in mean residence time in spring water and groundwater based on observed data. Therefore, this study aims to reveal the relationship between mean residence time and groundwater flow system using SFconcentration in spring and 10 minutes interval hydrological data such as discharge volume, groundwater level and precipitation amount in a headwater catchment in Fukushima, Japan. The SF6 concentration data in spring water observed from April 2015 to November 2016 shows the mean residence time of springs ranged from zero to 14 years. We also observed a clear negative correlation between discharge rate and residence time in the spring. The residence time in shallow groundwater in rainy season was younger as compared with that in low rainfall period. Therefore, the shallow groundwater with young residence time seems to contribute to the spring in rainy season, causing shorter residence time. Additionally, the residence time of groundwater ranged from 3 to 5 years even in low rainfall period. The residence time in high groundwater table level in ridge was older as compared with that in low groundwater table level. These suggest that the contribution of groundwater with older age in the ridge becomes dominant in the low discharge.

  4. Food security: who is being excluded? A case of older people with dementia in long-term care homes.

    PubMed

    Vahabi, M; Schindel Martin, L

    2014-07-01

    To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included. Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security. The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular

  5. Psychometric Properties of the Thai Internalized Stigma Scale (TIS-LCH) for Care Home Residents.

    PubMed

    Tosangwarn, Suhathai; Clissett, Philip; Blake, Holly

    2017-01-01

    Living in a care home is a source of stigma in Thai culture, although there is currently no measurement tool in the Thai language specifically designed to assess internalized stigma in care home residents. The Thai Version of Internalized Stigma of Living in a Care Home (TIS-LCH) scale was developed and tested for its psychometric properties among Thai older residents. The Thai version of Internalized Stigma of Mental Health Illness (ISMI) Scale was revised into the TIS-LCH by replacing the word of "mental health illness" to "living in a care home." Content validity of the TIS-LCH was determined through expert review (n = 6), and reliability testing was undertaken with older care home residents (n = 128). The TIS-LCH showed good internal consistency, with a Cronbach's alpha of .87. Test-retest reliability coefficient of TIS-LCH was excellent for the full scale (ICC = .90). The Thai version of IS-LCH (TIS-LCH) is a valid and reliable measurement tool for assessing internalized stigma in Thai care home residents. The IS-LCH will be a useful research tool to assess internalized stigma in older adults living in care settings. Understanding stigma will help health and social care professionals to plan interventions aimed at reducing or preventing negative emotional reactions and negative behavioural responses toward stigma, which are known to be associated with mental illness and particularly depression among this population.

  6. Prevalence and associated factors of hearing aid use among older adults in Chile.

    PubMed

    Fuentes-López, Eduardo; Fuente, Adrian; Cardemil, Felipe; Valdivia, Gonzalo; Albala, Cecilia

    2017-11-01

    The aim of this study was to determine the prevalence of use of hearing aids by older adults in Chile and the influence of some variables such as education level, income level and geographic area of residence on the prevalence of hearing aids. A national cross-sectional survey which was carried out in 2009. A representative sample of 4766 Chilean older adults aged 60 years and above. The percentage of older adults in Chile who self-reported hearing problems and used hearing aids was 8.9%. Such prevalence increased for adults living in urban areas and for those who knew about the new Chilean programme of universal access to health services (AUGE). For older adults who did not know about this programme, significant associations between the use of hearing aids and the variables of age, geographic area of residence, and income level were found. People's knowledge about AUGE programme may positively influence the use of hearing aids, although a direct effect cannot be attributed.

  7. The London low emission zone baseline study.

    PubMed

    Kelly, Frank; Armstrong, Ben; Atkinson, Richard; Anderson, H Ross; Barratt, Ben; Beevers, Sean; Cook, Derek; Green, Dave; Derwent, Dick; Mudway, Ian; Wilkinson, Paul

    2011-11-01

    On February 4, 2008, the world's largest low emission zone (LEZ) was established. At 2644 km2, the zone encompasses most of Greater London. It restricts the entry of the oldest and most polluting diesel vehicles, including heavy-goods vehicles (haulage trucks), buses and coaches, larger vans, and minibuses. It does not apply to cars or motorcycles. The LEZ scheme will introduce increasingly stringent Euro emissions standards over time. The creation of this zone presented a unique opportunity to estimate the effects of a stepwise reduction in vehicle emissions on air quality and health. Before undertaking such an investigation, robust baseline data were gathered on air quality and the oxidative activity and metal content of particulate matter (PM) from air pollution monitors located in Greater London. In addition, methods were developed for using databases of electronic primary-care records in order to evaluate the zone's health effects. Our study began in 2007, using information about the planned restrictions in an agreed-upon LEZ scenario and year-on-year changes in the vehicle fleet in models to predict air pollution concentrations in London for the years 2005, 2008, and 2010. Based on this detailed emissions and air pollution modeling, the areas in London were then identified that were expected to show the greatest changes in air pollution concentrations and population exposures after the implementation of the LEZ. Using these predictions, the best placement of a pollution monitoring network was determined and the feasibility of evaluating the health effects using electronic primary-care records was assessed. To measure baseline pollutant concentrations before the implementation of the LEZ, a comprehensive monitoring network was established close to major roadways and intersections. Output-difference plots from statistical modeling for 2010 indicated seven key areas likely to experience the greatest change in concentrations of nitrogen dioxide (NO2) (at least 3

  8. Leisure Activity and Caregiver Involvement in Middle-Aged and Older Adults With Down Syndrome.

    PubMed

    Mihaila, Iulia; Hartley, Sigan L; Handen, Benjamin L; Bulova, Peter D; Tumuluru, Rameshwari V; Devenny, Darlynne A; Johnson, Sterling C; Lao, Patrick J; Christian, Bradley T

    2017-04-01

    The present study examined leisure activity and its association with caregiver involvement (i.e., residence and time spent with primary caregiver) in 62 middle-aged and older adults with Down syndrome (aged 30-53 years). Findings indicated that middle-aged and older adults with Down syndrome frequently participated in social and passive leisure activities, with low participation in physical and mentally stimulating leisure activities. Residence and time spent with primary caregiver were associated with participation in physical leisure activity. The findings suggest a need for support services aimed at increasing opportunities for participating in physical and mentally stimulating leisure activity by middle-aged and older adults with Down syndrome. These support services should partner with primary caregivers in order to best foster participation in physical leisure activity.

  9. Development and Preliminary Evaluation of the Resident Coordinated-Transitional Care (RC-TraC) Program: A Sustainable Option for Transitional Care Education

    PubMed Central

    Chapman, E.; Eastman, A.; Gilmore-Bykovskyi, A.; Vogelman, B.; Kind, A. J.

    2016-01-01

    Older adults often face poor outcomes when transitioning from hospital to home. Although physicians play a key role in overseeing transitions, there is a lack of practice-based educational programs that prepare resident physicians to manage care transitions of older adults. An educational intervention to provide residents with real-life transitional care practice was therefore developed – Resident-coordinated Transitional Care (RC-TraC). RC-TraC adapted the evidence-based Coordinated-Transitional Care (C-TraC) nurse role for residents, providing opportunities to follow patients during the peri-hospital period without additional costs to the residency program. Between July 2010 and June 2013, thirty-one Internal Medicine residents participated in RC-TraC, caring for 721 patients. RC-TraC has been a sustainable, low-cost, practice-based education experience that is recognized as transitional care education by residents and continues in operation to this day. RC-TraC is a promising option for geriatric-based transitional care education of resident physicians and could also be adapted for non-physician learners. PMID:27749162

  10. Movement and Character. Lecture, London, 1946

    ERIC Educational Resources Information Center

    Montesorri, Maria

    2013-01-01

    Dr. Montessori's words from the 1946 London Lectures describe principles of intelligence and character, the work of the hand, and movement with a purpose as being integral to self-construction. The perfection of movement is spiritual, says Dr. Montessori. Repetition of practical life exercises are exercises in movement with the dignity of human…

  11. London Took the Lead: Institutes for Women.

    ERIC Educational Resources Information Center

    Hughes, Mary

    1992-01-01

    The creation in London of single-sex institutes for the education of women offered increased educational opportunities but did not widen their horizons. For working class women, educational policy regarding these institutes tended to support their domestic roles. (SK)

  12. The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study.

    PubMed

    Xu, Hanzhang; Dupre, Matthew E; Gu, Danan; Wu, Bei

    2017-05-15

    Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. After controlling for covariates, significant differences in cognitive function were found across the four groups: rural-to-urban and rural residents had a higher level of cognition than urban residents at baseline. On average, cognitive function decreased over the course of the study period. Rural-to-urban and rural residents demonstrated a faster decline in cognitive function than urban residents. This study suggests that residential status has an impact on the rate of changes in cognition among older adults in China. Results from this study provide directions for future research that addresses health disparities, particularly in countries that are undergoing significant socioeconomic transitions.

  13. Parish apprenticeship and the old poor law in London.

    PubMed

    Levene, Alysa

    2010-01-01

    This article offers an examination of the patterns and motivations behind parish apprenticeship in late eighteenth- and early nineteenth-century London. It stresses continuity in outlook from parish officials binding children, which involved placements in both the traditional and industrializing sectors of the economy. Evidence on the ages, employment types, and locations of 3,285 pauper apprentices bound from different parts of London between 1767 and 1833 indicates a variety of local patterns. The analysis reveals a pattern of youthful age at binding, a range of employment experiences, and parish-specific links to particular trades and manufactures.

  14. Putting partnership into practice: participatory wellbeing assessment on a south London housing estate

    PubMed Central

    Cornwall, Andrea; Lall, Pawan; Kennedy, Ken; Owen, Felicity

    2003-01-01

    Abstract Purpose  Bridging the gap between professionals and communities and establishing new forms of partnership is essential if service provision is to be made more responsive and accountable. This article describes an innovative approach to creating the basis for partnerships to address community wellbeing on an estate in south London. Methods  Drawing on participatory appraisal and action planning methods, and drawing together residents and professionals within and beyond the health service, a participatory wellbeing assessment exercise was carried out on a housing estate with a population of around 6000 people, involving just under 10% of residents. Results  The participatory wellbeing assessment exercise served as a means of seeking to bridge different perceptions, priorities and perspectives on wellbeing and forge new relationships, alliances and partnerships for change. Creating this vehicle for change also created opportunities for local people to participate in community wellbeing issues. This, in turn, strengthened connections between health policy, provision and grassroots community health development, broadening opportunities for service responsiveness and citizen involvement. Conclusion  Broadening involvement in assessing and determining priorities for improving wellbeing can serve to do more than enable citizens to engage more directly in making and shaping the policies that affect their lives. It can also serve as a way of establishing new kinds of partnerships across and within the statutory and non‐statutory services, opening up space for new, more ‘joined up’ forms of work that help to bridge the gap between citizens and services. PMID:12603626

  15. Additional Cost Because of Pneumonia in Nursing Home Residents: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Resident Study.

    PubMed

    Costa, Nadège; Hoogendijk, Emiel O; Mounié, Michael; Bourrel, Robert; Rolland, Yves; Vellas, Bruno; Molinier, Laurent; Cesari, Matteo

    2017-05-01

    Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included. Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5. Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded. Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia. NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs. Copyright © 2017. Published by Elsevier Inc.

  16. To Moscow with love: partial reconstruction of Vygotsky's trip to London.

    PubMed

    van der Veer, René; Zavershneva, Ekaterina

    2011-12-01

    The Russian psychologist Lev Vygotsky (1896-1934) left the Soviet Union only once to attend a conference on the education of the deaf in London. So far almost nothing was known about this trip, which took place in a period when Vygotsky was still completely unknown as a psychologist, both inside his own country and abroad. Making use of a newly discovered notebook, it proved possible to partially reconstruct Vygotsky's journey and stay in London. Vygotsky's very personal remarks show him to have been a very sensitive and spirited man, who was prey to strong emotions during the conference and afterwards. Rather surprisingly, Vygotsky's own paper about the education of the deaf was never presented during the conference and the stay in London appears to have had a limited value for his own scientific development.

  17. Preventing suicide on the London Underground.

    PubMed

    Clarke, R V; Poyner, B

    1994-02-01

    A field study was carried out to investigate the possibility of preventing suicide on the London Underground. Four groups of potentially valuable measures were identified with the objectives of: (i) reducing public access to the tracks; (ii) improving surveillance by station staff; (iii) facilitating emergency stops; and (iv) reducing injury. These strategies are discussed.

  18. Older adults' home- and community-based care service use and residential transitions: a longitudinal study.

    PubMed

    Chen, Ya-Mei; Berkowitz, Bobbie

    2012-08-10

    As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults' use of home- and community-based services and their residential transitions. The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults' residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.). Older adults' use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults' use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal

  19. Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

    PubMed Central

    2012-01-01

    Background As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. Methods The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.). Results Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as

  20. The physical environment, activity and interaction in residential care facilities for older people: a comparative case study.

    PubMed

    Nordin, Susanna; McKee, Kevin; Wallinder, Maria; von Koch, Lena; Wijk, Helle; Elf, Marie

    2017-12-01

    The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents' affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents' activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently. © 2016 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

  1. An Assessment of Course Needs for Older Adults at McCook Community College.

    ERIC Educational Resources Information Center

    Craig, Ford M.

    A study was conducted to assess the educational needs of older adults residing in McCook Community College's service area. A questionnaire focusing on respondents' interest in courses on financial management skills, employment needs, health and health care, social interaction, and self-esteem was administered to 150 older adults. The sample…

  2. Psychoanalysis of Jack London's "The Call of the Wild" and "White Fang"

    ERIC Educational Resources Information Center

    Yang, Hongyan

    2015-01-01

    "The Call of the Wild" and "White Fang" both are masterpieces of Jack London. The protagonists Buck and White Fang are the incarnation of Jack himself to some extent for the two novels reveal a great deal of the writer. This essay aims at psychoanalyzing Jack London's creative process, the Oedipus complex and the confliction…

  3. Low on the London Scale

    NASA Astrophysics Data System (ADS)

    Webb, S.

    2013-09-01

    Until relatively recently, many authors have assumed that if extraterrestrial life is discovered it will be via the discovery of extraterrestrial intelligence: we can best try to detect life by adopting the SETI approach of trying to detect beacons or artefacts. The Rio Scale, proposed by Almár and Tarter in 2000, is a tool for quantifying the potential significance for society of any such reported detection. However, improvements in technology and advances in astrobiology raise the possibility that the discovery of extraterrestrial life will instead be via the detection of atmospheric biosignatures. The London Scale, proposed by Almár in 2010, attempts to quantify the potential significance of the discovery of extraterrestrial life rather than extraterrestrial intelligence. What might be the consequences of the announcement of a discovery that ranks low on the London Scale? In other words, what might be society's reaction if 'first contact' is via the remote sensing of the byproducts of unicellular organisms rather than with the products of high intelligence? Here, I examine some possible reactions to that question; in particular, I discuss how such an announcement might affect our views of life here on Earth and of humanity's place in the universe.

  4. 'I have the world's best job' - staff experience of the advantages of caring for older people.

    PubMed

    Eldh, Ann Catrine; van der Zijpp, Teatske; McMullan, Christel; McCormack, Brendan; Seers, Kate; Rycroft-Malone, Jo

    2016-06-01

    Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care. To explore staff experience of the advantages of working in LTC settings for older people. Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis. Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews. Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents. The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study. The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail. © 2015 Nordic College of Caring Science.

  5. Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

    PubMed

    Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo

    2018-04-01

    To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  6. Opportunities for the Older Unemployed. An Investigation of Education and Training Needs and Opportunities for Unwaged Adults in Their 40s and 50s.

    ERIC Educational Resources Information Center

    Browning, Genia; Linn, Pamela

    A project was designed to assist older unemployed people in London, England, with the transition to education, vocational training, and employment. The project involved the development of a local tourist guide course at Thames Polytechnic (England), the accreditation of this course, and employment of some of the participants as local tourist…

  7. Estimating attendance for breast cancer screening in ethnic groups in London.

    PubMed

    Renshaw, Christine; Jack, Ruth H; Dixon, Steve; Møller, Henrik; Davies, Elizabeth A

    2010-03-25

    Breast screening uptake in London is below the Government's target of 70% and we investigate whether ethnicity affects this. Information on the ethnicity for the individual women invited is unavailable, so we use an area-based method similar to that routinely used to derive a geographical measure for socioeconomic deprivation. We extracted 742,786 observations on attendance for routine appointments between 2004 and 2007 collected by the London Quality Assurance Reference Centre. Each woman was assigned to a lower super output (LSOA) based on her postcode of residence. The proportions of the ethnic groups within each LSOA are known, so that the likelihood of a woman belonging to White, Black and Asian groups can be assigned. We investigated screening attendance by age group, socioeconomic deprivation using the Index of Deprivation 2004 income quintile, invitation type and breast screening service. Using logistic regression analysis we calculated odds ratios for attendance based on ethnic composition of the population, adjusting for age, socioeconomic status, the invitation type and screening service. The unadjusted attendance odds ratios were high for the White population (OR: 3.34 95% CI [3.26-3.42]) and low for the Black population (0.13 [0.12-0.13]) and the Asian population (0.55 [0.53-0.56]). Multivariate adjustment reduced the differences, but the Black population remained below unity (0.47 [0.44-0.50]); while the White (1.30 [1.26-1.35]) and Asian populations (1.10 [1.05-1.15]) were higher. There was little difference in the attendance between age groups. Attendance was highest for the most affluent group and fell sharply with increasing deprivation. For invitation type, the routine recall was higher than the first call. There were wide variations in the attendance for different ethnic groups between the individual screening services. Overall breast screening attendance is low in communities with large Black populations, suggesting the need to improve

  8. Socio-Spatial Integration of Older Adults in Four Types of Residential Environments in Israel.

    PubMed

    Schorr, Adi Vitman; Iecovich, Esther; Alfasi, Nurit; Shamai, Shmuel

    2017-10-01

    The socio-spatial integration of older people in different types of residential environments is a key factor affecting the well-being of older people. This study, which included a convenience sample of 565 participants, examined the socio-spatial integration of older people living in two different regional areas (central and peripheral) and four different residential environments (metropolitan hub, city, and town and rural settlements) in Israel. Willing participants were asked to complete a self-administered questionnaire. Socio-spatial integration was assessed by recognition of their neighbors and sense of belonging to the residential environment. The findings show that older adults who resided in the town and in rural settlements were more socio-spatially integrated in their living environments compared with their counterparts who resided in cities. The best predictors of socio-spatial integration were a combination of personal characteristics and characteristics of the environment (perceived accessibility) except for rural settlements, where none of the variables predicted socio-spatial integration.

  9. Mental healthcare need and service utilization in older adults living in public housing.

    PubMed

    Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

    2012-05-01

    Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

  10. Patterns and prevalence of violence-related skull trauma in medieval London.

    PubMed

    Krakowka, Kathryn

    2017-11-01

    This study aims to identify the patterns and prevalence of violence-related skull trauma (including the cranium and mandible) among a large sample of skeletons from medieval London (1050-1550 AD). In total, data from 399 skulls, representing six different sites from across medieval London, were analyzed for evidence of trauma and assessed for the likelihood that it was caused by violence. The sites include the three parish cemeteries of St Nicholas Shambles (GPO75), St Lawrence Jewry (GYE92), and St Benet Sherehog (ONE94); the two monastic houses of London Blackfriars (PIC87) and St Mary Graces (MIN86); and the early inmate cemetery from the medieval hospital of St Mary Spital (NRT85). The overall findings suggest that violence affected all aspects of medieval London society, but how that violence was characterized largely depended on sex and burial location. Specifically, males from the lay cemeteries appear to have been the demographic most affected by violence-related skull injuries, particularly blunt force trauma to the cranial vault. Using both archaeological and historical evidence, the results suggest that violence in medieval London may have been more prevalent than in other parts of medieval England, particularly rural environments, but similar to other parts of medieval Europe. However, more studies focusing on medieval trauma, and violence specifically, need to be carried out to further strengthen these results. In particular, males from the lay cemeteries were disproportionately affected by violence-related trauma, especially blunt force trauma. It perhaps indicates a means of informal conflict resolution as those of lower status did not always have the newly established medieval legal system available to them. © 2017 Wiley Periodicals, Inc.

  11. Identifying the Potential for Robotics to Assist Older Adults in Different Living Environments

    PubMed Central

    Mitzner, Tracy L.; Chen, Tiffany L.; Kemp, Charles C.; Rogers, Wendy A.

    2014-01-01

    As the older adult population grows and becomes more diverse, so will their needs and preferences for living environments. Many adults over 65 years of age require some assistance [1, 2]; yet it is important for their feelings of well-being that the assistance not restrict their autonomy [3]. Not only is autonomy correlated with quality of life [4], autonomy enhancement may improve functionality [2, 5]. The goal of this paper is to provide guidance for the development of technology to enhance autonomy and quality of life for older adults. We explore the potential for robotics to meet these needs. We evaluated older adults' diverse living situations and the predictors of residential moves to higher levels of care in the United States. We also examined older adults' needs for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and medical conditions when living independently or in a long-term care residence. By providing support for older adults, mobile manipulator robots may reduce need-driven, undesired moves from residences with lower levels of care (i.e., private homes, assisted living) to those with higher levels of care (i.e., skilled nursing). PMID:24729800

  12. Leisure Activity and Caregiver Involvement in Middle-Aged and Older Adults With Down Syndrome

    PubMed Central

    Mihaila, Iulia; Hartley, Sigan L.; Handen, Benjamin L.; Bulova, Peter D.; Tumuluru, Rameshwari V.; Devenny, Darlynne A.; Johnson, Sterling C.; Lao, Patrick J.; Christian, Bradley T.

    2017-01-01

    The present study examined leisure activity and its association with caregiver involvement (i.e., residence and time spent with primary caregiver) in 62 middle-aged and older adults with Down syndrome (aged 30–53 years). Findings indicated that middle-aged and older adults with Down syndrome frequently participated in social and passive leisure activities, with low participation in physical and mentally stimulating leisure activities. Residence and time spent with primary caregiver were associated with participation in physical leisure activity. The findings suggest a need for support services aimed at increasing opportunities for participating in physical and mentally stimulating leisure activity by middle-aged and older adults with Down syndrome. These support services should partner with primary caregivers in order to best foster participation in physical leisure activity. PMID:28375797

  13. Violent Crime Victimization Increases the Risk of Nursing Home Placement in Older Adults

    ERIC Educational Resources Information Center

    Lachs, Mark; Bachman, Ronet; Williams, Christianna S.; Kossack, Alice; Bove, Carolyn; O'Leary, John R.

    2006-01-01

    Purpose: We estimate the independent contribution of crime victimization to nursing home placement in a cohort of older adults who were community dwelling at baseline. Design and Methods: The data come from an observational cohort study of 2,321 community-residing older adults who were members of the New Haven Established Populations for…

  14. Length of stay for older adults residing in nursing homes at the end of life.

    PubMed

    Kelly, Anne; Conell-Price, Jessamyn; Covinsky, Kenneth; Cenzer, Irena Stijacic; Chang, Anna; Boscardin, W John; Smith, Alexander K

    2010-09-01

    To describe lengths of stay of nursing home decedents. Retrospective cohort study. The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. The mean age of decedents was 83.3 ± 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 ± 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. © 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.

  15. Storage of Poisonous Substances and Firearms in Homes with Young Children Visitors and Older Adults

    PubMed Central

    Coyne-Beasley, Tamera; Runyan, Carol W.; Baccaglini, Lorena; Perkis, David; Johnson, Renee M.

    2011-01-01

    Background Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children’s access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. Methods Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. Results There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged ≥70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. Conclusions Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors. PMID:15626565

  16. Multisensory environments for leisure: promoting well-being in nursing home residents with dementia.

    PubMed

    Cox, Helen; Burns, Ian; Savage, Sally

    2004-02-01

    Multisensory environments such as Snoezelen rooms are becoming increasingly popular in health care facilities for older individuals. There is limited reliable evidence of the benefits of such innovations, and the effect they have on residents, caregivers, and visitors in these facilities. This two-stage project examined how effective two types of multisensory environments were in improving the well-being of older individuals with dementia. The two multisensory environments were a Snoezelen room and a landscaped garden. These environments were compared to the experience of the normal living environment. The observed response of 24 residents with dementia in a nursing home was measured during time spent in the Snoezelen room, in the garden, and in the living room. In the second part of the project, face-to-face interviews were conducted with six caregivers and six visitors to obtain their responses to the multisensory environments. These interviews identified the components of the environments most used and enjoyed by residents and the ways in which they could be improved to maximize well-being.

  17. Tracer concentration profiles measured in central London as part of the REPARTEE campaign

    NASA Astrophysics Data System (ADS)

    Martin, D.; Petersson, K. F.; White, I. R.; Henshaw, S. J.; Nickless, G.; Lovelock, A.; Barlow, J. F.; Dunbar, T.; Wood, C. R.; Shallcross, D. E.

    2011-01-01

    There have been relatively few tracer experiments carried out that have looked at vertical plume spread in urban areas. In this paper we present results from two tracer (cyclic perfluorocarbon) experiments carried out in 2006 and 2007 in central London centred on the BT Tower as part of the REPARTEE (Regent's Park and Tower Environmental Experiment) campaign. The height of the tower gives a unique opportunity to study vertical dispersion profiles and transport times in central London. Vertical gradients are contrasted with the relevant Pasquill stability classes. Estimation of lateral advection and vertical mixing times are made and compared with previous measurements. Data are then compared with a simple operational dispersion model and contrasted with data taken in central London as part of the DAPPLE campaign. This correlates dosage with non-dimensionalised distance from source. Such analyses illustrate the feasibility of the use of these empirical correlations over these prescribed distances in central London.

  18. Breast cancer screening uptake among women from different ethnic groups in London: a population-based cohort study.

    PubMed

    Jack, Ruth H; Møller, Henrik; Robson, Tony; Davies, Elizabeth A

    2014-10-16

    To use newly available self-assigned ethnicity information to investigate variation in breast cancer screening uptake for women from the 16 specific ethnic groups within the broad Asian, Black and White groups that previous studies report. National cancer screening programme services within London. 655,516 female residents aged 50-69, invited for screening between March 2006 and December 2009. Ethnicity information was available for 475,478 (72.5%). White British women were the largest group (306,689, 46.8%), followed by Indian (34,687, 5.3%), White Other (30,053, 4.6%), Black Caribbean (25,607, 3.9%), White Irish (17,271, 2.6%), Black African (17,071, 2.6%) and Asian Other (10,579, 1.6%). Uptake for women in different ethnic groups aged 50-52 for a first call invitation to the programme, and for women aged 50-69 for a routine recall invitation after a previous mammography. Uptake is reported (1) for London overall, adjusted using logistic regression, for age at invitation, socioeconomic deprivation and geographical screening area, and (2) for individual areas, adjusted for age and deprivation. White British women attended their first call (67%) and routine recall (78%) invitations most often. Indian women were more likely to attend their first (61%) or routine recall (74%) than Bangladeshi women (43% and 61%, respectively), and Black Caribbean women were more likely than Black African women to attend first call (63% vs 49%, respectively) and routine recall (74% vs 64%, respectively). There was less variation between ethnic groups in some screening areas. Breast cancer screening uptake in London varies by specific ethnic group for first and subsequent invitations, with White British women being more likely to attend. The variation in the uptake for women from the same ethnic groups in different geographical areas suggests that collaboration about the successful engagement of services with different communities could improve uptake for all women. Published by the

  19. Serum cholesterol: attitudes and behavior of family practice residents.

    PubMed

    Kelly, R B; Velez-Holvino, O; Alemagno, S A

    1991-09-01

    Given the current health promotion efforts regarding coronary artery disease, more information is needed about residents' attitudes and behaviors that relate to identification and management of patients with elevated serum cholesterol levels. Family practice residents from eight US programs (N = 128) were surveyed in 1989 to assess their attitudes and reported practice patterns. Resident survey data were compared, when feasible, to published data from 1986 and 1990 surveys of practicing physicians performed by the National Heart, Lung, and Blood Institute. The use of faculty "key contacts" resulted in a 90% response rate (N = 115). Both residents and practicing physicians attributed a high degree of importance to cholesterol as a risk factor. Residents reported more frequent routine screening of middle-aged men than the routine screening rate of practicing physicians in 1986 (P less than .01). Residents reported less frequent screening of younger and older adults than of middle-aged men (P less than .001). Residents' threshold for the use of cholesterol-lowering medication was lower than that of practicing physicians surveyed in 1986, but higher than that of physicians surveyed in 1990. Compared with practicing physicians, residents did not believe they were as well prepared to counsel patients about dietary change or as successful when they tried to help patients make changes; residents reported a significantly higher rate of referral to dietitians (P less than .01). Residents may need more education regarding screening guidelines for children and young adults. A health promotion skills gap may exist that explains reported discrepancies between self-report and actual behavior and indicates that residency educators may need to pay more attention to fostering dietary assessment and counseling skills in their residents.

  20. The association between the physical environment and the well-being of older people in residential care facilities: A multilevel analysis.

    PubMed

    Nordin, Susanna; McKee, Kevin; Wijk, Helle; Elf, Marie

    2017-12-01

    To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications. © 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  1. The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes.

    PubMed

    Tse, Mimi M Y; Tang, Shuk Kwan; Wan, Vanessa T C; Vong, Sinfia K S

    2014-12-01

    Pain is common in the aging population, particularly among older residents of nursing homes. It has been found that 50% of older people living in the community have been experiencing chronic pain, and the number increased to 80% for older residents of nursing homes. Exercise is an effective non-pharmacological intervention that can reduce pain and improve physical and psychological functions. A quasi-experimental study with a pretest-posttest control group designed was conducted to evaluate the effects of a physical exercise program (PEP) on older residents of nursing homes who have chronic pain. Three-hundred-ninety-six older residents with chronic pain were recruited from 10 nursing homes run by non-governmental organizations in Hong Kong. The average age of the older residents was 85.44 ± 6.29. Five nursing homes were randomized to the experimental group with PEP (n = 225, age = 85.45 ± 6.25); the other five nursing homes were randomized to the control group without the PEP (n = 171, age = 85.44 ± 6.35). PEP was an eight-week training program given by a physiotherapist and nurses once a week. It consisted of warm-up exercises, muscle strengthening, stretching, balancing, and self-administered massage to acupressure points. At the end of each PEP session, pamphlets with pictures illustrating the "exercise of the day" were given to the older residents of nursing homes as a tool to enhance their self-management skills. The control group received no training during the eight weeks. Upon completion of the PEP, the experimental group experienced a significantly greater reduction in pain intensity from 4.19 ± 2.25 (on an 11 point scale) to 2.67 ± 2.08, as compared to the control group (p < .05). In addition, the psychological well-being (happiness, loneliness, life satisfaction, and depression) of the experimental group was significantly improved (p < .05). Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier

  2. Launch of the London Centre for Nanotechnology.

    PubMed

    Aeppli, Gabriel; Pankhurst, Quentin

    2006-12-01

    Is nanomedicine an area with the promise that its proponents claim? Professors Gabriel Aeppli and Quentin Pankhurst explore the issues in light of the new London Centre for Nanotechnology (LCN)--a joint enterprise between Imperial College and University College London--opened on November 7, 2006. The center is a multidisciplinary research initiative that aims to bridge the physical, engineering and biomedical sciences. In this interview, Professor Gabriel Aeppli, LCN co-Director, and Deputy Director Professor Quentin Pankhurst discuss the advent and future role of the LCN with Nanomedicine's Morag Robertson. Professor Aeppli was formerly with NEC, Bell Laboratories and MIT and has more than 15 years' experience in the computer and telecommunications industry. Professor Pankhurst is a physicist with more than 20 years' experience of working with magnetic materials and nanoparticles, who now works closely with clinicians and medics on innovative healthcare applications. He also recently formed the new start-up company Endomagnetics Inc.

  3. Normative beliefs about sharing housing with an older family member.

    PubMed

    Coleman, Marilyn; Ganong, Lawrence

    2008-01-01

    The aims of this study were: (a) to examine general perceptions of filial obligations toward sharing housing with older parents and stepparents; and (b) to assess the effects of selected contextual factors on those normative beliefs. A national sample of 579 men and 582 women (mean age = 44.6, SD = 17.2) responded to a multiple segment factorial vignette in which an older parent or stepparent was portrayed as needing help with housing. Respondents thought that parents should be helped more than stepparents, younger adults with greater resources were more obligated to help older parents and stepparents than were those with meager resources, and older parents and stepparents with greater need acuity were expected to be helped more than older parents and stepparents with less serious housing needs. Attitudes about co-residence were based on family obligation norms, beliefs about repaying older adults for past help, perceived relationship quality, other demands on the younger adult's resources, the older person's resources, and moral responsibilities to assist.

  4. Stuart London's standard of living: re-examining the Settlement of Tithes of 1638 for rents, income, and poverty.

    PubMed

    Baer, William C

    2010-01-01

    The Settlement of Tithes of 1638 can be tested for biases in its London rents. Even so, it proves to be a relatively good source for seventeenth-century London, and for calculating associated median and mean rents, as well as a Gini coefficient of inequality for the distribution of resources. Through other evidence in the Settlement, rent/income ratios for London can be approximated, and from them estimates made of London's median income. Median rents and income also allow estimates of the percentage of Londoners in poverty. Though the last is inevitably disputable, the estimate holds up well to testing by other evidence.

  5. Risk and presenting features of prostate cancer amongst African-Caribbean, South Asian and European men in North-east London.

    PubMed

    Chinegwundoh, Frank; Enver, Mohamed; Lee, Angela; Nargund, Vinod; Oliver, Tim; Ben-Shlomo, Yoav

    2006-12-01

    To determine whether there are ethnic differences in the incidence and presenting features of all patients with prostate cancer presenting in North-east London, UK. All newly diagnosed men with prostate cancer between 1999 and 2000 who were resident in the East London and City Health Authority were identified from various sources. Key clinical features were extracted from hospital records. The age-adjusted incidence rates for European, South Asian and African-Caribbean patients were calculated using census denominator data. For men aged >50 years the annual age-adjusted incidence rates (95% confidence interval) were 213 (186-240), 647 (504-789) and 199 (85-310) for the European, African-Caribbean and South Asian patients, respectively. African-Caribbean men had a three times greater risk (risk ratio 3.07, 2.40-3.93, P < 0.001) than European men. South Asian men had a lower risk of prostate cancer but this could have been compatible with chance. There was no evidence of marked ethnic differences for prostate-specific antigen levels, clinical staging and Gleason scores. The greater risk of prostate cancer for African-Caribbean men in South-east England is consistent with data from the USA and the Caribbean. Future work needs to determine whether this risk differs according to country of origin, and which genetic and/or environmental risk factors might be important in explaining these observations.

  6. Stress and burnout among Swiss dental residents.

    PubMed

    Divaris, Kimon; Lai, Caroline S; Polychronopoulou, Argy; Eliades, Theodore; Katsaros, Christos

    2012-01-01

    Stress and burnout have been well-documented in graduate medical and undergraduate dental education, but studies among dental graduate students and residents are sparse. The purpose of this investigation was to examine perceived stressors and three dimensions of burnout among dental residents enrolled in the University of Bern, Switzerland. Thirty-six residents enrolled in five specialty programmes were administered the Graduate Dental Environment Stress (GDES30) questionnaire and the Maslach Burnout Inventory (MBI). Individual stress items and overall GDES30 scores were used to quantify perceived stress. To measure burnout, proportions of burnout "cases" and MBI subscale scores were computed in the domains of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Analyses relied on descriptive and bi-variate methods. The mean GDES30 score was 2.1 (SD = 0.4). "Lack of leisure time", "meeting the research requirement of the programme" and "completing graduation requirements" emerged as the top three stressors. Thirty-six percent of respondents were burnout "cases" on the PA scale, while this proportion was 17% for EE and 8% for DP. Both stress and burnout levels increased according to year of study, whereas younger residents and females had consistently higher stress and burnout scores compared to older ones and males. Overall, low levels of perceived stress and burnout were found among this group of Swiss dental residents.

  7. The psychosocial effect of Tai Chi on nursing home residents.

    PubMed

    Lee, Linda Y K; Lee, Diana T F; Woo, Jean

    2010-04-01

    To determine the psychosocial effect of Tai Chi on nursing home residents. Moving into a nursing home usually imposes a certain degree of psychosocial challenge to older people. However, there is limited evidence suggesting a promising intervention that can promote the psychosocial health for this group. Although previous studies suggest that Tai Chi has the potential to enhance psychosocial well-being, existing evidence is deemed scarce and thus imposes a limitation on drawing out conclusions on this matter. Non-equivalent pretest-posttest control group design. A convenience sample of 139 residents from six nursing homes in Hong Kong was recruited for this study. The experimental group (n = 66) participated in a 26-week Tai Chi programme, while the control group (n = 73) continued its normal daily activities. The outcome measures included state self-esteem, the physical and mental component of health-related quality of life, social support network and social support satisfaction. Resident satisfaction was identified as a covariate because it demonstrated significant correlation with the outcome variables and, likewise, showed significant difference between the two study groups at baseline. Doubly multivariate analysis of covariance was performed to examine the effect of the intervention. Results indicate significant Group x Time interactions, with the experimental group experiencing significant improvement in the composite outcome of state self-esteem, the physical component of health-related quality of life and the mental component of health-related quality of life across the 26-week study period [F(6, 131) = 2.61, p = 0.02)]. No significant changes were detected regarding the effect of the Tai Chi programme on social support. Tai Chi practice is beneficial for nursing home residents. Tai Chi has unique characteristics that are particularly suitable in the practice of health exercise for nursing home residents. The inclusion of Tai Chi in residential care

  8. The impact of a pain assessment intervention on pain score and analgesic use in older nursing home residents with severe dementia: A cluster randomised controlled trial.

    PubMed

    Rostad, Hanne Marie; Utne, Inger; Grov, Ellen Karine; Småstuen, Milada Cvancarova; Puts, Martine; Halvorsrud, Liv

    2018-04-30

    Pain is highly prevalent in older adults, especially those in institutional settings such as nursing homes. The presence of dementia may increase the risk of underdiagnosed and undertreated pain. Pain assessment tools are not regularly used in clinical practice, however, there are indications that the regular use of pain assessments tools may influence the recognition of pain by nursing staff and thereby affect pain management. To assess whether regular pain assessment using a pain assessment tool is associated with changes in i) pain scores and ii) analgesic use in nursing home residents with severe dementia. Cluster-randomised controlled trial. The study was conducted in 16 nursing homes in four counties in Norway. A total of 112 nursing home residents aged 65 years and older with dementia who lacked the capacity for self-reporting pain or were non-verbal. The experimental group were regularly assessed pain with a standardised pain scale (the Doloplus-2) twice a week for a 12-week intervention period. The control group received usual care. The primary outcome was pain score measured with the Doloplus-2, and the secondary outcome was analgesic use (oral morphine equivalents and milligram/day paracetamol). Data on the outcomes were collected at baseline and at the end of week 12. The nursing staff in both the experimental and the control groups received training to collect the data. Linear mixed models were used to assess possible between-group difference over time. No overall effect of regular pain assessment was found on pain score or analgesic use. The mean score of Doloplus-2 and analgesic use remained unchanged and above the established cut-off in both groups. The current intervention did not change analgesic use or pain score compared with the control condition. However, there is not sufficient evidence to conclude that regular pain assessment using a pain assessment tool is not clinically relevant. Furthermore, our results indicated that pain continued to be

  9. London through Rose-Colored Graphics: Visual Rhetoric and Information Graphic Design in Charles Booth's Maps of London Poverty

    ERIC Educational Resources Information Center

    Kimball, Miles A.

    2006-01-01

    In this article, I examine a historical information graphic--Charles Booth's maps of London poverty (1889-1902)--to analyze the cultural basis of ideas of transparency and clarity in information graphics. I argue that Booth's maps derive their rhetorical power from contemporary visual culture as much as from their scientific authority. The visual…

  10. Living in institutional care: residents' experiences and coping strategies.

    PubMed

    Timonen, Virpi; O'Dwyer, Ciara

    2009-01-01

    Insights into daily living in residential care settings are rare. This article draws on a qualitative dataset (semi-structured interviews and recordings of residents' council meetings) that gives a glimpse of the experiences and coping strategies of (older) people living in residential care. The data highlight the range of unmet needs of the residents, similar to the categories of physiological, safety, love, esteem, and self-actualization needs in Maslow's hierarchy of needs theory. Our analysis indicates that "higher" and "lower" needs are closely intertwined and mutually reinforcing and should therefore be accorded equal emphasis by professionals (including social workers) employed within residential care settings.

  11. Is older adult care mediated by caregivers’ cultural stereotypes? The role of competence and warmth attribution

    PubMed Central

    Fernández-Ballesteros, Rocío; Bustillos, Antonio; Santacreu, Marta; Schettini, Rocio; Díaz-Veiga, Pura; Huici, Carmen

    2016-01-01

    Purpose The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. Methods A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers’ cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers’ cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents’ functioning) were applied. Results Caregivers’ cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. Conclusion Our results underline the influence of caregivers’ cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers’ cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component. PMID:27217736

  12. Limited urban growth: London's street network dynamics since the 18th century.

    PubMed

    Masucci, A Paolo; Stanilov, Kiril; Batty, Michael

    2013-01-01

    We investigate the growth dynamics of Greater London defined by the administrative boundary of the Greater London Authority, based on the evolution of its street network during the last two centuries. This is done by employing a unique dataset, consisting of the planar graph representation of nine time slices of Greater London's road network spanning 224 years, from 1786 to 2010. Within this time-frame, we address the concept of the metropolitan area or city in physical terms, in that urban evolution reveals observable transitions in the distribution of relevant geometrical properties. Given that London has a hard boundary enforced by its long standing green belt, we show that its street network dynamics can be described as a fractal space-filling phenomena up to a capacitated limit, whence its growth can be predicted with a striking level of accuracy. This observation is confirmed by the analytical calculation of key topological properties of the planar graph, such as the topological growth of the network and its average connectivity. This study thus represents an example of a strong violation of Gibrat's law. In particular, we are able to show analytically how London evolves from a more loop-like structure, typical of planned cities, toward a more tree-like structure, typical of self-organized cities. These observations are relevant to the discourse on sustainable urban planning with respect to the control of urban sprawl in many large cities which have developed under the conditions of spatial constraints imposed by green belts and hard urban boundaries.

  13. Resident and family member perceptions of cultural diversity in aged care homes.

    PubMed

    Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley

    2017-03-01

    Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home. © 2016 John Wiley & Sons Australia, Ltd.

  14. Make Mine Home: Spatial Modification With Physical and Social Implications in Older Adulthood

    PubMed Central

    2015-01-01

    Objective. The process of moving in older adulthood, intertwined with loss and anticipation, is grounded in material commodities that include one’s residence and its contents. This article emphasizes the role of material culture in housing transitions. Methods. Based on an ethnographic study (January 2009–May 2012) of older Americans (n = 81) relocating, this study utilized interviews, participant observation, and review of documents. Results. Personalization is both a reflection of a previous self as a homeowner and a projection of a future self as extensions of temporality intertwine with commodification processes. Through creative appropriations of their housing, residences are personalized to promote physical or social functionality or because of preference. Discussion. Given the findings, the transitions involved in relocation must be supported by greater understanding and facilitation of key issues of personalization and its importance to older adults’ decisions to relocate. PMID:24870030

  15. The Effects of a Diet and Exercise Program for Older Adults With Metabolic Syndrome.

    PubMed

    Lin, Yu-Hua; Chu, Li-Ling; Kao, Chia-Chan; Chen, Tai-Been; Lee, I; Li, Hui-Chi

    2015-09-01

    The prevalence of metabolic syndrome is high among older adults in Taiwan. However, few studies have studied the effect of a combined diet and exercise program on managing metabolic syndrome (MetS) in individuals 65 years and older and living in Taiwan's rural areas. This study tests the effectiveness of a diet and exercise program on the MetS biomarkers in older community residents with MetS. This study used a quasiexperimental study design. All participants were 65 years and older and were diagnosed with MetS. The outcome variables included biomarkers (blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglycerides) and demographic characteristics. The participants were distributed into a diet-and-exercise group (n = 163) and a nondiet-and-nonexercise group (n = 138). The outcome variables were examined 3 months after the start of the intervention program. The participants in the diet-and-exercise group had lower values than the nondiet-and-nonexercise group for blood pressure, waist circumference, hip circumference, body mass index, blood sugar, cholesterol, and triglyceride (all ps < .001). The diet and exercise program is an effective intervention for treating older individuals with MetS. Clear and concise information concerning the effects of diet and exercise in promoting the health of older residents with MetS is helpful to improve the health of the older adults inTaiwan.

  16. Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

    PubMed

    Dahlkvist, Eva; Hartig, Terry; Nilsson, Annika; Högberg, Hans; Skovdahl, Kirsti; Engström, Maria

    2016-09-01

    To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. A multi-level, cross-sectional, correlational design. Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  17. Leisure Activity and Caregiver Involvement in Middle-Aged and Older Adults with Down Syndrome

    ERIC Educational Resources Information Center

    Mihaila, Iulia; Hartley, Sigan L.; Handen, Benjamin L.; Bulova, Peter D.; Tumuluru, Rameshwari V.; Devenny, Darlynne A.; Johnson, Sterling C.; Lao, Patrick J.; Christian, Bradley, T.

    2017-01-01

    The present study examined leisure activity and its association with caregiver involvement (i.e., residence and time spent with primary caregiver) in 62 middle-aged and older adults with Down syndrome (aged 30-53 years). Findings indicated that middle-aged and older adults with Down syndrome frequently participated in social and passive leisure…

  18. Self-reported diabetes education among Chinese middle-aged and older adults with diabetes.

    PubMed

    Xu, Hanzhang; Luo, Jianfeng; Wu, Bei

    2016-12-01

    To compare self-reported diabetes education among Chinese middle-aged and older adults with diabetes in three population groups: urban residents, migrants in urban settings, and rural residents. We used data from the 2011 China Health and Retirement Longitudinal Study. The sample included 993 participants age 45 and older who reported having diabetes diagnosed from a health professional. We performed multilevel regressions performed to examine the associations between characteristics and different aspects of diabetes education received. Our study shows that 20.24% of the participants received no diabetes education at all. Among those who received information, 46.82% of respondents with diabetes received weight control advice from a health care provider, 90.97% received advice on exercise, 60.37% received diet advice, 35.12% were spoken to smoking control, and only 17.89% of persons were informed of foot care. After controlling socioeconomic factors, life style, number of comorbidities and community factors, we found that compared with migrant population and rural residents, urban residents were more likely to receive diabetes education on diet. Urban residents were also more likely to obtain diabetes education and more aspects of diabetes education comparison with migrants and rural residents. Our study suggests diabetes education is a serious concern in China, and a significant proportion of the participants did not receive advice on smoking control and foot care. Rural residents and migrants from rural areas received much less diabetes education compared with urban residents. Efforts to improve diabetes educations are urgently needed in China.

  19. Parish apprenticeship and the old poor law in London1

    PubMed Central

    Levene, Alysa

    2010-01-01

    This article offers an examination of the patterns and motivations behind parish apprenticeship in late eighteenth- and early nineteenth-century London. It stresses continuity in outlook from parish officials binding children, which involved placements in both the traditional and industrializing sectors of the economy. Evidence on the ages, employment types, and locations of 3,285 pauper apprentices bound from different parts of London between 1767 and 1833 indicates a variety of local patterns. The analysis reveals a pattern of youthful age at binding, a range of employment experiences, and parish-specific links to particular trades and manufactures. PMID:20939134

  20. Districts Adjust to Growth in Older Population

    ERIC Educational Resources Information Center

    Sparks, Sarah D.

    2012-01-01

    The 1,000-student Allegheny Valley district in Pennsylvania boasts generations of alumni and a community so involved with the schools that high school graduation becomes an open celebration in downtown Springdale Borough. Yet the district hasn't asked for a tax increase in three years, and it is pushing out a message to older residents about…

  1. "I Feel Trapped": The Tension Between Personal and Structural Factors of Social Isolation and the Desire for Social Integration Among Older Residents of a High-Crime Neighborhood.

    PubMed

    Portacolone, Elena; Perissinotto, Carla; Yeh, Jarmin Christine; Greysen, S Ryan

    2018-01-18

    The aim of this study was to examine the factors contributing to the social isolation of older residents of a high-crime neighborhood through the in-depth examination of their lived experiences. A deeper understanding of factors contributing to social isolation can allow policymakers and health care providers to create policies and programs to alleviate the social isolation of these vulnerable and understudied individuals. Participants were recruited through the support of the Housing Authority and Police and Fire Departments of Richmond, California, a town with a high-crime rate. Fifty-nine ethnographic interviews were conducted with 20 individuals of 58-95 years of age. Transcripts and fieldnotes were analyzed with a focus on the specific factors contributing the social isolation of participants. An overarching theme of tension between personal and structural factors of social isolation and desire for social integration emerged from qualitative content analysis. A tension emerged between a longing to participate in society and the immersion in a reality so dense with obstacles that made participation in society difficult to attain. Four specific themes also emerged. Three themes demonstrated underlying factors of social isolation stemming from the personal sphere and the physical and social environment. The fourth theme illustrated participants' desire for social integration. Findings demonstrate the salience of interventions and programs to make neighborhoods safe and accessible to older residents. Findings also suggest a need to reframe the conceptual framework for social isolation to better measure and alleviate this public health problem. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Interdisciplinary curriculum to train internal medicine and obstetrics-gynecology residents in ambulatory women's health: adapting problem-based learning to residency education.

    PubMed

    Spencer, Abby L; McNeil, Melissa

    2009-09-01

    Although residents in internal medicine (IM) and obstetrics-gynecology (OG) must provide primary care for women, studies indicate that both groups require more skills and training in women's health. Our goals were to assess the needs of residents at our academic medical center and to design an interdisciplinary curriculum that addresses these needs utilizing a modified problem-based learning (PBL) format. The aim of this article is to report on the development, logistics, and successful implementation of our innovative curriculum. Based on results from a targeted needs-assessment, we designed a curriculum for both IM and OG residents to address curricular deficiencies in an efficient and effective manner. Procurement of support was achieved by reviewing overlapping competency requirements and results of the needs-assessment with the program directors. The curriculum consists of six ambulatory clinical cases which lead residents through a discussion of screening, diagnosis, prevention, and management within a modified PBL format. Residents select one learning objective each week which allows them to serve as content experts during case discussions, applying what they learned from their literature review to guide the group as they decide upon the next step for the case. This format helps accommodate different experience levels of learners, encourages discussion from less-vocal residents, and utilizes theories of adult learning. Sixty-five residents have participated in the curriculum since it was successfully implemented. IM residents report that the cases were their first opportunity to discuss the health concerns of younger women; OG residents felt similarly about cases related to older women. Implementation challenges included resident accountability. Residents identified the timing of the sessions and clinical coverage requirements as barriers to conference attendance. Interdisciplinary modified PBL conferences focusing on shared curricular needs in ambulatory

  3. The Use of Local Parks by Older Residents of Urban Areas.

    ERIC Educational Resources Information Center

    Godbey, Geoffrey; Blazey, Michael

    Local parks in five large cities (San Francisco, Houston, Atlanta, Chicago, Boston) were selected for a study of the use of urban parks by older adults (55 to 65 and over). Interviews were conducted with park users to determine: (1) meaning, motivation, and satisfactions associated with local park usage; (2) factors of usage such as time of day,…

  4. Radical observations during the Clean air for London project

    NASA Astrophysics Data System (ADS)

    Whalley, L. K.; Stone, D.; Clancy, N.; Lee, J. D.; Laufs, S.; Kleffmann, J.; Heard, D. E.

    2012-12-01

    With greater than 50 % of the global population residing in urban conurbations, poor urban air quality has a demonstrable effect on human health. OH and HO2 radicals, (collectively termed HOx) together with RO2 radicals, mediate virtually all of the oxidative chemistry in the atmosphere, being responsible for the transformation of primary emissions into secondary pollutants such as NO2, O3 and particulates. Understanding the chemistry of free-radicals in the atmosphere is essential in improving predictions of the lifetimes of pollutants and spatial scales of their transport within urban areas. Results from earlier field campaigns in urban and polluted regions have demonstrated the significance of HONO photolysis and alkene ozonolysis in the production of HOx radicals. In many cases, however, measurements of HONO have not been made, reducing the ability to evaluate model successes for OH in these environments. Here we present measurements of OH, HO2, RO2 and OH reactivity taken during the wintertime (January - February, 2012) and summertime (July - August, 2012) as part of the Clean air for London (ClearfLo) project in London. RO2 was detected using a newly developed flow-reactor laser-induced fluorescence technique which is able to discriminate between HO2 and organic peroxy radicals [1]. Low concentrations of radicals were observed during the wintertime, midday [OH], [HO2] and [RO2] were ~ 0.04, 0.8 and 1.5 pptv respectively, comparable to observations of radicals at other urban locations in winter [2,3,4], and which displayed a negative correlation with NO concentrations. OH reactivity was high and largely tracked the diurnal profiles of NOx and CO, with the highest reactivity ~100 s-1 observed during the morning rush hour. Analysis of factors controlling OH concentrations during the wintertime suggests that the formation of OH from the photolysis of O3 and subsequent reaction of O(1D) with H2O is a minor contribution both under high and low NOx conditions owing

  5. Development of geriatric competencies for emergency medicine residents using an expert consensus process.

    PubMed

    Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

    2010-03-01

    The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

  6. Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

    PubMed Central

    Hogan, Teresita M.; Losman, Eve D.; Carpenter, Christopher R.; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M.

    2011-01-01

    Background The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. Objectives The objective was to develop a consensus document, “Geriatric Competencies for Emergency Medicine Residents,” by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. Methods This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. Results In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. Conclusions The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. PMID:20370765

  7. Correlates of post-hospital physical function at 1 year in skilled nursing facility residents.

    PubMed

    Lee, Jia; Rantz, Marilyn

    2008-05-01

    This paper is a report of a study to examine the relationship between health-related admission factors and post-hospital physical function at 3, 6, 9 and 12 months in older adult nursing facility residents. Physical functional decline is a significant health problem for older adults and has far-reaching effects. In particular, the immediate post-hospital period is a high-risk time, because shortened hospital stays make it likely that older patients are discharged in a state of incomplete recovery. Data spanning from July 2002 to June 2005 were extracted from a comprehensive assessment tool, the Minimum Data Set, for 38,591 beneficiaries of a federal health insurance programme covering older adults in the Midwestern region of the United States of America. We investigated relationships between admission factors and post-hospital physical function at 3, 6, 9 and 12 months. The admission factors were health-related variables assessed at the time of skilled nursing facility admission from an acute care hospital. The most important admission factors related to post-hospital physical function at 3, 6, 9 and 12 months were baseline physical function, urinary incontinence and pressure ulcer. Cognitive impairment at admission demonstrated a stronger relationship with poor physical function as resident length of stay increased. Nurses in skilled nursing facilities should screen post-hospital older adults for risk of physical functional decline at admission using identified admission factors. For continuous nursing care, older adults need to be assessed at least once a month during the first 3 months after hospital discharge.

  8. Traffic pollution and the incidence of cardiorespiratory outcomes in an adult cohort in London.

    PubMed

    Carey, I M; Anderson, H R; Atkinson, R W; Beevers, S; Cook, D G; Dajnak, D; Gulliver, J; Kelly, F J

    2016-12-01

    The epidemiological evidence for adverse health effects of long-term exposure to air and noise pollution from traffic is not coherent. Further, the relative roles of background versus near traffic pollution concentrations in this process are unclear. We investigated relationships between modelled concentrations of air and noise pollution from traffic and incident cardiorespiratory disease in London. Among 211 016 adults aged 40-79 years registered in 75 Greater London practices between 2005 and 2011, the first diagnosis for a range of cardiovascular and respiratory outcomes were identified from primary care and hospital records. Annual baseline concentrations for nitrogen oxide (NO x ), particulate matter with a median aerodynamic diameter <2.5 μm (PM 2.5 ) attributable to exhaust and non-exhaust sources, traffic intensity and noise were estimated at 20 m 2 resolution from dispersion models, linked to clinical data via residential postcode. HRs were adjusted for confounders including smoking and area deprivation. The largest observed associations were between traffic-related air pollution and heart failure (HR=1.10 for 20 μg/m 3 change in NO x , 95% CI 1.01 to 1.21). However, no other outcomes were consistently associated with any of the pollution indicators, including noise. The greater variations in modelled air pollution from traffic between practices, versus within, hampered meaningful fine spatial scale analyses. The associations observed with heart failure may suggest exacerbatory effects rather than underlying chronic disease. However, the overall failure to observe wider associations with traffic pollution may reflect that exposure estimates based on residence inadequately represent the relevant pattern of personal exposure, and future studies must address this issue. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Minimising barriers to dental care in older people

    PubMed Central

    Borreani, Elena; Wright, Desmond; Scambler, Sasha; Gallagher, Jennifer E

    2008-01-01

    Background Older people are increasingly retaining their natural teeth but at higher risk of oral disease with resultant impact on their quality of life. Socially deprived people are more at risk of oral disease and yet less likely to take up care. Health organisations in England and Wales are exploring new ways to commission and provide dental care services in general and for vulnerable groups in particular. This study was undertaken to investigate barriers to dental care perceived by older people in socially deprived inner city area where uptake of care was low and identify methods for minimising barriers in older people in support of oral health. Methods A qualitative dual-methodological approach, utilising both focus groups and individual interviews, was used in this research. Participants, older people and carers of older people, were recruited using purposive sampling through day centres and community groups in the inner city boroughs of Lambeth, Southwark and Lewisham in South London. A topic guide was utilised to guide qualitative data collection. Informants' views were recorded on tape and in field notes. The data were transcribed and analysed using Framework Methodology. Results Thirty-nine older people and/or their carers participated in focus groups. Active barriers to dental care in older people fell into five main categories: cost, fear, availability, accessibility and characteristics of the dentist. Lack of perception of a need for dental care was a common 'passive barrier' amongst denture wearers in particular. The cost of dental treatment, fear of care and perceived availability of dental services emerged to influence significantly dental attendance. Minimising barriers involves three levels of action to be taken: individual actions (such as persistence in finding available care following identification of need), system changes (including reducing costs, improving information, ensuring appropriate timing and location of care, and good patient

  10. Dying at home: a qualitative study of the perspectives of older South Asians living in the United Kingdom.

    PubMed

    Venkatasalu, Munikumar R; Seymour, Jane E; Arthur, Antony

    2014-03-01

    South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives on, and experiences of, end-of-life care. To explore beliefs, attitudes and expectations expressed by older South Asians living in East London about dying at home. A qualitative study using focus groups and semi-structured interviews. Data were analysed using a constructivist grounded theory approach. Five focus groups and 29 in-depth semi-structured interviews were conducted with a total of 55 older adults (24 men and 31 women) aged between 52 and 78 years. Participants from six South Asian ethnic groups were recruited via 11 local community organisations. Two key themes were identified. The theme of 'reconsidering the homeland' draws on the notion of 'diaspora' to help understand why for many participants, the physical place of death was perceived as less important than the opportunity to carry out cultural and religious practices surrounding death. The second theme 'home as a haven' describes participants' accounts of how their home is a place in which it is possible to perform various cultural and religious rituals. Cultural and religious practices were often seen as essential to achieving a peaceful death and honouring religious and filial duties. Older people of South Asian ethnicity living in East London perceive home as more than a physical location for dying relatives. They make efforts to adhere, and also adapt, to important social and cultural values relating to death and dying as part of the wider challenge of living in an emigrant society.

  11. Seeing Ourselves as Others See Us: Egyptian Teachers' Views of Science Education in Secondary Schools in London, UK.

    ERIC Educational Resources Information Center

    Swain, Julian; Monk, Martin; Johnson, Sally

    1999-01-01

    Explores Egyptian science teachers' views of (1) science education in London secondary schools and (2) how London schools influenced their teaching in Egypt. Explains that the Egyptian teachers were participating in a 12-week in-service course at King's College, London. Discusses the results. (CMK)

  12. On the Relationship Between Neighborhood Perception, Length of Residence and Co-Ethnic Concentration

    PubMed Central

    Saenz, Joseph

    2014-01-01

    We investigate how co-ethnic concentration and length of residence are related to neighborhood perception in aged Mexican Americans, and discuss sources of information for measuring social environments. Neighborhood perception scale, length of residence in current home, and all individual-level covariates in a hierarchical linear model are derived from data on community-dwelling older adults. Tract-level measures are obtained from Census data. We find no relationship between co-ethnic concentration and positive neighborhood perception, and find a direct relationship between length of residence and positive neighborhood perception. Until further evidence is found, different sources of information when measuring place should be treated equally. PMID:25057331

  13. Living in an older adult community: a pharmacy student's experience.

    PubMed

    Anastasia, Emily; Estus, Erica

    2013-12-01

    Interacting with older adults is a daily practice for pharmacists. It is important to understand how medications affect their wellbeing, but there are many other factors that affect quality of life. To truly understand some of the challenges facing older adults, Emily Anastasia, a sixth-year pharmacy student at the University of Rhode Island, moved into South Bay Retirement Living, a senior living community, for an eight-day immersion experience as a special project within one of her advanced pharmacy practice experience rotations. During her stay, she did not attend classes nor leave the facility unless on the South Bay bus with the other assisted living residents. She lived with a 92-year-old roommate, developed close friendships with many of the residents, and kept a detailed journal of her experience. The purpose of this reflection is to share her experience and recognize lifestyle as well as social and physical environment as factors in understanding the aging process. Immersing a pharmacy student within an assisted living community provides a unique opportunity to observe and appreciate characteristics of older adults that cannot be learned within a classroom setting.

  14. Reproducibility of blood pressure variation in older ambulatory and bedridden subjects.

    PubMed

    Tsuchihashi, Takuya; Kawakami, Yasunobu; Imamura, Tsuyoshi; Abe, Isao

    2002-06-01

    We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. Nursing home in Japan. Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.

  15. Presence of Legionella in London's water supplies.

    PubMed

    Colbourne, J S; Trew, R M

    1986-09-01

    Legionella occurs frequently (52 to 54%) in domestic water and cooling water inside commercial, industrial and health care buildings, and these types of water systems are now regarded as a normal habitat for Legionella. The factors that predispose a particular water system to colonization by these organisms are ill-defined, although it is fairly certain that biological and physicochemical environmental factors play an important role in allowing Legionella to multiply in the circulating water. It has been postulated that the organism may gain access to water systems inside buildings by one of three routes: contact with air through open points such as uncovered storage tanks or vents, ingress of soil or surface water during construction or repair, or intermittent seeding with organisms present in low numbers in the public water supply. Three studies in the USA have found Legionella in 0.4 to 8.8% of drinking-water samples, but these were not representative of the public supply network as a whole. The aim of this study was to determine, over a period of 1 year, the frequency of Legionella in London's drinking water--from the treatment plant through to the consumer's tap. To date, Legionella has not been isolated from raw river water entering London's treatment works or from treated water entering the distribution network. Sixty-two monitoring taps in buildings located in 21 supply areas have been sampled twice for Legionella; only 2 (2.4%) have proved positive during the autumn and winter of 1985/86. The strain found was L. pneumophila serotype 1, subgroup Olda, and the numbers ranged from 10(2) to 10(4)/l. Although the survey is incomplete, it is already clear that the public water supplies in London are not a source of strains of Legionella associated with disease.

  16. Mind the gap: financial London and the regional class pay gap.

    PubMed

    Friedman, Sam; Laurison, Daniel

    2017-09-01

    The hidden barriers, or 'gender pay gap', preventing women from earning equivalent incomes to men is well documented. Yet recent research has uncovered that, in Britain, there is also a comparable class-origin pay gap in higher professional and managerial occupations. So far this analysis has only been conducted at the national level and it is not known whether there are regional differences within the UK. This paper uses pooled data from the 2014 and 2015 Labour Force Survey (N = 7,534) to stage a more spatially sensitive analysis that examines regional variation in the class pay gap. We find that this 'class ceiling' is not evenly spatially distributed. Instead it is particularly marked in Central London, where those in high-status occupations who are from working-class backgrounds earn, on average, £10,660 less per year than those whose parents were in higher professional and managerial employment. Finally, we inspect the Capital further to reveal that the class pay gap is largest within Central London's banking and finance sector. Challenging policy conceptions of London as the 'engine room' of social mobility, these findings suggest that class disadvantage within high-status occupations is particularly acute in the Capital. The findings also underline the value of investigating regional differences in social mobility, and demonstrate how such analysis can unravel important and previously unrecognized spatial dimensions of class inequality. © London School of Economics and Political Science 2017.

  17. School bullying and traumatic dental injuries in East London adolescents.

    PubMed

    Agel, M; Marcenes, W; Stansfeld, S A; Bernabé, E

    2014-12-01

    To explore the association between school bullying and traumatic dental injuries (TDI) among 15-16-year-old school children from East London. Data from phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents, were analysed. Adolescents provided information on demographic characteristics, socioeconomic measures and frequency of bullying in school through self-administered questionnaires and were clinically examined for overjet, lip coverage and TDI. The association between school bullying and TDI was assessed using binary logistic regression models. The prevalence of TDI was 17%, while lifetime and current prevalence of bullying was 32% and 11%, respectively. The prevalence of TDI increased with a growing frequency of bullying; from 16% among adolescents who had never been bullied at school, to 21% among those who were bullied in the past but not this school term, to 22% for those who were bullied this school term. However, this association was not statistically significant either in crude or adjusted regression models. There was no evidence of an association between frequency of school bullying and TDI in this sample of 15-16-year-old adolescents in East London.

  18. Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents

    PubMed Central

    Hanlon, Joseph T.; Zhao, Xinhua; Naples, Jennifer G.; Aspinall, Sherrie L.; Perera, Subashan; Nace, David A.; Castle, Nicholas G.; Greenspan, Susan L.; Thorpe, Carolyn T.

    2016-01-01

    Objectives To examine the association between CNS medication burden and serious falls in those with a recent fall history. Design Nested-case control study; cases matched to four controls by age, gender, and date. Setting US nursing homes Participants 5,556 residents age ≥ 65 with a recent fall history admitted to a nursing home between 1/1–9/30/2010 and followed until discharge, death, or 12/31/2010. Measurements Outcome was serious falls as per Medicare Part A and B ICD/CPT codes. CNS burden, from Medicare Part D data, was calculated by dividing the daily dose of each CNS agent (i.e., specific antidepressants, antiepileptic, antipsychotic, benzodiazepine and opioid receptor agonists) received during the six days prior to the index (outcome) date by the minimum effective geriatric daily dose and summing the results across medications. Results There were 367 cases and 1468 matched controls. Those taking 3+ CNS standardized daily doses were more likely to have a serious fall than those not taking any CNS medications (Adjusted Odds Ratio 1.83; 95% confidence interval 1.35–2.48). There was no significant difference in fall risk for residents taking >0 to <3 CNS standardized daily doses compared to residents taking no CNS medications (Adjusted Odds Ratio 0.85; 95% CI 0.63–1.15). Conclusion CNS medication burden, approximately 3+ standardized daily doses, was associated with an increased risk of serious falls in nursing home residents with recent fall. Clinicians should be vigilant for opportunities to discontinue or decrease the doses of individual CNS medications and/or consider non-pharmacological alternatives. Such interventions that reduce use of CNS medications in nursing homes could reduce fall rates but further research is needed to confirm this. PMID:28152179

  19. Older Chinese people's views on food: implications for supportive cancer care.

    PubMed

    Payne, Sheila Alison; Seymour, Jane E; Chapman, Alice; Holloway, Margaret

    2008-11-01

    As people face cancer and the end of life, the social, cultural and therapeutic role of food takes on an increasing significance. As part of a larger study involving older Chinese people resident in the UK, we investigated their beliefs about the influence of food on cancer and its role in supportive cancer care. A two-phase qualitative research study involved older Chinese people identified via Chinese community groups. In phase one, 46 older Chinese people participated in seven focus group discussions. In phase two, semi-structured interviews were conducted in Cantonese or Mandarin with 46 different older Chinese people to elicit their understandings of the role of food in health and illness generally and specifically for those with cancer. The analyses revealed four main themes: (1) food as 'therapeutic'; (2) food as 'risky'; (3) food as supportive and comforting; and (4) beliefs about the lack of culturally appropriate and acceptable food in hospitals. Expectations about the lack of Chinese food and the poor quality and perceived unsuitability of 'western' food were regarded as major concerns in relation to hospital admission. Understanding the perceived cultural and therapeutic significance of food and its functions in social exchange is one important aspect of promoting supportive and end-of-life cancer care for minority communities. These views helped explain the diversity and salience of food use in illness for older Chinese people resident in the UK.

  20. Diversity in Adoption of Linguistic Features of London English by Chinese and Bangladeshi Adolescents

    ERIC Educational Resources Information Center

    Pennington, Martha C.; Lau, Lawrence; Sachdev, Itesh

    2011-01-01

    This comparative study, conducted in multicultural London, investigates the occurrence in interviews with a researcher and in constructed same-sex peer conversations of five linguistic features characteristic of London English in the speech of two groups of British-born adolescents: ethnic Bangladeshis and ethnic Chinese of Cantonese heritage. The…

  1. Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study.

    PubMed

    Cowman, Seamus; Bowers, Len

    2009-05-01

    The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses. Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. A descriptive survey research design was employed. Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared. A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security. There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU. There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.

  2. Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia.

    PubMed

    Allers, Katharina; Hoffmann, Falk

    2018-05-02

    The proportion of deaths occurring in nursing homes is increasing and end of life hospitalizations in residents are common. This study aimed to obtain the time from nursing home admission to death and the frequency of hospitalizations prior to death among residents with and without dementia. This retrospective cohort study analyzed claims data of 127,227 nursing home residents aged 65 years and older newly admitted to a nursing home between 2010 and 2014. We analyzed hospitalizations during the last year of life and assessed mortality rates per 100 person-years. Factors potentially associated with time to death were analyzed in Cox proportional hazard models. The median time from nursing home admission to death was 777 and 635 days in residents with and without dementia, respectively. Being male, older age and a higher level of care decreased the survival time. Sex and age had a higher influence on survival time in residents with dementia, whereas level of care was found to have a higher influence in residents without dementia. Half of the residents of both groups were hospitalized during the last month and about 37% during the last week before death. Leading causes of hospitalizations were infections (with dementia: 20.6% vs. without dementia: 17.2%) and cardiovascular diseases (with dementia: 16.6% vs. without dementia: 19.0%). A high proportion of residents with and without dementia are hospitalized shortly before death. There should be an open debate about the appropriateness of hospitalizing nursing home residents especially those with dementia near death.

  3. The New Education and the Institute of Education, University of London, 1919-1945

    ERIC Educational Resources Information Center

    Aldrich, Richard

    2009-01-01

    The London Day Training College (LDTC), founded in 1902, soon became the leading institution for the study of education and for the training of teachers in England. In 1932 it was transmuted into the Institute of Education of the University of London. Its title and pre-eminence have continued to this day. In the period 1919-1945 it was closely,…

  4. Behind the Wheel: Predictors of Driving Exposure in Older Drivers.

    PubMed

    Coxon, Kristy; Chevalier, Anna; Lo, Serigne; Ivers, Rebecca; Brown, Julie; Keay, Lisa

    2015-06-01

    To explore and deepen understanding of factors influencing driving exposure for older drivers. Cross-sectional. Baseline data on function and driving exposure from 1 week of driving were evaluated. A convenience sample of 380 drivers aged 75 and older, residing in northwest Sydney, was recruited. Participants were required to be the primary drivers of their own vehicle. Driver function was evaluated using the DriveSafe and DriveAware clinic-based assessments to measure visual attention to the driving environment and awareness of driving ability. Demographic information was obtained through interview. An in-vehicle monitoring device with data logger and GPS receiver, was used to measure driving exposure in 362 of 380 participants' vehicles. Driving exposure outcomes were total distance driven, furthest distance traveled from home, and average trip length. Factors influencing these exposure outcomes were analyzed using generalized linear regression. Drivers typically drove 100 km in local and surrounding areas during the week. Function was predictive of all driving exposure outcomes. Drivers with lower levels of function drove fewer kilometers and took shorter trips closer to home. Age, health status, and personal circumstance (e.g., rural residence) also influenced exposure, but sex did not. Using objective measures, this study provides evidence that function, age, health status, and personal circumstance influence driving exposure of older drivers. Understanding how older people use driving to preserve their independence is important for exploring safe driving strategies for older people. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  5. Serious events in older Ontario residents receiving bowel preparations for outpatient colonoscopy with various comorbidity profiles: A descriptive, population-based study

    PubMed Central

    Ho, Joanne M; Gruneir, Andrea; Fischer, Hadas D; Fu, Longdi; Lipscombe, Lorraine L; Bell, Chaim M; Cavalcanti, Rodrigo B; Anderson, Geoffrey M; Rochon, Paula A

    2012-01-01

    BACKGROUND: Polyethylene glycol-based bowel preparations (PEGBPs) and sodium picosulfate (NaPS) are commonly used for bowel cleansing before colonoscopy. Little is known about adverse events associated with these preparations, particularly in older patients or patients with medical comorbidities. OBJECTIVE: To characterize the incidence of serious events following outpatient colonoscopy in patients using PEGBPs or NaPS. METHODS: The present population-based retrospective cohort study examined data from Ontario health care databases between April 1, 2005 and December 31, 2007, including patients ≥66 years of age who received either PEGBP or NaPS for an outpatient colonoscopy. Patients with cardiac or renal disease, long-term care residents or patients receiving concurrent diuretic therapy were identified as high risk for adverse events. The primary outcome was a serious event (SE) defined as a composite of nonelective hospitalization, emergency department visit or death within seven days of the colonoscopy. RESULTS: Of the 50,660 outpatients ≥66 years of age who underwent a colonoscopy, SEs were observed in 675 (2.4%) and 543 (2.4%) patients in the PEGBP and NaPS groups, respectively. Among high-risk patients (n=30,168), SEs occurred in 481 (2.8%) and 367 (2.8%) of patients receiving PEGBP and NaPS, respectively. CONCLUSIONS: The SE rate within seven days of outpatient colonoscopy was 24 per 1000 procedures, and among high-risk patients was 28 per 1000 procedures. The rates were similar for PEGBP and NaPS. Clinicians should be aware of the risks associated with colonoscopy in older patients with comorbidities. PMID:22803018

  6. Assessing the sources and bioaccessibility of Lead in Soils from London

    NASA Astrophysics Data System (ADS)

    Cave, Mark R.; Wragg, Joanna; Chenery, Simon

    2013-04-01

    The lead content of soil is important since it is toxic to humans and particularly because children tend to more readily absorb lead than do adults: children absorb up to 40% into the bloodstream from ingested or inhaled lead, versus 5-15% in adults. Studies have shown that relatively low concentrations of lead in blood can lead to significant decrease in IQ of children (e.g. Jakubowski, 2011) leading to neuropathy and hypertension in adults. The British Geological Survey has recently completed a systematic high-density geochemical soil survey of the Greater London Area (GLA) in which over 6000 surface soil samples were collected and analysed for 50 elements. The Pb content of the soils range from 11 mg/kg to greater than 10000 mg/kg with mean and median values of 301 and 185 mg/kg, respectively. The ingestion bioaccessible fraction of Pb was measured using an in-vitro bioaccessibility test showing that 68% of the total Pb in London soils is bioaccessible. Measurement of Pb isotopic ratios in selected soils matched with those found in London air particulates and, to a lesser extent, with petrol lead. Self modelling mixture resolution of the 50 element geochemical data set was used to identify geochemically distinct components in the data with Pb being associated with 11 of the components which were of both natural and anthropogenic origin. Relationships between the soil components, the bioaccessible fraction and the Pb isotope ratios provided an indication of the sources of mobile lead in the London soils. References JAKUBOWSKI, M. 2011. Low-level environmental lead exposure and intellectual impairment in children - the current concepts of risk assessment. International Journal of Occupational Medicine and Environmental Health, Vol. 24, 1-7. APPLETON, J D, CAVE, M R, and WRAGG, J. 2012. Modelling lead bioaccessibility in urban topsoils based on data from Glasgow, London, Northampton and Swansea, UK. Environmental Pollution, Vol. 171, 265-272.

  7. Active Citizenship & Adult Learning In Inner London. Research Paper in Continuing Education Number 2.

    ERIC Educational Resources Information Center

    Payne, John

    The impact of the abolition of the Inner London Educational Authority (ILEA) on adult education in London (England) was explored. Specifically, the impact of abolition, that might support the concept and practice of active citizenship, was studied on three areas of adult education: environmental education, antiracist work, and work with voluntary…

  8. Incidence of venous thromboembolism in nursing home residents.

    PubMed

    Reardon, Gregory; Pandya, Naushira; Nutescu, Edith A; Lamori, Joyce; Damaraju, C V; Schein, Jeff; Bookhart, Brahim

    2013-08-01

    Venous thromboembolism (VTE) is common in the elderly, but its epidemiology in nursing home residents remains unclear. This study estimated rates of VTE recorded on nursing home admission and incidence during residence. Retrospective analysis of AnalytiCare long term care (LTC) database for the period January 2007 to June 2009. 181 nursing homes in 19 US states. Eligible residents had 1 or more admission Minimum Data Set (MDS) 2.0 assessment(s) over the study period. All VTE cases were extracted if MDS indicated deep vein thrombosis or pulmonary embolism. The number of admissions and days at risk were estimated from a random sample (n = 1350) of all residents. The earliest admission was identified as the admission index date. VTE cases were classified as either "On Admission" (VTE coded on admission index date) or "During Residence" (coded afterward). Residents were followed from admission index date until censoring. A total of 2144 VTE admission cases (3.7% of all admissions) were identified. A further 757 cases of VTE occurring during residence were identified, yielding an incidence of 3.68 cases of VTE per 100 person-years of postadmission residence. VTE admission rates were highest for residents younger than 50 years (4.8%, confidence interval [CI]: 3.9%-5.9%) and 50 to 64 years (5.1%, CI: 4.6%-5.7%) but similar for those aged 65 to 74 (3.6%, CI: 3.3%-4.0%), 75 to 84 (3.6%, CI: 3.3%-3.9%), and 85 years or older (3.1%, CI: 2.9%-3.4%). The incidence of VTE during residence was similar among these age strata. Approximately 1 in 25 nursing home admissions had a VTE diagnosis. VTE incidence during residence was higher than reported in earlier nursing home studies. These incidence rates merit further investigation because diagnostic improvements may be driving greater recognition of VTE in LTC. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  9. Knives and Other Weapons in London Schools

    ERIC Educational Resources Information Center

    Neill, S. R. St. J.

    2005-01-01

    London schools operate in an area where crime rates, including violent crime, is statistically more frequent than the average for the whole of England and Wales (Moore and Yeo 2004). Violent crime in the capital increased (though not to a statistically significant extent) between 2002/3 and 2003/4 (Moore and Yeo 2004b). This has led to a…

  10. How elderly nursing home residents transcend losses of later life.

    PubMed

    Bickerstaff, Kathleen A; Grasser, Carol M; McCabe, Barbara

    2003-01-01

    Losses of later life can prove overwhelming to older adults. Some elderly persons seem to cope with these losses with a spirit of acceptance and serenity. The purpose of this study was to identify qualities in selected nursing home residents that allow them to transcend difficulties and continue living with some degree of contentment and satisfaction. Qualitative data were obtained in taped interviews from 95 functionally impaired residents (mean age 82.16 years). Content analysis resulted in several themes supporting the spiritual perspective of Reed's theory of self-transcendence: generativity, introjectivity, temporal integration, body-transcendence, and relationship with self, others, and a higher being.

  11. Dentists with enhanced skills (Special Interest) in Endodontics: gatekeepers views in London.

    PubMed

    Ghotane, Swapnil G; Al-Haboubi, Mustafa; Kendall, Nick; Robertson, Claire; Gallagher, Jennifer E

    2015-09-21

    Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS. A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0. Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification. The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet

  12. Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors.

    PubMed

    Yawson, Alfred E; Ackuaku-Dogbe, Edith M; Seneadza, Nana A Hagan; Mensah, George; Minicuci, Nadia; Naidoo, Nirmala; Chatterji, Somnath; Kowal, Paul; Biritwum, Richard B

    2014-09-12

    Changes in function of sensory organs with increasing age have significant impact on health and wellbeing of older persons. This paper describes cataract, a chronic eye condition, self-reported among older adults in Ghana and the need for improving access to eye care services. This work was based on the World Health Organization's multi-country Study on global AGEing and adult health (SAGE), conducted in six countries including Ghana. SAGE Wave 1 in Ghana was conducted in 2007-2008 in a nationally representative sample of 4278 older adults, ≥ 50 years. Data were obtained on sociodemographic and health factors related to self-reported cataracts in older persons in Ghana. Data were analysed using descriptive measures (frequencies and proportions), chi-square test for associations in categorical outcome measures, and logistic regression for predictors of cataracts with SPSS version 21. Overall prevalence of self-reported cataracts among 4278 older adults in Ghana was 5.4%. Prevalence was proportionately higher for women (5.9%) than men (4.7%). Reported cataracts increased with age, among urban residents, in older adults living without partners and among those with the worse life satisfaction index. Older adults in lower income groups, poorly educated or living alone had difficulty seeking vision care services. Prevalence was 8.4% among persons with diabetes, 10.4% among hypertensives and 11.4% in persons with previous history of stroke. Among older persons who had ever used alcohol or tobacco, prevalence rates of reported cataracts were 5.7% and 4.9%, respectively. Logistic regression analysis indicated that increasing age, lower income status and self-reported hypertension were significantly associated with cataract among older adults in Ghana. Cataract is prevalent in older people in Ghana with approximately 1 in 20 people aged 50 years or older reporting a previous diagnosis of cataract. As cataract surgery is restorative, a public health approach on behavioural

  13. Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

    PubMed Central

    Goll, Johanna C.; Charlesworth, Georgina; Scior, Katrina; Stott, Joshua

    2015-01-01

    Introduction Loneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England. Method An inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed. Results Participants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity. Discussion It is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided. PMID:25706933

  14. A comparison of verbal communication and psychiatric medication use by Greek and Italian residents with dementia in Australian ethno-specific and mainstream aged care facilities.

    PubMed

    Runci, Susannah J; Eppingstall, Barbara J; O'Connor, Daniel W

    2012-05-01

    Older migrants with dementia and limited English language proficiency in residential care may have unmet needs for social interaction. This project compared verbal communication and prescribed psychiatric medication of Greek and Italian residents with dementia in ethno-specific and mainstream residential care. Participants were 82 older Australians of Greek or Italian background who had been diagnosed with dementia and were residing in mainstream or ethno-specific care. Residents were observed and their language use was recorded. An assessment of cognitive impairment was conducted. A structured interview was held with a family member and a staff member. The observed rate of resident-to-resident communication was higher in the ethno-specific facilities. Staff-to-resident interaction rate did not differ between the facility types. Residents in ethno-specific care were prescribed antipsychotics at a significantly lower rate. Residents with dementia and limited English language proficiency in mainstream care would benefit from greater opportunities to interact with peers in their own language. Prescribed medication should be monitored to ensure that these residents are not misinterpreted as "disruptive," or are not actually more agitated due to difficulty in communicating their needs.

  15. Using maps and funnel plots to explore variation in place of death from cancer within London, 2002-2007.

    PubMed

    Madden, P; Coupland, Vh; Møller, H; Davies, Ea

    2011-06-01

    London has a high proportion of hospital deaths, which health policy seeks to reduce. We explore variation and trends in place of death from cancer within London between 2002 and 2007. Mortality data based on death certificates were used to define deaths from cancer at home, hospice, hospital and nursing home and examine trends over time for London. Proportions of deaths in each place were presented in maps for 31 London primary care trusts (PCTs). Funnel plots were used to identify consistent performance outside the control limits of three standard deviations. There was little overall change in place of death for London, but consistent variation between PCTs. Outer London PCTs had higher proportions of home deaths and inner London PCTs higher proportions of hospice deaths. Funnel plots identified consistent high outlying performance for home, hospice and hospital deaths. No PCT showed a change of 10% or more in home deaths, but five showed decreasing hospital deaths and three increasing hospice deaths. Maps and funnel plots appear useful for identifying areas with differing performance for home, hospital, nursing home and hospice deaths. These methods may help further investigation of how local services may successfully support deaths outside hospital. © The Author(s) 2011

  16. Well-being in elderly long-term care residents with chronic mental disorder: a systematic review.

    PubMed

    van der Wolf, Elja; van Hooren, Susan A H; Waterink, Wim; Lechner, Lilian

    2017-12-21

    One of the most important objectives of care for older long-term care residents with chronic mental disorders is to facilitate well-being. This review provides an overview of research literature on well-being in this population. A systematic review was conducted using Pubmed, PsycINFO and PsycARTICLES for all studies up until March 2016. Three reviewers independently assessed the eligibility of the publications and made a selection. From a total of 720 unique search results, ten studies were deemed eligible. Specialized care, specifically the presence of mental health-workers was associated with increased well-being outcomes. Perceived amount of personal freedom was also related to higher well-being, whereas stigmatization and depression were related to reduced well-being. Size of residence, single or group-accommodation or moving to another locationdid not, however, seem to have an impact on well-being. Specialized care, aimed at psychiatric disorders and extra attention for depressed residents are useful tools to promote well-being. Additionally, themes like personal freedom and stigmatization should be taken into consideration in the care for older long-term care residents with chronic mental disorder. However, as very little research has been conducted on this topic, conclusions should be interpreted with caution. More research is highly desirable.

  17. Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey.

    PubMed

    Chuang, Yeu-Hui; Kuo, Li-Min

    2018-05-24

    The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression. © 2018 Australian College of Mental Health Nurses Inc.

  18. Time-dependent London approach: Dissipation due to out-of-core normal excitations by moving vortices

    DOE PAGES

    Kogan, V. G.

    2018-03-19

    The dissipative currents due to normal excitations are included in the London description. The resulting time-dependent London equations are solved for a moving vortex and a moving vortex lattice. It is shown that the field distribution of a moving vortex loses its cylindrical symmetry. It experiences contraction that is stronger in the direction of the motion than in the direction normal to the velocity v. The London contribution of normal currents to dissipation is small relative to the Bardeen-Stephen core dissipation at small velocities, but it approaches the latter at high velocities, where this contribution is no longer proportional tomore » v 2. Here, to minimize the London contribution to dissipation, the vortex lattice is oriented so as to have one of the unit cell vectors along the velocity. This effect is seen in experiments and predicted within the time-dependent Ginzburg-Landau theory.« less

  19. Time-dependent London approach: Dissipation due to out-of-core normal excitations by moving vortices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kogan, V. G.

    The dissipative currents due to normal excitations are included in the London description. The resulting time-dependent London equations are solved for a moving vortex and a moving vortex lattice. It is shown that the field distribution of a moving vortex loses its cylindrical symmetry. It experiences contraction that is stronger in the direction of the motion than in the direction normal to the velocity v. The London contribution of normal currents to dissipation is small relative to the Bardeen-Stephen core dissipation at small velocities, but it approaches the latter at high velocities, where this contribution is no longer proportional tomore » v 2. Here, to minimize the London contribution to dissipation, the vortex lattice is oriented so as to have one of the unit cell vectors along the velocity. This effect is seen in experiments and predicted within the time-dependent Ginzburg-Landau theory.« less

  20. Time-dependent London approach: Dissipation due to out-of-core normal excitations by moving vortices

    NASA Astrophysics Data System (ADS)

    Kogan, V. G.

    2018-03-01

    The dissipative currents due to normal excitations are included in the London description. The resulting time-dependent London equations are solved for a moving vortex and a moving vortex lattice. It is shown that the field distribution of a moving vortex loses its cylindrical symmetry. It experiences contraction that is stronger in the direction of the motion than in the direction normal to the velocity v . The London contribution of normal currents to dissipation is small relative to the Bardeen-Stephen core dissipation at small velocities, but it approaches the latter at high velocities, where this contribution is no longer proportional to v2. To minimize the London contribution to dissipation, the vortex lattice is oriented so as to have one of the unit cell vectors along the velocity. This effect is seen in experiments and predicted within the time-dependent Ginzburg-Landau theory.

  1. Characterizing Students' Mechanistic Reasoning about London Dispersion Forces

    ERIC Educational Resources Information Center

    Becker, Nicole; Noyes, Keenan; Cooper, Melanie

    2016-01-01

    Characterizing how students construct causal mechanistic explanations for chemical phenomena can provide us with important insights into the ways that students develop understanding of chemistry concepts. Here, we present two qualitative studies of undergraduate general chemistry students' reasoning about the causes of London dispersion forces in…

  2. Seasonal influenza vaccination delivery through community pharmacists in England: evaluation of the London pilot

    PubMed Central

    Atkins, Katherine; van Hoek, Albert Jan; Watson, Conall; Baguelin, Marc; Choga, Lethiwe; Patel, Anika; Raj, Thara; Jit, Mark; Griffiths, Ulla

    2016-01-01

    Objective To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies. Design We analysed 2013–2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011–2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme. Setting All London boroughs. Participants London-based GPs, and pharmacies that currently offer seasonal flu vaccination. Interventions Not applicable. Main outcome measures Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative. Results No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data. Conclusions Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data. PMID:26883237

  3. Treatment With Multiple Blood Pressure Medications, Achieved Blood Pressure, and Mortality in Older Nursing Home Residents: The PARTAGE Study.

    PubMed

    Benetos, Athanase; Labat, Carlos; Rossignol, Patrick; Fay, Renaud; Rolland, Yves; Valbusa, Filippo; Salvi, Paolo; Zamboni, Mauro; Manckoundia, Patrick; Hanon, Olivier; Gautier, Sylvie

    2015-06-01

    Clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals older than 80 years. However, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality. To assess all-cause mortality in institutionalized individuals older than 80 years according to systolic BP (SBP) levels and number of antihypertensive drugs. This longitudinal study included elderly residents of nursing homes. The interaction between low (<130 mm Hg) SBP and the presence of combination antihypertensive treatment on 2-year all-cause mortality was analyzed. A total of 1127 women and men older than 80 years (mean, 87.6 years; 78.1% women) living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Blood pressure was measured with assisted self-measurements in the nursing home during 3 consecutive days (mean, 18 measurements). Patients with an SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants. All-cause mortality over a 2-year follow-up period. A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in patients with low SBP who were receiving multiple BP medicines compared with the other participants. Three sensitivity analyses confirmed the significant excess of risk: propensity score-matched subsets (unadjusted HR, 1.97; 95% CI, 1.32-2.93; P < .001; adjusted HR, 2.05; 95% CI, 1.37-3.06; P < .001), adjustment for cardiovascular comorbidities (HR, 1.73; 95% CI, 1.29-2.32; P < .001), and exclusion of patients without a history of hypertension who were receiving BP-lowering agents (unadjusted HR, 1.82; 95% CI, 1.33-2.48; P < .001

  4. Social Connections for Older People with Intellectual Disability in Ireland: Results from Wave One of IDS-TILDA.

    PubMed

    McCausland, Darren; McCallion, Philip; Cleary, Eimear; McCarron, Mary

    2016-01-01

    The literature on influences of community versus congregated settings raises questions about how social inclusion can be optimised for people with intellectual disability. This study examines social contacts for older people with intellectual disability in Ireland, examining differences in social connection for adults with intellectual disability and other adults. Data were drawn from the IDS-TILDA study in Ireland. A nationally representative sample (n = 753) included adults aged 40 years and older, with additional comparison with general population participants. Predictors of social contacts were explored. Residence, level of intellectual disability and age were significant factors determining social contact. People in institutional residences, older respondents and those with severe/profound intellectual disability had the lowest levels of contact; older adults with intellectual disability had much lower rates than general population counterparts. Community-dwelling people with intellectual disability have greater social contact than those living in institutions, but levels are below those for other adults in Ireland. © 2015 John Wiley & Sons Ltd.

  5. Multilevel examination of facility characteristics, social integration, and health for older adults living in nursing homes.

    PubMed

    Leedahl, Skye N; Chapin, Rosemary K; Little, Todd D

    2015-01-01

    Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes. Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff. The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes. To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Rasch analysis of the London Handicap Scale in stroke patients: a cross-sectional study.

    PubMed

    Park, Eun-Young; Choi, Yoo-Im

    2014-07-31

    Although activity and participation are the target domains in stroke rehabilitation interventions, there is insufficient evidence available regarding the validity of participation measurement. The purpose of this study was to investigate the psychometric properties of the London Handicap Scale in community-dwelling stroke patients, using Rasch analysis. Participants were 170 community-dwelling stroke survivors. The data were analyzed using Winsteps (version 3.62) with the Rasch model to determine the unidimensionality of item fit, the distribution of item difficulty, and the reliability and suitability of the rating process for the London Handicap Scale. Data of 16 participants did not fit the Rasch model and there were no misfitting items. The person separation value was 2.42, and the reliability was .85; furthermore, the rating process for the London Handicap Scale was found to be suitable for use with stroke patients. This was the first trial to investigate the psychometric properties of the London Handicap Scale using Rasch analysis; the results supported the suitability of this scale for use with stroke patients.

  7. A Comparison of the Health of Older Hispanics in the United States and Mexico

    PubMed Central

    Angel, Ronald J.; Angel, Jacqueline L.; Hill, Terrence D.

    2014-01-01

    Objectives This study compares various dimensions of physical and emotional health between older Mexican-origin individuals in the United States and in Mexico. Method The samples are drawn from the Mexican Health and Aging Study (MHAS) and the Hispanic Established Epidemiologic Study of the Elderly (H-EPESE) and include 3,875 Mexican residents with no history of residence in the United States and 2,734 Mexican-origin individuals 65 and older who live in the southwestern United States. Results Both immigrant and native-born Mexican-origin elders in the United States report more chronic conditions than elderly Mexicans, but they report fewer symptoms of psychological distress. Longer residence in the United States is associated with higher body mass index scores. Discussion The discussion addresses the possibility that access to care influences reports of diagnosed conditions and touches on issues of comparability in cross-cultural research and the difficulty in clearly distinguishing cultural and system-level factors in the production and measurement of health. PMID:18252935

  8. A review of social housing regeneration in the London Borough of Brent.

    PubMed

    Stewart, J; Rhoden, M

    2003-03-01

    Council high-rise estates sprang up rapidly during the 1960s and 1970s, with cross-governmental support to resolve the nation's housing crisis. It soon became apparent that many such new estates, designed by remote architects, and sometimes constructed rapidly and unsatisfactorily, did not provide the ideal living initially perceived. Many estates had early problems with architecture, construction and design. They proved an inhumane environment for many residents and there were frequent problems with communal features. Such estates were soon stigmatised and difficult to let as increasingly residual households were placed there, creating majority welfare-dependent estates. This created a downward spiral that traditional, and remote, housing management found difficult to address, and was too wide-scale to rectify financially within existing regimes. Prior to the 1980s, there were no specific government policies to tackle housing regeneration on high-rise estates. Problems became wider than traditional housing management and poor housing environments, encompassing social and economic exclusion. This paper, based on historical and contemporary literature as well as estate visits, reviews regeneration policy in three council housing estates within the London Borough of Brent. It traces successive government approaches since the 1980s from one that challenged the very status of council housing--notably at Stonebridge Park and Chalkhill, to one of partnership with the local authority--at South Kilburn. Housing policy is now concerned with more than just housing--it is about moving toward social inclusion, which requires initiative, flair, resource and commitment. It is about new accountabilities--not just numbers of bricks and mortar constructions, but about the lives, opportunities and health of those who live in an area. This fundamentally involves a partnership approach with residents at the centre of regeneration. This paper finds that sustainable estate regeneration

  9. Effective health care for older people resident in care homes: the optimal study protocol for realist review

    PubMed Central

    2014-01-01

    Background Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion This realist review will

  10. The effects of an enhanced environment on nursing home residents who pace.

    PubMed

    Cohen-Mansfield, J; Werner, P

    1998-04-01

    This study sought to enhance the well-being of older nursing home residents who pace and wander by enriching their nursing home environment. Visual, auditory, and olfactory stimuli were added to the nursing home unit environment to simulate two types of environments: a home environment and an outdoor nature environment. Participants seemed to prefer the enhanced environments by choosing to spend more time in them, and by sitting on benches in those environments. There was a trend toward less trespassing, exit-seeking, and other agitated behaviors being exhibited in the enhanced environment, and residents were observed to manifest more pleasure in it. Staff members and family members definitely expressed a preference for the enhanced environment over the regular one. Although effects on residents were limited, this approach offers a low-cost method for making the nursing home environment a better place for those residents.

  11. Does restructuring theory and clinical courses better prepare nursing students to manage residents with challenging behaviors in long-term care settings?

    PubMed

    O'Connell, Beverly; Guse, Lorna; Greenslade, Loreley

    2018-01-30

    Bachelor of Nursing students (BN) placed in long-term care encounter residents who exhibit challenging behaviors. Students are often inadequately prepared to manage these behaviors, and this is a source of distress for students. This study explored whether enhancing and restructuring theoretical and clinical courses resulted in student nurses feeling better prepared to manage residents' challenging behaviors and improve their levels of distress. This study was conducted in two phases with 116 BN students (first phase) and 99 students (second phase) where the course on older adults was restructured. The findings of this study indicated that students who felt less prepared experienced greater distress by residents' behaviors than those who felt better prepared. Scheduling a theoretical course on the care of older adults prior to the clinical course placement, as well as offering an online learning module focused on responsive behaviors, significantly increased students' feelings of preparedness to manage residents' complex behaviors.

  12. Recruitment of mobility limited older adults into a facility-led exercise-nutrition study: the effect of social involvement

    USDA-ARS?s Scientific Manuscript database

    Purpose of the Study: Older adults are among the most challenging population groups to enroll into health-related research. This article describes two methods used by investigators to recruit mobility limited older adults residing at assisted living or senior housing (SH) facilities into a facility-...

  13. The effects of playing Nintendo Wii on depression, sense of belonging and social support in Australian aged care residents: a protocol study of a mixed methods intervention trial.

    PubMed

    Chesler, Jessica; McLaren, Suzanne; Klein, Britt; Watson, Shaun

    2015-09-03

    The proportion of people aged 65 or older is the fastest growing age group worldwide. Older adults in aged care facilities have higher levels of depression, and lower levels of social support and sense of belonging compared with older adults living in the community. Research has begun to assess the effectiveness of interventions to improve the mental health of residents and has found both cognitive and physical benefits of video game playing. The benefits of playing these games in a group may also lead to greater social interaction and decreased loneliness. The current study aims to investigate an intervention program designed to foster relationships among older adults in care based on shared interests. Residents will be assessed on the effectiveness of a 6 week program of playing Wii bowling in comparison to a control group. Participants will be allocated to the intervention (Wii bowling) or the control group based on their place of residence. Participants in the intervention group will be invited to participate in Wii bowling twice weekly, with up to three other residents for a period of 6 weeks. Residents in both conditions will be assessed for depression, social support, sense of belonging, and current self-rated mood at pre-intervention (0 weeks), post-intervention (6 weeks), and at 2-month follow up (14 weeks). Qualitative data on social interaction between group members will also be collected at weeks 1, 3, and 6. Both groups will receive a Wii console after week 6 to establish if residents and staff engage with the Wii without intervention. The Wii provides a user friendly platform for older adults to use video games, and it incorporates both social and competitive aspects in the game play. Existing research has not extensively investigated the social aspects of using this type of technology with older adults. If found to be effective, incorporating Wii games into an activity schedule may benefit the mental health of older adults living in care by

  14. Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings

    ERIC Educational Resources Information Center

    Kumar, Chandrika; Bensadon, Benjamin A.; Van Ness, Peter H.; Cooney, Leo M.

    2016-01-01

    Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals…

  15. Challenges in access to health services and its impact on quality of life: a randomised population-based survey within Turkish speaking immigrants in London.

    PubMed

    Topal, Kenan; Eser, Erhan; Sanberk, Ismail; Bayliss, Elizabeth; Saatci, Esra

    2012-01-26

    There are a significant number of Turkish speaking immigrants living in London. Their special health issues including women's health, mental health, and alcohol and smoking habits has been assessed. The aim of this study was to explore the ongoing challenges in access to health care services and its impact on Quality of Life of immigrants. This cross-sectional population-based study was conducted between March and August 2010 with Turkish immigrants (n = 416) living in London. Of these, 308 (74%) were Turkish and 108 (26%) were Turkish Cypriots. All healthy or unhealthy adults of 17-65 years of age were enrolled. A structured questionnaire with 44 items in five subcategories and 26-items WHOQOL BREF were used. Mean duration of stay for Turkish Cypriots (26.9 ± 13.9 years) was significantly longer than Turkish immigrants (13.3 ± 7.5) (p < 0.001). Turkish immigrants (n = 108, 36.5%) need interpretation more often when using health services than Turkish Cypriots (n = 16, 15%) (p < 0.001). Multivariate analyses suggested significant effects of older age, non-homeownership, low socioeconomic class, poor access to health services, being ill, poor community integration and being obese on physical well-being and also significant effects of low income and poor community integration on perceived overall Quality of Life (WHOQOL) of the participants. The results of this study demonstrate how the health and well-being of members of the Turkish speaking community living in London are affected by social aspects of their lives. Providing culturally competent care and interpretation services and advocacy may improve the accessibility of the health care.

  16. Maintenance of Function in Relocation of Community-Dwelling Older Adults

    ERIC Educational Resources Information Center

    Storandt, Martha; Wittels, Ilene

    1975-01-01

    Relocation is often seen as a high-risk stress for the elderly. The present study compared relatively healthy older people moving voluntarily with nonmovers. An examination of behavioral test performance in a pre-post design revealed no decrement in function among those who changed residence. (Author)

  17. Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study.

    PubMed

    Azam, Mohsin; Marwood, Lindsey; Ismail, Khalida; Evans, Tyrrell; Sivaprasad, Sobha; Winkley, Kirsty; Amiel, Stephanie Anne

    2015-01-01

    Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes.

  18. Residents' perceptions of their own sadness--a qualitative study in Norwegian nursing homes.

    PubMed

    Iden, Kristina Riis; Ruths, Sabine; Hjørleifsson, Stefan

    2015-03-08

    Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness. We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation. The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity. Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.

  19. A Pilot Study Evaluating the Feasibility of Psychological First Aid for Nursing Home Residents.

    PubMed

    Brown, Lisa M; Bruce, Martha L; Hyer, Kathryn; Mills, Whitney L; Vongxaiburana, Elizabeth; Polivka-West, Lumarie

    2009-07-01

    OBJECTIVES: The objectives of the pilot study were to modify existing psychological first aid (PFA) materials so they would be appropriate for use with institutionalized elders, evaluate the feasibility of using nursing home staff to deliver the intervention to residents, and solicit feedback from residents about the intervention. The STORM Study, an acronym for "services for treating older residents' mental health", is the first step in the development of an evidence-based disaster mental health intervention for this vulnerable and underserved population. METHOD: Demographic characteristics were collected on participating residents and staff. Program evaluation forms were completed by staff participants during the pilot test and nurse training session. Staff and resident discussion groups were conducted during the pilot test to collect qualitative data on the use of PFA in nursing homes. RESULTS: Results demonstrate the feasibility of the PFA program to train staff to provide residents with PFA during disasters. CONCLUSIONS: Future research should focus on whether PFA improves coping and reduces stress in disaster exposed nursing home residents.

  20. Productive aging of Korean older people based on time use.

    PubMed

    Kim, Ju Hyun

    2018-04-16

    This study differentiated the diversified aspects of older adulthood in terms of productive activities and examined which attributes of the elderly shaped these dissimilarities of productive aging. This research shed light on the multi-dimensional nature of the productive activities of the Korean elderly, using the 2014 Time Use Survey produced by Statistics Korea. This study selected 3766 older adults aged 65 and older who resided in city areas. The results revealed that the time used for productive activities for older adults were different based on objective factors. These differences were clear enough to be classified into distinctive clusters. When analyzed in terms of the amount of time spent, gender of the elderly turned out to be the most discriminating factor. As for the dimension of labor, gender division of labor still existed during older adulthood in that older men were more active in doing paid work, whereas care of family was assigned as women's responsibility. Furthermore, most of the elderly did not participate in productive activities, and this possibility rose as one's age increased. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Space, Emotions and the Everyday: The Affective Ecology of 1980s London.

    PubMed

    Brooke, Stephen

    2017-03-01

    This article explores the relationship between emotions, space and politics in 1980s London, using the Greater London Council, childcare, and racial harassment as particular foci. It brings together political history, the history of emotions, and geography to offer a new way of thinking about political culture, as well as contributing to the history of the 1980s. It is based upon archival sources. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. 77 FR 67566 - Regulated Navigation Area; Thames River Degaussing Range Replacement Operations; New London, CT

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... establishing a regulated navigation area (RNA) on the navigable waters of the Thames River in New London Harbor, New London, CT. The RNA will establish speed and wake restrictions and allow the Coast Guard to prohibit all vessel traffic through the RNA during degaussing range replacement operations, both planned...

  3. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.

    PubMed

    Veronese, N; Cereda, E; Solmi, M; Fowler, S A; Manzato, E; Maggi, S; Manu, P; Abe, E; Hayashi, K; Allard, J P; Arendt, B M; Beck, A; Chan, M; Audrey, Y J P; Lin, W-Y; Hsu, H-S; Lin, C-C; Diekmann, R; Kimyagarov, S; Miller, M; Cameron, I D; Pitkälä, K H; Lee, J; Woo, J; Nakamura, K; Smiley, D; Umpierrez, G; Rondanelli, M; Sund-Levander, M; Valentini, L; Schindler, K; Törmä, J; Volpato, S; Zuliani, G; Wong, M; Lok, K; Kane, J M; Sergi, G; Correll, C U

    2015-11-01

    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting. © 2015 World Obesity.

  4. Evaluation of respiratory functions of residents around the Orhaneli thermal power plant in Turkey.

    PubMed

    Pala, Kayihan; Türkkan, Alpaslan; Gerçek, Harika; Osman, Erdinc; Aytekin, Hamdi

    2012-01-01

    The aim of this cross-sectional study was to evaluate the health and respiratory function of residents around the Orhaneli thermal power plant in Turkey. The study was conducted using face-to-face interviews, and respiratory functions were measured with a spirometer. The respiratory functions of 2350 residents, 15 years and older, living in communities near the coal-fired Orhaneli thermal power plant in Turkey were measured. The control group consisted of 469 persons from similar communities without a nearby power plant. The FEV1 (forced expiratory volume after 1 s) and FVC (forced vital capacity) values of the study participants were significantly lower than those of the control group, and residents directly downwind of the plant's smokestack showed greater impairment of respiratory functions compared with residents upwind.

  5. Evaluation of care quality for disabled older patients living at home and in institutions.

    PubMed

    Chang, Shu-Ching; Shiu, Ming-Neng; Chen, Huey-Tzy; Ng, Yee-Yung; Lin, Li-Chan; Wu, Shiao-Chi

    2015-12-01

    This study aimed to evaluate the level of care quality received by disabled older patients residing at home vs. those residing in institutions. Taiwan has an aging society and faces issues of caring for disabled older patients, including increasing needs, insufficient resources and a higher economic burden of care. Retrospective study extracting patient data from Taiwan's National Health Insurance database. We enrolled 76,672 disabled older patients aged 65 years and older who resided at home or institutions and had submitted claims for coverage of National Health Insurance for home care received for the first time between 2004-2006. Propensity score matching was applied to create a home-care group and an institutional-care group with 27,894 patients each. Indicators of care quality (emergency services use, hospitalisation, infection, pressure ulcers, death) within the first year were observed. The home care group had significantly higher emergency services use, fewer hospital admissions and fewer infections, but had significantly higher occurrence of pressure ulcers. The institutional-care group had significantly lower time intervals between emergencies, fewer deaths, lower risk of emergencies and lower pressure ulcer risk. Males had significantly higher emergency services use than females, and higher risk of hospital admission and death. Care quality indicators for elder care are significantly different between home care and institutional care. The quality of home care is associated with higher emergency services use and pressure ulcer development, and institutional care is associated with number of infections and hospitalisations. Care quality indicators were significantly different between home-care and institutional-care groups and were closely associated with the characteristics of individual patients' in the specific settings. Nursing capabilities must be directed towards reducing unnecessary care quality-related events among high-risk disabled older

  6. Optical legacy of Imperial College London

    NASA Astrophysics Data System (ADS)

    Kidger Webb-Moore, Tina E.

    2016-10-01

    The Industrial Revolution, beginning primarily in the UK, generated an increasing need for highly skilled technical people. Throughout the 19th century, technical instruction increased dramatically and the formation of schools specializing in science and technology grew quickly. In England, there was much motivation in favour of a national prestige center for science and technology centered in London. Central among the motivating forces was Queen Victoria's husband, Prince Albert. Although there were already existing specialist science and technology institutions in major English cities, the growth of superior institutions in other countries within Europe, especially Germany and the Charlottenburg area of Berlin (e.g., the Berlin Technical High School), encouraged important English dignitaries to become more competitive with continental Europe. As a result of this strong continental motivation, several science and technology institutions were built in the south Kensington part of London during the latter half of the 19th century. Imperial College, founded at the start of the 20th century, was a culmination and consolidation of several of these 19th century English institutions. Optical science and technology was an early beneficiary of the founding of Imperial College. This paper will attempt to provide the reader with an understanding of how great was the influence of the optical section of Imperial College in the further development of the world's optical science and technology.

  7. Pain management for older persons living in nursing homes: a pilot study.

    PubMed

    Tse, Mimi M Y; Ho, Suki S K

    2013-06-01

    Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  8. Environment and cognitive aging: A cross-sectional study of place of residence and cognitive performance in the Irish longitudinal study on aging.

    PubMed

    Cassarino, Marica; O'Sullivan, Vincent; Kenny, Rose Anne; Setti, Annalisa

    2016-07-01

    Stimulating environments foster cognitive vitality in older age. However, it is not known whether and how geographical and physical characteristics of lived environments contribute to cognitive aging. Evidence of higher prevalence of dementia in rural rather than urban contexts suggests that urban environments may be more stimulating either cognitively, socially, or in terms of lifestyle. The present study explored urban/rural differences in cognition for healthy community-dwelling older people while controlling for a comprehensive spectrum of confounding factors. Cognitive performance of 3,765 healthy Irish people aged 50+ years participating in Wave 1 of The Irish Longitudinal Study on Aging was analyzed in relation to current location of residence-urban, other settlements, or rural areas-and its interaction with childhood residence. Regression models controlled for sociodemographic, health, and lifestyle factors. Urban residents showed better performance than the other 2 residence groups for global cognition and executive functions after controlling for covariates. Childhood urban residence was associated with a cognitive advantage especially for currently rural participants. Our findings suggest higher cognitive functioning for urban residents, although childhood residence modulates this association. Suggestions for further developments of these results are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  9. The Quality of Medication Use in Older Adults: Methods of a Longitudinal Study

    PubMed Central

    Roth, Mary T.; Moore, Charity G.; Ivey, Jena L.; Esserman, Denise A.; Campbell, William H.; Weinberger, Morris

    2009-01-01

    Background The quality of medication use in older adults is a recurring problem of substantial concern. Efforts to both measure and improve the quality of medication use often define quality too narrowly and fall short of addressing the complexity of an older adult's medication regimen. Objective In an effort to more comprehensively define the quality of medication use in older adults, we conducted a prospective cohort study to: 1) describe the quality of medication use in community-residing older adults at baseline, examining differences between Whites and African Americans; 2) examine the effect of race on medication-related problems[mtr1], and 3) assess the change in quality medication use between Whites and African Americans over time. This paper presents the research design and methods of this longitudinal study. Methods We interviewed 100 White and 100 African-American community-residing older adults three times over one year (baseline, 6, and 12 months). We oversampled African Americans so that we could estimate racial differences in the quality of medication use. We collected information on the quality of medication use, relying on a clinical pharmacist's assessment of quality and the Assessing Care of Vulnerable Elders (ACOVE) quality indicators. We also collected data on demographic characteristics, health literacy, functional status, and participant-reported drug therapy concerns. Results Two hundred older adults were enrolled into the study and completed a baseline visit. Of the 200, 92% completed the 6-month visit (n=183) and 88% completed the 12-month visit (n=176). We present baseline demographic characteristics for the 200 older adults enrolled in the study. Conclusion This longitudinal study is an initial step toward developing more comprehensive, patient-centered measures and interventions to improve the quality of medication use in older adults. PMID:19028378

  10. Infant Mortality and Income in 4 World Cities: New York, London, Paris, and Tokyo

    PubMed Central

    Rodwin, Victor G.; Neuberg, Leland G.

    2005-01-01

    Objectives. We investigated the association between average income or deprivation and infant mortality rate across neighborhoods of 4 world cities. Methods. Using a maximum likelihood negative binomial regression model that controls for births, we analyzed data for 1988–1992 and 1993–1997. Results. In Manhattan, for both periods, we found an association (.05% significance level) between income and infant mortality. In Tokyo, for both periods, and in Paris and London for period 1, we found none (5% significance level). For period 2, the association just missed statistical significance for Paris, whereas for London it was significant (5% level). Conclusions. In stark contrast to Tokyo, Paris, and London, the association of income and infant mortality rate was strongly evident in Manhattan. PMID:15623865

  11. A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes.

    PubMed

    Ellis, Julie M; Ayala Quintanilla, Beatriz Paulina; Ward, Louise; Campbell, Fergus; Hillel, Stav; Downing, Carolyn; Teresi, Jeanne; Ramirez, Mildred

    2018-05-06

    To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. Quantitative systematic review registered on PROSPERO (CRD42017080925). A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being. © 2018 John Wiley & Sons Ltd.

  12. The economic status of older people's households in urban and rural settings in Peru, Mexico and China: a 10/66 INDEP study cross-sectional survey.

    PubMed

    Prince, Martin J; Lloyd-Sherlock, Peter; Guerra, Mariella; Huang, Yueqin; Sosa, Ana Luisa; Uwakwe, Richard; Acosta, Isaac; Liu, Zhaorui; Gallardo, Sara; Guerchet, Maelenn; Mayston, Rosie; de Oca, Veronica Montes; Wang, Hong; Ezeah, Peter

    2016-01-01

    Few data are available from middle income countries regarding economic circumstances of households in which older people live. Many such settings have experienced rapid demographic, social and economic change, alongside increasing pension coverage. Population-based household surveys in rural and urban catchment areas in Peru, Mexico and China. Participating households were selected from all households with older residents. Descriptive analyses were weighted back for sampling fractions and non-response. Household income and consumption were estimated from a household key informant interview. 877 Household interviews (3177 residents). Response rate 68 %. Household income and consumption correlated plausibly with other economic wellbeing indicators. Household Incomes varied considerably within and between sites. While multigenerational households were the norm, older resident's incomes accounted for a high proportion of household income, and older people were particularly likely to pool income. Differences in the coverage and value of pensions were a major source of variation in household income among sites. There was a small, consistent inverse association between household pension income and labour force participation of younger adult co-residents. The effect of pension income on older adults' labour force participation was less clear-cut. Historical linkage of social protection to formal employment may have contributed to profound late-life socioeconomic inequalities. Strategies to formalise the informal economy, alongside increases in the coverage and value of non-contributory pensions and transfers would help to address this problem.

  13. Needing smart home technologies: the perspectives of older adults in continuing care retirement communities.

    PubMed

    Courtney, Karen L; Demiris, George; Rantz, Marilyn; Skubic, Marjorie

    2008-01-01

    At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs), which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies. This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology. Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities). This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3). The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns. Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.

  14. 77 FR 54495 - Regulated Navigation Area; Thames River Degaussing Range Replacement Operations; New London, CT

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-05

    ... to establish a regulated navigation area (RNA) on the navigable waters of the Thames River in New London Harbor, New London, CT. The proposed RNA would establish speed and wake restrictions as well as allow the Coast Guard to prohibit all vessel traffic through the RNA during degaussing range replacement...

  15. Rural Residence and Prescription Medication Use by Community-Dwelling Older Adults: A Review of the Literature

    ERIC Educational Resources Information Center

    Grymonpre, Ruby E.; Hawranik, Pamela G.

    2008-01-01

    Context: Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts. Purpose: To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess…

  16. Use of Opioid Analgesics in Older Australians.

    PubMed

    Veal, Felicity C; Bereznicki, Luke R E; Thompson, Angus J; Peterson, Gregory M

    2015-08-01

    To identify potential medication management issues associated with opioid use in older Australians. Retrospective cross-sectional review of the utilization of analgesics in 19,581 people who underwent a medication review in Australia between 2010 and 2012. Australian residents living in the community deemed at risk for adverse medication outcomes or any resident living fulltime in an aged care facility. Patient characteristics in those taking regularly dosed opioids and not and those taking opioid doses >120 mg and ≤120 mg MEQ/day were compared. Multivariable binary logistic regression was used to analyze the association between regular opioid and high dose opioid usage and key variables. Additionally, medication management issues associated with opioids were identified. Opioids were taken by 31.8% of patients, with 22.1% taking them regularly. Several major medication management issues were identified. There was suboptimal use of multimodal analgesia, particularly a low use of non-opioid analgesics, in patients taking regular opioids. There was extensive use (45%) of concurrent anxiolytics/hypnotics among those taking regular opioid analgesics. Laxative use in those prescribed opioids regularly was low (60%). Additionally, almost 12% of patients were taking doses of opioid that exceeded Australian recommendations. A significant evidence to practice gap exists regarding the use of opioids amongst older Australians. These findings highlight the need for a quick reference guide to support prescribers in making appropriate decisions regarding pain management in older patients with persistent pain. This should also be combined with patient and caregiver education about the importance of regular acetaminophen to manage persistent pain. Wiley Periodicals, Inc.

  17. Learning behaviour and preferences of family medicine residents under a flexible academic curriculum

    PubMed Central

    Sy, Alice; Wong, Eric; Boisvert, Leslie

    2014-01-01

    Abstract Objective To determine family medicine residents’ learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Design Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. Setting London, Ont. Participants All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Main outcome measures Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. Results A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians’ teaching sessions (20%), and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents’ homes (32%), and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Conclusion Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents’ various learning preferences and

  18. Perceived Barriers to Optimum Nutrition among Congregate (Sheltered) Housing Residents in the USA

    ERIC Educational Resources Information Center

    Mahadevan, Meena; Hartwell, Heather; Feldman, Charles; Raines, Emily

    2014-01-01

    Objective: Malnutrition, secondary to decreased food intake, is a public health problem of epidemic proportions among older adults in the United States of America (USA). Compared to community-dwelling senior citizens, congregate (sheltered) housing residents are found to be frailer, with documented deficiencies in several major and minor…

  19. The role of social relationships among elderly community-dwelling and nursing-home residents: findings from a quality of life study.

    PubMed

    Scocco, Paolo; Nassuato, Mario

    2017-07-01

    In Western countries, older adults' needs are often managed through institutionalization. Based on the assumption that quality of life, particularly social relationships, may be perceived differently according to residential setting, the aims of this study were to compare World Health Organization Quality of Life brief version (WHOQOL-BREF) scores of elderly community-dwelling residents and nursing home residents. A sample of 207 older adults (135 community-dwelling residents, 72 nursing home residents) was evaluated with Mini-Mental State Examination (MMSE), WHOQOL-BREF, and Geriatric Depression Scale (GDS). Nursing home residents achieved lower WHOQOL-BREF scores on the physical health scale only (P = 0.002). In a linear regression model, physical score correlated negatively with GDS score (P = 0.0001) and Mini-Mental State Examination score (P = 0.04), but positively with male gender (P = 0.02) and community-dwelling residence (P = 0.001); psychological score correlated negatively with GDS score (P = 0.0001) and being married (P = 0.03), but positively with male gender (P = 0.009) and being unmarried (P = 0.03). The social relationships score correlated negatively with the GDS score (P = 0.0001) and male gender (P = 0.02), but positively with high education level (P = 0.04). The environment score negatively correlated with GDS score (P = 0.0001). In a logistic regression model, living in a nursing home correlated with female gender (P = 0.001), age (P = 0.0001), a lower physical score (P = 0.0001), and a higher social relationships score (P = 0.02). Depressive symptoms correlated with low scores in all WHOQOL-BREF domains. The variables that correlated with living conditions in a nursing home were older age, male gender, lower physical domain scores, and higher social relationship scores. Opportunities for socialization in nursing homes may thus improve perception of quality of life in this domain. © 2017 Japanese Psychogeriatric Society.

  20. Lounging with robots--social spaces of residents in care: A comparison trial.

    PubMed

    Peri, Kathryn; Kerse, Ngaire; Broadbent, Elizabeth; Jayawardena, Chandimal; Kuo, Tony; Datta, Chandan; Stafford, Rebecca; MacDonald, Bruce

    2016-03-01

    To investigate whether robots could reduce resident sleeping and stimulate activity in the lounges of an older persons' care facility. Non-randomised controlled trial over a 12-week period. The intervention involved situating robots in low-level and high-dependency ward lounges and a comparison with similar lounges without robots. A time sampling observation method was utilised to observe resident behaviour, including sleep and activities over periods of time, to compare interactions in robot and no robot lounges. The use of robots was modest; overall 13% of residents in robot lounges used the robot. Utilisation was higher in the low-level care lounges; on average, 23% used the robot, whereas in high-level care lounges, the television being on was the strongest predictor of sleep. This study found that having robots in lounges was mostly a positive experience. The amount of time residents slept during the day was significantly less in low-level care lounges that had a robot. © 2015 AJA Inc.

  1. Methane Emissions in the London Region: Deciphering Regional Sources with Mobile Measurements

    NASA Astrophysics Data System (ADS)

    Zazzeri, G.; Lowry, D.; Fisher, R. E.; France, J. L.; Lanoisellé, M.; Bjorkegren, A.; Nisbet, E. G.

    2014-12-01

    Methane stable isotope analysis, coupled with mole fraction measurement, has been used to link isotopic signature to methane emissions from the leading methane sources in the London region, such as landfills and gas leaks. A mobile Picarro G2301 CRDS analyser was installed in a vehicle, together with an anemometer and a Hemisphere GPS receiver, to measure atmospheric methane mole fractions and their relative location. When methane plumes were located and intercepted, air samples were collected in Tedlar bags, for δ13C-CH4 isotopic analysis by CF-GC-IRMS (Continous Flow-Gas Chromatography-Isotopic Ratio Mass Spectroscopy). This method provides high precision isotopic values, determining δ13C-CH4 to ±0.05 per mil. The bulk signature of the methane plume into the atmosphere from the whole source area was obtained by Keeling plot analysis, and a δ13C-CH4 signature, with the relative uncertainty, allocated to each methane source investigated. The averaged δ13C-CH4 signature for landfill sites around the London region is - 58 ± 3 ‰, whereas the δ13C-CH4 signature for gas leaks is fairly constant at -36 ± 2 ‰, a value characteristic of North Sea supply. The Picarro G2301 analyser was installed also on the roof of King's College London, located in the centre of the city, and connected to an air inlet located 7 meters above roof height. An auto-sampler was connected to the same air inlet and launched remotely when a high nocturnal build up was expected, allowing up to twenty air bags to be collected for methane isotopic analysis over a 24 hour period. The main source contributing to overnight methane build up in central London is fugitive gas, in agreement with inventories. From the isotopic characterisation of urban methane sources and the source mix in London, the contribution to the urban methane budget and the local distribution of the methane sources given in inventories can be validated.

  2. Contrasting VOC Composition in London, UK and Beijing, China

    NASA Astrophysics Data System (ADS)

    Dunmore, R.; Hopkins, J. R.; Shaw, M.; Squires, F. A.; Lee, J. D.; Lewis, A. C.; Hamilton, J. F.

    2017-12-01

    With an increasing fraction of the world's population now living in megacities, urban air quality in those locations has the potential to be one of the largest controllable factors for public health. Both London and Beijing are classified as megacities, with the latter almost twice as densely populated. The key drivers and trajectory of air pollution are unique to each location; London has substantially reduced PM10 concentrations over the past two decades but continues to have high urban NO2. Beijing has had well-reported high levels of PM, is now in a phase of gradual decline, and has proportionately low NO2. Both locations however, continue to emit a mix of gas phase pollutants with the potential to form photochemical ozone. Whilst the abundance of NOx in each city is relatively straightforward to quantify, the VOC mixtures that are present differ between these two cities and this has consequential impacts on the downwind ozone formation potential. This work reports a comprehensive assessment of VOC speciation, reactivity and abundance in the two cities using a common set of inter-comparable measurement approaches. Hourly observations of VOCs over the range C2 - C13+ were made using two gas chromatography (GC) instruments; a PLOT column based GC for the most volatile fraction (C2-C7) and a comprehensive two-dimensional GC (GCxGC) for VOCs with more than 7 carbons. London has atmospheric VOC concentrations that in mass and reactivity terms are dominated by longer chain VOCs from diesel fuel. The VOC mixture in ambient Beijing air is dominated by short chain VOCs, a mix of both alkenes from incomplete combustion sources and alkanes and aromatics from petrochemical sources. The substantial difference in the fleet proportions of gasoline and diesel powered vehicles between the two cities is clearly reflected in ambient VOCs. In summertime, isoprene was a notable contributor to VOC reactivity in both cities despite both being highly urbanised locations. The absolute

  3. VOC emission rates over London and South East England obtained by airborne eddy covariance.

    PubMed

    Vaughan, Adam R; Lee, James D; Shaw, Marvin D; Misztal, Pawel K; Metzger, Stefan; Vieno, Massimo; Davison, Brian; Karl, Thomas G; Carpenter, Lucy J; Lewis, Alastair C; Purvis, Ruth M; Goldstein, Allen H; Hewitt, C Nicholas

    2017-08-24

    Volatile organic compounds (VOCs) originate from a variety of sources, and play an intrinsic role in influencing air quality. Some VOCs, including benzene, are carcinogens and so directly affect human health, while others, such as isoprene, are very reactive in the atmosphere and play an important role in the formation of secondary pollutants such as ozone and particles. Here we report spatially-resolved measurements of the surface-to-atmosphere fluxes of VOCs across London and SE England made in 2013 and 2014. High-frequency 3-D wind velocities and VOC volume mixing ratios (made by proton transfer reaction - mass spectrometry) were obtained from a low-flying aircraft and used to calculate fluxes using the technique of eddy covariance. A footprint model was then used to quantify the flux contribution from the ground surface at spatial resolution of 100 m, averaged to 1 km. Measured fluxes of benzene over Greater London showed positive agreement with the UK's National Atmospheric Emissions Inventory, with the highest fluxes originating from central London. Comparison of MTBE and toluene fluxes suggest that petroleum evaporation is an important emission source of toluene in central London. Outside London, increased isoprene emissions were observed over wooded areas, at rates greater than those predicted by a UK regional application of the European Monitoring and Evaluation Programme model (EMEP4UK). This work demonstrates the applicability of the airborne eddy covariance method to the determination of anthropogenic and biogenic VOC fluxes and the possibility of validating emission inventories through measurements.

  4. Living and dying with dignity: a qualitative study of the views of older people in nursing homes.

    PubMed

    Hall, Sue; Longhurst, Susan; Higginson, Irene

    2009-07-01

    most older people living in nursing homes die there. An empirically based model of dignity has been developed, which forms the basis of a brief psychotherapy to help promote dignity and reduce distress at the end of life. to explore the generalisability of the dignity model to older people in nursing homes. qualitative interviews were used to explore views on maintaining dignity of 18 residents of nursing homes. A qualitative descriptive approach was used. The analysis was both deductive (arising from the dignity model) and inductive (arising from participants' views). the main categories of the dignity model were broadly supported: illness-related concerns, social aspects of the illness experience and dignity conserving repertoire. However, subthemes relating to death were not supported and two new themes emerged. Some residents saw their symptoms and loss of function as due to old age rather than illness. Although residents did not appear to experience distress due to thoughts of impending death, they were distressed by the multiple losses they had experienced. these findings add to our understanding of the concerns of older people in care homes on maintaining dignity and suggest that dignity therapy may bolster their sense of dignity.

  5. Vocational training for general practice in inner London. Is there a dearth? And if so what's to be done?

    PubMed Central

    Harris, T.; Silver, T.; Rink, E.; Hilton, S.

    1996-01-01

    OBJECTIVE--To identify the nature and extent of any vocational training deficit within the London initiative zone and investigate the reasons. DESIGN--Collation of statistics and postal questionnaire surveys. SETTING--Thames regions inside and outside the London initiative zone. SUBJECTS--General practice registrars, trainers, principals from non-training practices, and vocational training course organisers. MAIN OUTCOME MEASURES--Trends in numbers of general practice registrars, proportions of trainers, views on current vocational training in inner London. RESULTS--Numbers of general practice registrars fell significantly between 1988 and 1993 within the London initiative zone and in England overall. The number of registrars within the zone fell by more than in the rest of the Thames regions, where the decline was not statistically significant. A lower proportion of principals were approved as trainers within the zone than in the rest of the Thames regions and England overall. In their responses to the survey (88% of inner London registrars responded and 81% of outer Thames registrars) registrars suggested that improving remuneration and personal safety would make training in London more attractive. Trainers and non-trainers (response rates 89% and 66% respectively) also suggested increasing remuneration for trainers together with more protected time for training. CONCLUSIONS--Less vocational training takes place within the London initiative zone than in the rest of the Thames regions and England overall, although there are discrepancies in official statistics. As well as specific recommendations for improving recruitment to vocational training in inner London, measures to tackle inner city deprivation should also remain high on the political agenda. PMID:8555940

  6. Reisebericht London: Interner Workshop: "Knowledge Based Systems in Information Science" (London Travel Report: Internal Workshop: "Knowledge Based Systems in Information Science").

    ERIC Educational Resources Information Center

    Simon, Hans-Reiner

    Written in German, this report summarizes a workshop on teaching and research activities in information science that was held at the City University, London, and attended by faculty and students from the university's Department of Information Science and H.-R. Simon of the GID (Gesellschaft fur Information und Dokumentation), Frankfort am Main,…

  7. Spatially resolved flux measurements of NOx from London suggest significantly higher emissions than predicted by inventories.

    PubMed

    Vaughan, Adam R; Lee, James D; Misztal, Pawel K; Metzger, Stefan; Shaw, Marvin D; Lewis, Alastair C; Purvis, Ruth M; Carslaw, David C; Goldstein, Allen H; Hewitt, C Nicholas; Davison, Brian; Beevers, Sean D; Karl, Thomas G

    2016-07-18

    To date, direct validation of city-wide emissions inventories for air pollutants has been difficult or impossible. However, recent technological innovations now allow direct measurement of pollutant fluxes from cities, for comparison with emissions inventories, which are themselves commonly used for prediction of current and future air quality and to help guide abatement strategies. Fluxes of NOx were measured using the eddy-covariance technique from an aircraft flying at low altitude over London. The highest fluxes were observed over central London, with lower fluxes measured in suburban areas. A footprint model was used to estimate the spatial area from which the measured emissions occurred. This allowed comparison of the flux measurements to the UK's National Atmospheric Emissions Inventory (NAEI) for NOx, with scaling factors used to account for the actual time of day, day of week and month of year of the measurement. The comparison suggests significant underestimation of NOx emissions in London by the NAEI, mainly due to its under-representation of real world road traffic emissions. A comparison was also carried out with an enhanced version of the inventory using real world driving emission factors and road measurement data taken from the London Atmospheric Emissions Inventory (LAEI). The measurement to inventory agreement was substantially improved using the enhanced version, showing the importance of fully accounting for road traffic, which is the dominant NOx emission source in London. In central London there was still an underestimation by the inventory of 30-40% compared with flux measurements, suggesting significant improvements are still required in the NOx emissions inventory.

  8. Seasonal influenza vaccination delivery through community pharmacists in England: evaluation of the London pilot.

    PubMed

    Atkins, Katherine; van Hoek, Albert Jan; Watson, Conall; Baguelin, Marc; Choga, Lethiwe; Patel, Anika; Raj, Thara; Jit, Mark; Griffiths, Ulla

    2016-02-16

    To evaluate the effectiveness and cost of the pan-London pharmacy initiative, a programme that allows administration of seasonal influenza vaccination to eligible patients at pharmacies. We analysed 2013-2015 data on vaccination uptake in pharmacies via the Sonar reporting system, and the total vaccination uptake via 2011-2015 ImmForm general practitioner (GP) reporting system data. We conducted an online survey of London pharmacists who participate in the programme to assess time use data, vaccine choice, investment costs and opinions about the programme. We conducted an online survey of London GPs to assess vaccine choice of vaccine and opinions about the pharmacy vaccine delivery programme. All London boroughs. London-based GPs, and pharmacies that currently offer seasonal flu vaccination. Not applicable. Comparison of annual vaccine uptake in London across risk groups from years before pharmacy vaccination introduction to after pharmacy vaccination introduction. Completeness of vaccine uptake reporting data. Cost to the National Health Service (NHS) of flu vaccine delivery at pharmacies with that at GPs. Cost to pharmacists of flu delivery. Opinions of pharmacists and GPs regarding the flu vaccine pharmacy initiative. No significant change in the uptake of seasonal vaccination in any of the risk groups as a result of the pharmacy initiative. While on average a pharmacy-administered flu vaccine dose costs the NHS up to £2.35 less than a dose administered at a GP, a comparison of the 2 recording systems suggests there is substantial loss of data. Flu vaccine delivery through pharmacies shows potential for improving convenience for vaccine recipients. However, there is no evidence that vaccination uptake increases and the use of 2 separate recording systems leads to time-consuming data entry and missing vaccine record data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Factors Influencing Food Choices Among Older Adults in the Rural Western USA.

    PubMed

    Byker Shanks, Carmen; Haack, Sarah; Tarabochia, Dawn; Bates, Kate; Christenson, Lori

    2017-06-01

    Nutrition is an essential component in promoting health and quality of life into the older adults years. The purpose of this qualitative research is to explore how the rural food environment influences food choices of older adults. Four focus groups were conducted with 33 older adults (50 years of age and older) residing in rural Montana communities. Four major themes related to factors influencing food choices among rural older adults emerged from this study: perception of the rural community environment, support as a means of increasing food access, personal access to food sources, and dietary factors. The findings from this current study warrant further research and promotion of specifically tailored approaches that influence the food choices of older adults in the rural western USA, including the developing and expanding public transportation systems, increasing availability of local grocers with quality and affordable food options, increasing awareness and decreasing stigma surrounding community food programs, and increasing nutrition education targeting senior health issues.

  10. Battersea: Education in a London Parish since 1750

    ERIC Educational Resources Information Center

    Saint, Andrew

    2010-01-01

    This paper examines the development of educational institutions and buildings in one slice of a big city over a long timescale. The city is London and the slice Battersea, an inner suburb of mixed character and volatile fortunes. The narrative explores the shifts and interactions between state and voluntary provision, local community needs and…

  11. Medical pluralism of the Chinese in London: an exploratory study.

    PubMed

    Rochelle, Tina L; Marks, David F

    2010-11-01

    This study was designed to examine the extent of medical pluralism among the Chinese in London. Members of the London Chinese community were recruited through Chinese organizations in London and participated in six focus groups. A total of 48 Chinese men and women aged 24-74 years were asked to talk about their health behaviour and health utilization patterns. Transcripts of the focus group discussions underwent thematic analysis to explore and describe the utilization of traditional Chinese medicine (TCM) and Western medicine (WM) of informants and factors that impacted on utilization. Findings focus on participants' evaluation of TCM and WM as two systems of health provision, how informants used these two health systems, and the reasons associated with use of these two systems. Utilization of TCM and WM varied. Concurrent use of TCM and WM was common. The National Health Service was generally perceived as difficult to use, with concerns over the language barrier, and communicating with and being able to trust health providers. The UK TCM trade was perceived as being aimed at the non-Chinese market and there were issues of trust related to the regulation of UK TCM. Although none of these issues are unique to the Chinese in the UK, previous experience with different approaches to health care, particularly TCM, may make the experience of such barriers more extreme.

  12. Seeing you through London 2012: eye care at the Paralympics.

    PubMed

    Wilson, Clare M; Thomson, W David; D'Ath, Penny J

    2013-09-01

    The provision of eye care services for competitors and support teams is integral to the modern Olympic Games. The eye clinic for the London 2012 Paralympic Games employed a multidisciplinary team of eye care professionals using state-of-the-art instrumentation to provide the highest level of eye care. The detailed organisation of the eye care clinic at London 2012 is described in a companion paper which summarises the eye care clinic during the London 2012 Olympic Games. These two reports will aid in planning eye care clinics at future Games. This paper summarises the organisation of the eye clinic and provides outline audit data relating to eye conditions encountered during the Paralympic Games. A total of 870 patients representing 102 countries attended the eye clinic. 274 (31.5%) were competitors; the remainder were trainers and support staff. No serious ocular injuries resulted from competitor injury in the field of play during the Paralympic Games, although seven patients were referred urgently to hospital eye services for conditions including orbital cellulitis, retinal detachment, exudative macular degeneration, corneal ulcer, Stevens-Johnson syndrome and macular oedema. A total of 749 spectacles, 14 pairs of contact lenses and 7 low vision aids were dispensed. By combining excellent facilities and equipment with a multidisciplinary team of eye care professionals, we feel we provided the highest level of eye care, providing a legacy for future Games.

  13. Life Satisfaction among Older Persons: Rural-Urban and Racial Comparisons.

    ERIC Educational Resources Information Center

    Donnenwerth, Gregory V.; And Others

    1978-01-01

    Investigates the effect of residence and race on life satisfaction among older persons living in rural and urban counties in the mid-South. Finds satisfaction highest among rural Blacks followed by urban Whites, rural Whites, and urban Blacks. Examines income and social contact as correlates of life satisfaction. (Author/KC)

  14. Engendering City Politics and Educational Thought: Elite Women and the London Labour Party, 1914-1965

    ERIC Educational Resources Information Center

    Martin, Jane

    2008-01-01

    This article uses biographical approaches to recover the contribution of hitherto neglected figures in the history of education and the political history of the Left in London. Place and location are important since it is important to grasp the uniqueness of the London County Council within the framework of English local government and of the…

  15. Why is tractable vision loss in older people being missed? Qualitative study.

    PubMed

    Kharicha, Kalpa; Iliffe, Steve; Myerson, Sybil

    2013-07-16

    There is compelling evidence that there is substantial undetected vision loss amongst older people. Early recognition of undetected vision loss and timely referral for treatment might be possible within general practice, but methods of identifying those with unrecognised vision loss and persuading them to take up services that will potentially improve their eyesight and quality of life are not well understood. Population screening does not lead to improved vision in the older population. The aim of this study is to understand why older people with vision loss respond (or not) to their deteriorating eyesight. Focus groups and interviews were carried out with 76 people aged 65 and over from one general practice in London who had taken part in an earlier study of health risk appraisal. An analytic induction approach was used to analyse the data. Three polarised themes emerged from the groups and interviews. 1) The capacity of individuals to take decisions and act on them effectively versus a collection of factors which acted as obstacles to older people taking care of their eyesight. 2) The belief that prevention is better than cure versus the view that deteriorating vision is an inevitable part of old age. 3) The incongruence between the professionalism and personalised approach of opticians and the commercialisation of their services. The reasons why older people may not seek help for deteriorating vision can be explained in a model in which psychological attributes, costs to the individual and judgments about normal ageing interact. Understanding this model may help clinical decision making and health promotion efforts.

  16. Promoting older peoples' participation in activity, whose responsibility? A case study of the response of health, local government and voluntary organizations.

    PubMed

    Goodman, C; Davies, S; Tai, S See; Dinan, S; Iliffe, S

    2007-10-01

    The benefits for older people of participating in regular activity are well documented. This paper focuses on how publicly funded community-based organizations enable older people to engage in physical activity. The research questions were: (i) What activity promotion schemes/initiatives exist for older people? (ii) Who has responsibility for them, how are they funded and organized and what evidence exists of interagency working? (iii) Who are the older people that participate? (iv) What are the perceived and measurable outcomes of the initiatives identified? To establish the type and range of provision for older people in a sector of London, the strategies and information about existing activity promoting schemes of inner city health, local government and voluntary organizations were reviewed. Key informants were then interviewed to establish the rationale, achievements and different schemes. One hundred and nine activity-promoting initiatives for older people were identified. Most were provided within an environment of short-term funding and organizational upheaval and reflected eclectic theoretical and ideological approaches. The findings demonstrate: (i) the need for organizations to apply evidence about what attracts and sustains older people's participation in physical activity, and (ii) the need to develop funded programmes that build on past achievements, have explicit outcomes and exploit opportunities for cross agency working.

  17. Functional performance and exercise of older adults in long-term care settings.

    PubMed

    Resnick, B

    2000-03-01

    Performing functional activities and exercising are important for older adults living in long-term care settings. Participation in these activities not only improves and maintains function in older adults but also can improve physical and emotional health and quality of life. The purpose of this study was to explore the variables that influence functional performance and exercise activity in a group of nursing home residents. Participants included 59 residents in a long-term care facility. The mean age of participants was 88 +/- 6.9, and the majority were women (76%), White (97%), and unmarried (76%). Residents participated in a single face-to-face interview. Chart reviews for demographic and health information also were performed. Based on stepwise multiple regression analyses, upper and lower extremity contractures and cognitive status were the only variables that significantly influenced functional performance and accounted for 49% of the variance in function. Self-efficacy and outcome expectations were the only variables to significantly influence exercise behavior and accounted for 57% of the variance in this behavior. These findings can be used to help develop and implement effective restorative nursing care programs in long-term care settings.

  18. Paediatric primary care in Inner London

    PubMed Central

    Jackson, Jane

    1980-01-01

    A week's census was taken of children attending family doctors or hospital accident and emergency departments in an inner city area of London. Most attendances at general hospitals were for cases of trauma while the children's hospital was used mainly by the very young, coming from a wide catchment area. An over-emphasis on hospital-based primary care would not be appropriate in this area and would run counter to the whole philosophy of British medical practice. ImagesFigure 1.Figure 4. PMID:7452588

  19. The Rural – Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

    PubMed Central

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    Context Mexico Purpose Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen’s “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168

  20. Different Ways of Experiencing Music-Making in Later Life: Creative Music Sessions for Older Learners in East London

    ERIC Educational Resources Information Center

    Varvarigou, Maria; Hallam, Susan; Creech, Andrea; McQueen, Hilary

    2013-01-01

    There has been a gradual increase in the body of literature regarding seniors' musical preferences, learning approaches, development, and creativity. This literature dispels existing myths that perceive older people as a homogeneous group, characterized by decrepitude and diminishing capacity, and with a passive contribution to society. A…

  1. [Medication use among community-dwelling older Icelanders. Population-based study in urban and rural areas].

    PubMed

    Sigurdardottir, Arun K; Arnadottir, Solveig Asa; Gunnarsdottir, Elín Díanna

    2011-12-01

    To describe medication use among older community-dwelling Icelanders by collecting information on number of medicine, polypharmacy (>5 medications), and medications by ATC categories. Moreover, to explore the relationship between medication use and various influential factors emphasizing residency in urban and rural areas. Population-based, cross-sectional study. Participants were randomly selected from the National registry in one urban (n=118) and two rural (n=68) areas. 1) ≥ 65 years old, 2) community-dwelling, 3) able to communicate verbally. Information on medication use was obtained from each person's medication list and interviews. A questionnaire and five standardized instruments were used to assess the potential influencing factors. On average, participants used 3.9 medications and prevalence of polypharmacy was 41%. Men used 3.5 medications on average and women 4.4 (p=0.018). Compared to rural residents, urban residents had fewer medical diagnoses, better mobility, less pain, and fewer depressive symptoms. By controlling for the effects of these variables, more medications were associated with urban living (p<0.001) and more medical diagnoses (p<0.001). Likewise, adjusted odds for polypharmacy increased with urban residency (p=0.023) and more medical diagnoses (p=0.005). Urban residency, more medical diagnoses, higher age, and male gender were related to use of drugs for blood and blood forming organs. The results reveal an unexplained regional difference in medications use by older Icelanders. Further studies are required on why urban residents use at least equal amount of medications as rural residents despite better scores on health assessments.

  2. Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

    PubMed

    Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G

    2015-10-14

    Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

  3. Thoughts of Quitting General Surgery Residency: Factors in Canada.

    PubMed

    Ginther, David Nathan; Dattani, Sheev; Miller, Sarah; Hayes, Paul

    2016-01-01

    Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors. An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center. The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age. Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  4. Workplace satisfaction in a mental health service for older adults: an analysis of the effects of setting and professional status.

    PubMed

    McCrae, Niall; Prior, Sue; Silverman, Marisa; Banerjee, Sube

    2007-02-01

    Research in mental health services for working-age adults has repeatedly shown that work is found more satisfying, if more stressful, by community practitioners than by hospital-based staff. This study examined whether similar differences exist in services for older adults and how this might be influenced by the high proportion of nonprofessionally qualified workers in inpatient settings for mentally infirm older people. The Work Environment Scale was given to all practitioners in a mental health service for older adults in a single London borough. Adjusting for the effect of professional status, community practitioners rated involvement, task orientation, and supervision more positively than institutional staff, but gave less favorable ratings for work pressure and physical comfort. Nurses rated peer cohesion, supervision, autonomy, and innovation more positively than nursing assistants, after controlling for type of setting. Multivariate modeling confirmed that type of setting and professional group were both associated with workplace satisfaction, accounting for 24% and 13% of the variance, respectively. The study highlights aspects of the work environment of mental health staff working with older adults that might benefit from attention.

  5. Changing incidence and management of penetrating neck injuries in the South East London trauma centre.

    PubMed

    Harris, R; Olding, C; Lacey, C; Bentley, R; Schulte, K M; Lewis, D; Kandasamy, N; Oakley, R

    2012-05-01

    A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King's College Hospital over a 3-year period in the 1980s. In April 2010 King's College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years. Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment. The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality. The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.

  6. Are residents of aged care facilities willing to have their medications deprescribed?

    PubMed

    Kalogianis, Mona J; Wimmer, Barbara C; Turner, Justin P; Tan, Edwin C K; Emery, Tina; Robson, Leonie; Reeve, Emily; Hilmer, Sarah N; Bell, J Simon

    2016-01-01

    There has been recent interest in deprescribing, particularly among older people. No previous studies have assessed whether residents of aged care facilities are willing to have their medications deprescribed. Understanding residents' attitudes toward deprescribing is important for developing deprescribing interventions. To investigate residents' willingness to have their medications deprescribed. This was a cross-sectional survey of 232 residents aged ≥65 years from six residential aged care facilities (RACFs) across metropolitan and regional South Australia. Overall, 163 of the 232 residents (70.3%) took ≥9 regular medications. All participants completed the 10-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. Overall, 40.5% of residents reported a desire to stop taking one or more of their medications. If their doctor said it was possible, 78.9% of residents were willing to have one or more of their medications deprescribed. Residents taking ≥9 medications were more likely to feel that they were taking a large number of medications compared to residents taking <9 medications (50.3% vs 14.5%, P < 0.01), and were more likely to believe one or more of their medications was causing side effects (14.7% vs 10.1%, P = 0.02). However, residents taking ≥9 regular medications were not significantly more likely to want to reduce their number of medications than residents taking <9 medications. Deprescribing interventions are likely to be acceptable to residents' of RACFs, with a high willingness to discontinue medicines if doctors say it is possible. This highlights the importance of the proactive involvement of health care professionals in an individualized deprescribing process. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Thermal and health outcomes of energy efficiency retrofits of homes of older adults.

    PubMed

    Ahrentzen, S; Erickson, J; Fonseca, E

    2016-08-01

    Mitigation of thermal stress and adverse indoor climatic conditions is important to older low-income populations whose age, health, and economic circumstances make them vulnerable to indoor environmental conditions. This research examines whether energy retrofits in affordable housing for older adults can also improve indoor climatic (i.e., temperature, humidity, air infiltration) conditions and whether such improvements correspond with improved health and comfort of residents. An apartment complex for low-income older adults in Phoenix was the study site. In 2010, renovations were undertaken to make it more energy efficient and to replace interior cabinetry, flooring, and paint with materials that had low or no volatile organic compounds (VOCs). Fifty-seven residents from 53 apartment units participated in both baseline (pre-renovation) and 1 year post-renovation data collection trials. Environmental measures included temperature, relative humidity, and air infiltration. Health measures included general health, emotional distress, and sleep. Four questions addressed residents' perceptions of temperature quality. Results demonstrated a 19% reduction in energy consumption following the retrofit. In addition, fixed effects statistical models of the panel data showed significant stabilization of unit temperature from pre-retrofit to 1 year post-retrofit. Reductions in an apartment's temperature extremes of 27.2°C (81°F) and above also corresponded with improvement in occupant's reported health over the same time period, although not with occupant's perceptions of thermal comfort. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Using GIS to Understand and Prioritise Worker Movements during the 2012 London Olympics

    NASA Astrophysics Data System (ADS)

    McGuinness, I. M.

    2013-05-01

    The performance of the transport network and the associated movement of people was one of the most critical elements to London's successful delivery of the 2012 Olympic Games. During the planning stages Transport for London asked the London Borough of Newham to mitigate the impact of the authority's 13 500 employees on transport infrastructure close to the Olympic Park. To achieve this, the authority needed to understand the geographic distribution of its workforce and the demand it placed on roads and local transport hubs. The authority's Geospatial Team led the research based on four cross-referenced data sources, and spatial analysis was used to determine priorities for special absence arrangements and a commissioned coach service. The research was used to support a targeted information campaign but also presented considerations on large-scale data collection, the use of Human Resources data, and the degree to which the movement of people can be measured and managed.

  9. Tracer concentration profiles measured in central London as part of the REPARTEE campaign

    NASA Astrophysics Data System (ADS)

    Martin, D.; Petersson, K. F.; White, I. R.; Henshaw, S. J.; Nickless, G.; Lovelock, A.; Barlow, J. F.; Dunbar, T.; Wood, C. R.; Shallcross, D. E.

    2009-11-01

    There have been relatively few tracer experiments carried out that have looked at vertical plume spread in urban areas. In this paper we present results from cyclic perfluorocarbon tracer experiments carried out in 2006 and 2007 in central London centred on the BT Tower as part of the REPARTEE (Regent's Park and Tower Environmental Experiment) campaign. The height of the tower gives a unique opportunity to study dispersion over a large vertical gradient. These gradients are then compared with classical Gaussian profiles of the relevant stability classes over a range of distances as well as interpretation of data with reference to both anemometry and LIDAR measurements made. Data are then compared with an operational model and contrasted with data taken in central London as part of the DAPPLE campaign looking at dosage compared with non-dimensionalised distance from source. Such analysis illustrates the feasibility of the use of these empirical correlations over these prescribed distances in central London.

  10. A tale of two cities: Comparison of impacts on CO2 emissions, the indoor environment and health of home energy efficiency strategies in London and Milton Keynes

    NASA Astrophysics Data System (ADS)

    Shrubsole, C.; Das, P.; Milner, J.; Hamilton, I. G.; Spadaro, J. V.; Oikonomou, E.; Davies, M.; Wilkinson, P.

    2015-11-01

    Dwellings are a substantial source of global CO2 emissions. The energy used in homes for heating, cooking and running electrical appliances is responsible for a quarter of current total UK emissions and is a key target of government policies for greenhouse gas abatement. Policymakers need to understand the potential impact that such decarbonization policies have on the indoor environment and health for a full assessment of costs and benefits. We investigated these impacts in two contrasting settings of the UK: London, a predominantly older city and Milton Keynes, a growing new town. We employed SCRIBE, a building physics-based health impact model of the UK housing stock linked to the English Housing Survey, to examine changes, 2010-2050, in end-use energy demand, CO2 emissions, winter indoor temperatures, airborne pollutant concentrations and associated health impacts. For each location we modelled the existing (2010) housing stock and three future scenarios with different levels of energy efficiency interventions combined with either a business-as-usual, or accelerated decarbonization of the electricity grid approach. The potential for CO2 savings was appreciably greater in London than Milton Keynes except when substantial decarbonization of the electricity grid was assumed, largely because of the lower level of current energy efficiency in London and differences in the type and form of the housing stock. The average net impact on health per thousand population was greater in magnitude under all scenarios in London compared to Milton Keynes and more beneficial when it was assumed that purpose-provided ventilation (PPV) would be part of energy efficiency interventions, but more detrimental when interventions were assumed not to include PPV. These findings illustrate the importance of considering ventilation measures for health protection and the potential variation in the impact of home energy efficiency strategies, suggesting the need for tailored policy

  11. Recent TB transmission, clustering and predictors of large clusters in London, 2010–2012: results from first 3 years of universal MIRU-VNTR strain typing

    PubMed Central

    Hamblion, Esther L; Le Menach, Arnaud; Anderson, Laura F; Lalor, Maeve K; Brown, Tim; Abubakar, Ibrahim; Anderson, Charlotte; Maguire, Helen; Anderson, Sarah R

    2016-01-01

    Background The incidence of TB has doubled in the last 20 years in London. A better understanding of risk groups for recent transmission is required to effectively target interventions. We investigated the molecular epidemiological characteristics of TB cases to estimate the proportion of cases due to recent transmission, and identify predictors for belonging to a cluster. Methods The study population included all culture-positive TB cases in London residents, notified between January 2010 and December 2012, strain typed using 24-loci multiple interspersed repetitive units-variable number tandem repeats. Multivariable logistic regression analysis was performed to assess the risk factors for clustering using sociodemographic and clinical characteristics of cases and for cluster size based on the characteristics of the first two cases. Results There were 10 147 cases of which 5728 (57%) were culture confirmed and 4790 isolates (84%) were typed. 2194 (46%) were clustered in 570 clusters, and the estimated proportion attributable to recent transmission was 34%. Clustered cases were more likely to be UK born, have pulmonary TB, a previous diagnosis, a history of substance abuse or alcohol abuse and imprisonment, be of white, Indian, black-African or Caribbean ethnicity. The time between notification of the first two cases was more likely to be <90 days in large clusters. Conclusions Up to a third of TB cases in London may be due to recent transmission. Resources should be directed to the timely investigation of clusters involving cases with risk factors, particularly those with a short period between the first two cases, to interrupt onward transmission of TB. PMID:27417280

  12. Challenges in researching migration status, health and health service use: an intersectional analysis of a South London community

    PubMed Central

    Gazard, Billy; Frissa, Souci; Nellums, Laura; Hotopf, Matthew; Hatch, Stephani L.

    2015-01-01

    Objectives. This study aimed to investigate the associations between migration status and health-related outcomes and to examine whether and how the effect of migration status changes when it is disaggregated by length of residence, first language, reason for migration and combined with ethnicity. Design. A total of 1698 adults were interviewed from 1076 randomly selected households in two South London boroughs. We described the socio-demographic and socio-economic differences between migrants and non-migrants and compared the prevalence of health-related outcomes by migration status, length of residence, first language, reason for migration and migration status within ethnic groups. Unadjusted models and models adjusted for socio-demographic and socio-economic indicators are presented. Results. Migrants were disadvantaged in terms of socio-economic status but few differences were found between migrant and non-migrants regarding health or health service use indicators; migration status was associated with decreased hazardous alcohol use, functional limitations due to poor mental health and not being registered with a general practitioner. Important differences emerged when migration status was disaggregated by length of residence in the UK, first language, reason for migration and intersected with ethnicity. The association between migration status and functional limitations due to poor mental health was only seen in White migrants, migrants whose first language was not English and migrants who had moved to the UK for work or a better life or for asylum or political reasons. There was no association between migration status and self-rated health overall, but Black African migrants had decreased odds for reporting poor health compared to their non-migrant counterparts [odds ratio = 0.15 (0.05–0.48), p < 0.01]. Conclusions. Disaggregating migration status by length of residence, first language and reason for migration as well as intersecting it with ethnicity leads

  13. Multimodal and ubiquitous computing systems: supporting independent-living older users.

    PubMed

    Perry, Mark; Dowdall, Alan; Lines, Lorna; Hone, Kate

    2004-09-01

    We document the rationale and design of a multimodal interface to a pervasive/ubiquitous computing system that supports independent living by older people in their own homes. The Millennium Home system involves fitting a resident's home with sensors--these sensors can be used to trigger sequences of interaction with the resident to warn them about dangerous events, or to check if they need external help. We draw lessons from the design process and conclude the paper with implications for the design of multimodal interfaces to ubiquitous systems developed for the elderly and in healthcare, as well as for more general ubiquitous computing applications.

  14. Developing an Integrated Institutional Repository at Imperial College London

    ERIC Educational Resources Information Center

    Afshari, Fereshteh; Jones, Richard

    2007-01-01

    Purpose: This paper aims to demonstrate how a highly integrated approach to repository development and deployment can be beneficial in producing a successful archive. Design/methodology/approach: Imperial College London undertook a significant specifications process to gather and formalise requirements for its repository system. This was done…

  15. Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK

    PubMed Central

    Lambri, Maria; Chakraborty, Apu; Leavey, Gerard; King, Michael

    2012-01-01

    Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably. Conclusions. Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance. PMID:23213300

  16. A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study.

    PubMed

    Tan, Charlie; Graves, Erin; Lu, Hong; Chen, Anna; Li, Shudong; Schwartz, Kevin L; Daneman, Nick

    2017-12-21

    Antimicrobials are frequently prescribed to community-dwelling older adults. Our aim was to examine the prevalence, quantity and indications of antimicrobial prescriptions to older residents of Ontario. We conducted a population-based analysis of outpatient antimicrobial prescriptions to residents of Ontario aged 65 years or more from 2006 to 2015. Antimicrobial prescriptions, infectious disease diagnoses and prescriber information were determined from linked health care databases. Our analyses were primarily focused on antibiotics, which account for most antimicrobial use. We identified 2 879 779 unique Ontario residents aged 65 years or more over our study period. On average, 40.7% (range 40.1%-41.5%) of older adult outpatients in any given year received 1 or more antibiotic prescriptions. Antibiotic use remained stable over the study period, averaging 25.1 (range 24.1-25.6) defined daily doses per 1000 person-days per year. Selection of antibiotics evolved, with increasing use of penicillins and decreasing use of fluoroquinolones and macrolides. For 65.7% of prescriptions, no infectious disease diagnoses were identified within 7 days of the prescription. Among prescriptions with an associated diagnosis, upper respiratory tract infection was most common (18.9%), followed by urinary tract infection (6.2%), skin/soft-tissue infection (4.3%), lower respiratory tract infection (4.2%) and other infection (1.2%). Most antibiotics were prescribed by family physicians. Antibiotic use among older adult outpatients in Ontario remained stable between 2006 and 2015. Current methods of measuring use are not capable of accurately determining indication, and, thus, additional data sources to monitor the appropriateness of community antimicrobial use are needed. Copyright 2017, Joule Inc. or its licensors.

  17. Crucial aspects promoting meaning and purpose in life: perceptions of nursing home residents.

    PubMed

    Drageset, Jorunn; Haugan, Gørill; Tranvåg, Oscar

    2017-10-30

    Meaning and purpose in life are fundamental to human beings. In changing times, with an aging population and increased life expectancy, the need for health care services and long-term care is likely to grow. More deeply understanding how older long-term care residents perceive meaning and purpose in life is critical for improving the quality of care and the residents' quality of life. The purpose of this study was to explore crucial aspects promoting nursing home residents' experience of meaning and purpose in everyday life. An exploratory hermeneutical design with qualitative interviews for collecting data. Four key experiences were found to promote meaning and purpose in life: 1) physical and mental well-being, 2) belonging and recognition, 3) personally treasured activities and 4) spiritual closeness and connectedness. In supporting meaning and purpose in life of nursing home residents, the residents' everyday well-being should be a central focus of care and facilitate personally treasured activities. Focused attention should also be given to the meaning-making power of experiencing belonging, recognition and spiritual connectedness.

  18. Provision of out-of-hours interventional radiology services in the London strategic health authority.

    PubMed

    Illing, R O; Clark, C L Ingham; Allum, C

    2010-04-01

    To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An "ad-hoc" service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24h service. Only two hospitals providing a 24h service had six radiologists on the rota. Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

  19. Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study

    PubMed Central

    Azam, Mohsin; Marwood, Lindsey; Ismail, Khalida; Evans, Tyrrell; Sivaprasad, Sobha; Winkley, Kirsty; Amiel, Stephanie Anne

    2015-01-01

    Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes. PMID:26090473

  20. Parasuicide in central London 1984-1988.

    PubMed Central

    Fuller, G N; Rea, A J; Payne, J F; Lant, A F

    1989-01-01

    Experience of a central London unit dedicated to the care of patients following parasuicide between 1984 and 1988 is reviewed. There were 1160 admissions, which accounted for 11% of all acute adult medical admissions. The female to male ratio was 1.3, with a peak rate for females below 25 years and for males between 20 and 35. Unemployment was found to be a risk factor for parasuicide in men. Benzodiazepines were the most frequently used drug in parasuicide (35%), followed by paracetamol (13%) and aspirin (9%). PMID:2574238

  1. Career goals and expectations of men and women pharmacy residents.

    PubMed

    King, C M; Oliver, E J; Jeffrey, L P

    1982-11-01

    Personal and professional characteristics of men and women hospital pharmacy residents were studied to identify differences that could affect future hospital pharmacy practice. Residents in 111 ASHP-accredited pharmacy residency programs received a survey containing questions on demographic information, reasons for selecting a residency, areas of professional interest, postresidency career goals, responsibilities to home and family, and advantages and disadvantages associated with gender. Of 286 residents receiving questionnaires, 226 responded; the percentages of men and women responding corresponded to the ratio of men and women in hospital pharmacy residencies. While men and women expressed educational goals that were not significantly different, more men than women had earned or were in the process of earning advanced degrees. No significant differences were evident between men's and women's plans for marriage and children, but 73% of the women indicated that they would take time out from their practice to raise children, compared with only 9% of the men. The majority of residents did not think their gender affected them in their residency programs, but in professional interactions more men saw gender as an advantage and more women as a disadvantage. Significantly more than women aspired to be hospital pharmacy directors. The results suggest that men are obtaining advanced training closer to the time they graduate from pharmacy school and that in the future women competing for promotions may be older than men competing for comparable positions. Those planning pharmacy staffing should consider the needs of women, and men, who expect to take time out from their careers for family responsibilities and possibly seek part-time positions when they return to the work force.

  2. Symptom distress in older adults following cancer surgery.

    PubMed

    Van Cleave, Janet H; Egleston, Brian L; Ercolano, Elizabeth; McCorkle, Ruth

    2013-01-01

    Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P < .001, 6 months: P = .002) than at baseline while controlling for demographic, biologic, psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P < .05). Participants 75 years or older reported increased symptom distress over time compared with those aged 65 to 69 years (P < .05). Age, type of cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

  3. A study on the factors influencing the community participation of older adults in China: based on the CHARLS2011 data set.

    PubMed

    Lin, Wenyi

    2017-05-01

    Many communities provide older people with various opportunities to participate in the society. The 2010 Chinese census reveals that the majority of the older adults in China are still healthy, but research shows that older adults have relatively low levels of community participation. This study aims to determine the factors that affect the community participation of older adults in China using data collected from the 2011 China Health and Retirement Longitudinal Study (CHARLS). The CHARLS survey used a multistage sampling strategy to select respondents from 450 resident or village communities in China. A total of 17,000 persons from 10,000 families participated in the survey. The sample for this study includes 4283 individuals aged 60 years and above who have been invited to answer the survey based on their participation in entertainment and volunteer activities within the past month; 1009 were from urban areas and 3247 were from rural areas. Using logistic regression, this study identifies several variables that can predict the community participation of older adults. These variables included educational background, residence status, self-rated living standard and health status, number of available community facilities, expected social support, family care responsibility and involvement/non-involvement in old-age insurance schemes. In addition, an urban-rural difference was observed in the participation of these adults in entertainment activities, and the differences between older adults residing in urban and rural areas were insignificant in terms of their participation in volunteer work. These findings imply that the Chinese government should consider these predictors and the urban-rural differences when making policies regarding the community participation of older adults. © 2017 John Wiley & Sons Ltd.

  4. Seasonality of Formic Acid (HCOOH) in London during the ClearfLo Campaign: Seasonality of Formic Acid in London

    DOE PAGES

    Bannan, Thomas J.; Murray Booth, A.; Le Breton, Michael; ...

    2017-11-09

    Following measurements in the winter of 2012, formic acid (HCOOH) and nitric acid (HNO 3) were measured using a chemical ionization mass spectrometer (CIMS) during the Summer Clean Air for London (ClearfLo) campaign in London, 2012. Consequently, the seasonal dependence of formic acid sources could be better understood. A mean formic acid concentration of 1.3 ppb and a maximum of 12.7 ppb was measured which is significantly greater than that measured during the winter campaign (0.63 ppb and 6.7 ppb, respectively). Daily calibrations of formic acid during the summer campaign gave sensitivities of 1.2 ion counts s -1 parts permore » trillion (ppt) by volume -1 and a limit of detection of 34 ppt. During the summer campaign, there was no correlation between formic acid and anthropogenic emissions such as NO x and CO or peaks associated with the rush hour as was identified in the winter. Rather, peaks in formic acid were observed that correlated with solar irradiance. Analysis using a photochemical trajectory model has been conducted to determine the source of this formic acid. The contribution of formic acid formation through ozonolysis of alkenes is important but the secondary production from biogenic VOCs could be the most dominant source of formic acid at this measurement site during the summer.« less

  5. Seasonality of Formic Acid (HCOOH) in London during the ClearfLo Campaign: Seasonality of Formic Acid in London

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bannan, Thomas J.; Murray Booth, A.; Le Breton, Michael

    Following measurements in the winter of 2012, formic acid (HCOOH) and nitric acid (HNO 3) were measured using a chemical ionization mass spectrometer (CIMS) during the Summer Clean Air for London (ClearfLo) campaign in London, 2012. Consequently, the seasonal dependence of formic acid sources could be better understood. A mean formic acid concentration of 1.3 ppb and a maximum of 12.7 ppb was measured which is significantly greater than that measured during the winter campaign (0.63 ppb and 6.7 ppb, respectively). Daily calibrations of formic acid during the summer campaign gave sensitivities of 1.2 ion counts s -1 parts permore » trillion (ppt) by volume -1 and a limit of detection of 34 ppt. During the summer campaign, there was no correlation between formic acid and anthropogenic emissions such as NO x and CO or peaks associated with the rush hour as was identified in the winter. Rather, peaks in formic acid were observed that correlated with solar irradiance. Analysis using a photochemical trajectory model has been conducted to determine the source of this formic acid. The contribution of formic acid formation through ozonolysis of alkenes is important but the secondary production from biogenic VOCs could be the most dominant source of formic acid at this measurement site during the summer.« less

  6. Sociopolitical context and depressive symptoms in an older Mexican-origin population

    NASA Astrophysics Data System (ADS)

    Miranda, Patricia Yvonne

    A large proportion of older adult Latinos have at least one chronic physical health condition; those same individuals who also exhibit depressive symptoms experience higher mortality rates. Given their projected population growth of 500% by 2050, it is important to disentangle the factors influencing the health status of Latinos aged 65 and older, specifically those who also experience depressive symptoms. Prior studies of depressive symptoms among Latino populations have often failed to consider the role of sociopolitical context---that is, the social, economic, political and historical circumstances that shape an individual's lived experience---and its contribution to understanding within-group differences for health outcomes. This study explores the relationships between sociopolitical context and number of depressive symptoms among an older Mexican-origin population in the U.S., and seeks to disentangle the importance of sociopolitical context from other widely used group stratifications for capturing U.S.-Mexican experiences, including nativity status, length of residence in the U.S., and place of residence during formative years. Study findings do not support rejecting the null hypothesis that there were differences in number of depressive symptoms by nativity status, length of residence in the U.S., or place of residence during formative years. Rather, findings suggest that the interaction of sociopolitical context and the age at which individuals arrive in the U.S. has a significant association with number of depressive symptoms among immigrants. This study takes a novel approach to examine the relationships between sociopolitical context at time of entry in the U.S. and symptoms of depression in later life. The implications of its findings for immigration as well as other social policies are discussed. The significant relationship between the interaction of sociopolitical context during time of entry into the U.S. and age of arrival into the U.S. suggests

  7. Promoting Active Urban Aging: A Measurement Approach to Neighborhood Walkability for Older Adults

    PubMed Central

    Weiss, Rachael L.; Maantay, Juliana A.; Fahs, Marianne

    2011-01-01

    Understanding the role of the built environment on physical activity behavior among older adults is an important public health goal, but evaluating these relationships remains complicated due to the difficulty of measuring specific attributes of the environment. As a result, there is conflicting evidence regarding the association between perceived and objectively measured walkability and physical activity among urban-dwelling older adults. This suggests that both actual environmental features and perceptions of these attributes influence walking behavior. The purpose of this pilot project is to create an Objective Walkability Index (OWI) by census block using a Geographic Information System (GIS) and supplement the results with resident perceptions thus more accurately characterizing the context of walkability. Computerized Neighborhood Environment Tracking (ComNET) was used to systematically assess environmental risks impacting activity patterns of older adults in two New York City neighborhoods. In addition, the Senior Center Evaluation of the Neighborhood Environment (SCENE) survey was administered to older adults attending two senior centers located within the target neighborhoods. The results indicate that there is substantial variation in OWI score both between and within the neighborhoods suggesting that residence in some communities may increase the risk of inactivity among older adults. Also, low walkability census blocks were clustered within each neighborhood providing an opportunity for targeted investigation into localized threats to walkability. A lack of consensus regarding the association between the built environment and physical activity among older adults is a consequence of the problems inherent in measuring these determinants. Further empirical evidence evaluating the complex relationships between the built environment and physical activity is an essential step towards creating active communities. PMID:21874149

  8. Factors associated with falls among older adults living in institutions

    PubMed Central

    2013-01-01

    Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. Results The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with ≤ 1 condition) was 84% (95% CI, 45-95%). Conclusions Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337 PMID:23320746

  9. High School Students Residing in Educational Public Institutions: Health-Risk Behaviors

    PubMed Central

    Silveira, Nusa de Almeida; Noll, Matias; Barros, Patrícia de Sá

    2016-01-01

    Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14–19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of <8 months and those of >20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors. PMID:27560808

  10. Keeping It Safe: Aging in Place among Rural Older Adults

    ERIC Educational Resources Information Center

    Peek, Gina G.; Bishop, Alex J.

    2016-01-01

    The purpose of the study addressed in this article was to identify ways to reduce risk and improve safe aging in place among rural older adults. Resident and Extension faculty and county educators visited study participants at home to assess functional capacity and the home environment. Extension professionals may be uniquely positioned to provide…

  11. Intergenerational Learning between Children and Grandparents in East London

    ERIC Educational Resources Information Center

    Kenner, Charmian; Ruby, Mahera; Jessel, John; Gregory, Eve; Arju, Tahera

    2007-01-01

    This study investigates the learning exchange between three- to six-year-old children and their grandparents, in Sylheti/Bengali-speaking families of Bangladeshi origin and monolingual English-speaking families living in east London. The following concepts from sociocultural theory are applied to this new area of intergenerational learning:…

  12. Place and provision: mapping mental health advocacy services in London.

    PubMed

    Foley, Ronan; Platzer, Hazel

    2007-02-01

    The National Health Service (NHS) Executive for London carried out an investigation in 2002 as part of their wider mental health strategy to establish whether existing mental health advocacy provision in the city was meeting need. The project took a two-part approach, with an emphasis on, (a) mapping the provision of advocacy services and, (b) cartographic mapping of service location and catchments. Data were collected through a detailed questionnaire with service providers in collaboration with the Greater London Mental Health Advocacy Network (GLMHAN) and additional health and government sources. The service mapping identified some key statistics on funding, caseloads and models of service provision with an additional emphasis on coverage, capacity, and funding stability. The questionnaire was augmented by interviews and focus groups with commissioners, service providers and service users and identified differing perspectives and problems, which informed the different perspectives of each of these groups. The cartographic mapping exercise demonstrated a spatially-even provision of mental health advocacy services across the city with each borough being served by at least one local service as well as by London wide specialist schemes. However, at local level, no one borough had the full range of specialist provision to match local demographic need. Ultimately the research assisted the Advisory Group in providing commissioning agencies with clear information on the current status of city-wide mental health advocacy services, and on gaps in existing advocacy provision alongside previously unconsidered geographical and service dimensions of that provision.

  13. Patterns of early transmission of pandemic influenza in London – link with deprivation

    PubMed Central

    Balasegaram, Sooria; Ogilvie, Flora; Glasswell, Amy; Anderson, Charlotte; Cleary, Vivien; Turbitt, Deborah; McCloskey, Brian

    2012-01-01

    Please cite this paper as: Balasegaram et al. (2012) Patterns of early transmission of pandemic influenza in London – link with deprivation. Influenza and Other Respiratory Viruses 6(3), e35–e41. Background  During the early containment phase in England from April to June 2009, the national strategy for H1N1 pandemic influenza involved case investigation and treatment, and tracing and prophylaxis of contacts. Objective  To describe the relationship between early transmission of H1N1 pandemic influenza in London and age and socio‐economic status. Methods  Epidemiological data on cases of pandemic flu in London reported to the London Flu Response Centre were analysed to determine patterns of transmission. Results  There were 3487 reported cases (2202 confirmed, 1272 presumed and 14 probable) from 20 April to 28 June 2009, during the ‘containment’ period. The highest report rate of 206 per 100 000 (95% CI 195–218) was seen in primary school–age children (5−11 years) followed by 129 (95% CI 119–139) in secondary school–age children (12–18 years). Reports of cases were initially concentrated in affluent areas but overall showed a clear trend with deprivation and risk ratio of 2·32 (95% CI 1·94–2·78) between the most deprived and the least deprived. Conclusion  Early transmissions were highest amongst school‐aged children but linked with socio‐economic deprivation across all age groups. PMID:22236079

  14. Trends in the epidemiology of head and neck cancer in London.

    PubMed

    Tataru, D; Mak, V; Simo, R; Davies, E A; Gallagher, J E

    2017-02-01

    Head and neck cancers [HNCs] are biologically heterogeneous tumours. The objectives of this study were to describe trends in incidence of HNCs amongst London residents by sex, age, anatomical site, deprivation and ethnicity. Annual age-standardised incidence rates [ASRs] were calculated on HNC registration data, overall and for specific cancer sites, by sex and morphology (1985-2010) and area-based socio-economic deprivation score (2006-2010). Age-standardised incidence rate ratios [IRRs] for the main ethnic groups were calculated by cancer site, using White males and females as the reference groups (1998-2009). The ASR of HNC in males increased by 40% from 17.3 [95% CI: 15.8-18.6] to 24.2 [95% CI: 22.5-25.8] per 100 000 and in females by 87% from 7.0 [95% CI: 6.2-7.8] to 13.1 [95% CI: 11.9-14.2] per 100 000. Seventy-three per cent of cases spanned four cancer sites: larynx, thyroid, oral and oropharynx. Larynx was most common (23%), and had the highest male: female ratio (6 : 1); ASRs decreased significantly over time, most notably in males [P < 0.001]. Oral cavity was the second most common (21%), with a male: female ratio of 2 : 1, and increasing ASRs in both sexes [P < 0.001]. The majority of cases were male (64%) and from deprived areas (59%). Deprivation was associated with a significantly higher incidence for larynx (males), oropharynx (males and females) and oral cavity (females) [P < 0.05]. The age-specific rate for middle-aged adults (45-64 years) was high for oropharyngeal cancer. The incidence of thyroid cancers increased significantly in both sexes [P < 0.001], and this was the only site more common in females. One in five cases with known ethnicity was from a non-White group (20%). Compared with their White counterparts, Bangladeshi females had a higher incidence of oral, laryngeal and thyroid cancers; Chinese males and females had a higher incidence of nasopharyngeal cancer; and Pakistani and Indian females and Indian males also had higher incidence

  15. Patterns and Impact of Comorbidity and Multimorbidity among Community-Resident American Indian Elders

    ERIC Educational Resources Information Center

    John, Robert; Kerby, Dave S.; Hennessy, Catherine Hagan

    2003-01-01

    Purpose: The purpose of this study is to suggest a new approach to identifying patterns of comorbidity and multimorbidity. Design and Methods: A random sample of 1,039 rural community-resident American Indian elders aged 60 years and older was surveyed. Comorbidity was investigated with four standard approaches, and with cluster analysis. Results:…

  16. East London Experience with Enteric Fever 2007-2012

    PubMed Central

    Dave, Jayshree; Millar, Michael; Maxeiner, Horst; Freedman, Joanne; Meade, Rachel; Rosmarin, Caryn; Jordan, Matthew; Andrews, Nick; Holliman, Richard; Sefton, Armine

    2015-01-01

    Purpose The clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007–2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment. Methods A retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected. Results Clinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0–57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1–20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown. Conclusions Further interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required. PMID:25790017

  17. Experience of elder abuse among older Korean immigrants.

    PubMed

    Chang, Miya

    2016-01-01

    Studies on the scope and nature of Asian American elder abuse conducted with older immigrants are extremely limited. The overall purpose of this study was to examine the extent and type of elder abuse among older Korean immigrants, and to investigate critical predictors of elder abuse in this population. The sample consisted of 200 older Korean immigrants aged 60 to 90 years who resided in Los Angeles County in 2008. One of the key findings indicated that 58.3% of respondents experienced one or more types of elder abuse. Logistic regression indicated that the victims' health status and educational level were statistically significant predictors of the likelihood of experiencing abuse. The present study, although limited in sample size, measures, sampling methods, and population representation, has contributed to this important area of knowledge. It is recommended that future studies conduct research on elder abuse with more representative national samples that can measure the extent of abuse and neglect more accurately.

  18. Nurses' and personal care assistants' role in improving the relocation of older people into nursing homes.

    PubMed

    Ellis, Julie M; Rawson, Helen

    2015-07-01

    This article presents findings from a study that explored nurses' and personal care assistants' role in improving the relocation of older people into a nursing home. Suggestions for improving the relocation process for older people moving into a nursing home have been the outcomes of studies that have interviewed residents and their families. However, the views of nurses and personal care assistants working in nursing homes have not been previously explored. An exploratory, descriptive qualitative research design. Individual interviews were conducted with 20 care staff (seven registered nurses, five enrolled nurses and eight personal care assistants) employed at four nursing homes. Using thematic analysis, two key themes were identified: 'What it's like for them' - highlighted staffs' awareness of the advantages, disadvantages and meaning of relocation, and focused on staffing and nursing care; other services provided and the environment. The second theme - 'We can make it better', revealed suggestions for improving the relocation process, and included spending time with new residents and the importance of a person-centred approach to care. Care staff have an important role in improving the relocation process of older people into a nursing home, as well as contributing to the discussion on this important clinical topic. Challenging care staff to acknowledge the importance of their role in helping older people settle into a nursing home is a key requirement of nursing practice in aged care. Nursing practice guidelines, with a focus on person-centred care, on how to manage the relocation process for an older person and their family are required for this aspect of nursing home care. Education of staff on relocation policies and procedures is essential to ensure that residents and their families are supported through this process. © 2015 John Wiley & Sons Ltd.

  19. Are the birch trees in Southern England a source of Betula pollen for North London?

    PubMed

    Skjøth, C A; Smith, M; Brandt, J; Emberlin, J

    2009-01-01

    Birch pollen is highly allergenic. Knowledge of daily variations, atmospheric transport and source areas of birch pollen is important for exposure studies and for warnings to the public, especially for large cities such as London. Our results show that broad-leaved forests with high birch tree densities are located to the south and west of London. Bi-hourly Betula pollen concentrations for all the days included in the study, and for all available days with high birch pollen counts (daily average birch pollen counts>80 grains/m3), show that, on average, there is a peak between 1400 hours and 1600 hours. Back-trajectory analysis showed that, on days with high birch pollen counts (n=60), 80% of air masses arriving at the time of peak diurnal birch pollen count approached North London from the south in a 180 degree arc from due east to due west. Detailed investigations of three Betula pollen episodes, with distinctly different diurnal patterns compared to the mean daily cycle, were used to illustrate how night-time maxima (2200-0400 hours) in Betula pollen counts could be the result of transport from distant sources or long transport times caused by slow moving air masses. We conclude that the Betula pollen recorded in North London could originate from sources found to the west and south of the city and not just trees within London itself. Possible sources outside the city include Continental Europe and the Betula trees within the broad-leaved forests of Southern England.

  20. Grief and loss in older people residing in nursing homes: (un)detected by nurses and care-assistants?

    PubMed

    Van Humbeeck, Liesbeth; Dillen, Let; Piers, Ruth; Van Den Noortgate, Nele

    2016-12-01

    The aim of this study was to explore how nurses and care-assistants (nursing staff) working in six Flemish nursing homes experience and describe their involvement in grief care. Although grief in older people is widely described in literature, less is known about how nursing staff in nursing homes offer and perceive grief care. A qualitative research design with elements of constructivist grounded theory was used. Loosely structured face-to-face interviews were done with fourteen nurses and care-assistants. Data were collected from October 2013-March 2014. Interview transcripts were analysed using the Qualitative Analysis Guide of Leuven (QUAGOL) method with support of NVivo 10. Grief care in nursing homes is characterized by a complex tension between two care dimensions: (1) being involved while keeping an appropriate distance; and (2) being while doing. Nursing staff described key enablers and influencing factors for grief care at the level of both the individual and the organizational context. Findings suggest an established personal sensitivity for grief care considered from the nursing staff points of view. Nevertheless, a common denominator was the necessity to further develop a supportive and multidisciplinary grief care policy ingrained in the existing care culture. Suggested components of this grief care policy are: (a) centring attention on non-death-related loss and the cumulative nature of loss in residents; (b) building capacity by means of reflective practices; and (c) the importance of self-care strategies for nursing staff. Furthermore, the findings from this study point towards a need for education and training. © 2016 John Wiley & Sons Ltd.

  1. The correlates of slow gait and its relation with social network among older adults in Singapore.

    PubMed

    Shafie, Saleha; Shahwan, Shazana; Abdin, Edimansyah; Vaingankar, Janhavi; Picco, Louisa; Sambasivam, Rajeswari; Zhang, Yunjue; Ng, Li Ling; Chong, Siow Ann; Subramaniam, Mythily

    2017-11-01

    This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

  2. Autistic Disorder in Nineteenth-Century London. Three Case Reports

    ERIC Educational Resources Information Center

    Waltz, Mitzi; Shattock, Paul

    2004-01-01

    This article examines the existence, description, perception, treatment, and outcome of symptoms consistent with autistic disorder in nineteenth-century London, England, based on case histories from the notes of Dr William Howship Dickinson at Great Ormond Street Hospital for Children. Three cases meeting the DSM-IV criteria for autistic disorder…

  3. An analysis of population and social change in London wards in the 1980s.

    PubMed

    Congdon, P

    1989-01-01

    "This paper discusses the estimation and projection of small area populations in London, [England] and considers trends in intercensal social and demographic indices which can be calculated using these estimates. Information available annually on vital statistics and electorates is combined with detailed data from the Census Small Area Statistics to derive demographic component based population estimates for London's electoral wards over five year periods. The availability of age disaggregated population estimates permits derivation of small area social indicators for intercensal years, for example, of unemployment and mortality. Trends in spatial inequality of such indicators during the 1980s are analysed and point to continuing wide differentials. A typology of population and social indicators gives an indication of the small area distribution of the recent population turnaround in inner London, and of its association with other social processes such as gentrification and ethnic concentration." excerpt

  4. Graded Interface Models for more accurate Determination of van der Waals-London Dispersion Interactions across Grain Boundaries

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    van Benthem, Klaus; Tan, Guolong; French, Roger H

    2006-01-01

    Attractive van der Waals V London dispersion interactions between two half crystals arise from local physical property gradients within the interface layer separating the crystals. Hamaker coefficients and London dispersion energies were quantitatively determined for 5 and near- 13 grain boundaries in SrTiO3 by analysis of spatially resolved valence electron energy-loss spectroscopy (VEELS) data. From the experimental data, local complex dielectric functions were determined, from which optical properties can be locally analysed. Both local electronic structures and optical properties revealed gradients within the grain boundary cores of both investigated interfaces. The obtained results show that even in the presence ofmore » atomically structured grain boundary cores with widths of less than 1 nm, optical properties have to be represented with gradual changes across the grain boundary structures to quantitatively reproduce accurate van der Waals V London dispersion interactions. London dispersion energies of the order of 10% of the apparent interface energies of SrTiO3 were observed, demonstrating their significance in the grain boundary formation process. The application of different models to represent optical property gradients shows that long-range van der Waals V London dispersion interactions scale significantly with local, i.e atomic length scale property variations.« less

  5. Molecular Self-Assembly Driven by London Dispersion Forces

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, Guo; Cooper, Valentino R; Cho, Jun-Hyung

    2011-01-01

    The nature and strength of intermolecular interactions are crucial to a variety of kinetic and dynamic processes at surfaces. Whereas strong chemisorption bonds are known to facilitate molecular binding, the importance of the weaker yet ubiquitous van der Waals (vdW) interactions remains elusive in most cases. Here we use first-principles calculations combined with kinetic Monte Carlo simulations to unambiguously demonstrate the vital role that vdW interactions play in molecular self-assembly, using styrene nanowire growth on silicon as a prototypical example. We find that, only when the London dispersion forces are included, accounting for the attractive parts of vdW interactions, canmore » the effective intermolecular interaction be reversed from being repulsive to attractive. Such attractive interactions, in turn, ensure the preferred growth of long wires under physically realistic conditions as observed experimentally. We further propose a cooperative scheme, invoking the application of an electric field and the selective creation of Si dangling bonds, to drastically improve the ordered arrangement of the molecular structures. The present study represents a significant step forward in the fundamental understanding and precise control of molecular self-assembly guided by London dispersion forces.« less

  6. Spatial and temporal variability of urban fluxes of methane, carbon monoxide and carbon dioxide above London, UK

    NASA Astrophysics Data System (ADS)

    Helfter, Carole; Tremper, Anja H.; Halios, Christoforos H.; Kotthaus, Simone; Bjorkegren, Alex; Grimmond, C. Sue B.; Barlow, Janet F.; Nemitz, Eiko

    2016-08-01

    We report on more than 3 years of measurements of fluxes of methane (CH4), carbon monoxide (CO) and carbon dioxide (CO2) taken by eddy-covariance in central London, UK. Mean annual emissions of CO2 in the period 2012-2014 (39.1 ± 2.4 ktons km-2 yr-1) and CO (89 ± 16 tons km-2 yr-1) were consistent (within 1 and 5 % respectively) with values from the London Atmospheric Emissions Inventory, but measured CH4 emissions (72 ± 3 tons km-2 yr-1) were over two-fold larger than the inventory value. Seasonal variability was large for CO with a winter to summer reduction of 69 %, and monthly fluxes were strongly anti-correlated with mean air temperature. The winter increment in CO emissions was attributed mainly to vehicle cold starts and reduced fuel combustion efficiency. CO2 fluxes were 33 % higher in winter than in summer and anti-correlated with mean air temperature, albeit to a lesser extent than for CO. This was attributed to an increased demand for natural gas for heating during the winter. CH4 fluxes exhibited moderate seasonality (21 % larger in winter), and a spatially variable linear anti-correlation with air temperature. Differences in resident population within the flux footprint explained up to 90 % of the spatial variability of the annual CO2 fluxes and up to 99 % for CH4. Furthermore, we suggest that biogenic sources of CH4, such as wastewater, which is unaccounted for by the atmospheric emissions inventories, make a substantial contribution to the overall budget and that commuting dynamics in and out of central business districts could explain some of the spatial and temporal variability of CO2 and CH4 emissions. To our knowledge, this study is unique given the length of the data sets presented, especially for CO and CH4 fluxes. This study offers an independent assessment of "bottom-up" emissions inventories and demonstrates that the urban sources of CO and CO2 are well characterized in London. This is however not the case for CH4 emissions which are

  7. Maltreated and comparison adolescents' recollections of lifetime residences: Relationship to delinquency and marijuana use.

    PubMed

    Schneiderman, Janet U; Kennedy, Andrea K; Negriff, Sonya; Jones, Jennifer; Trickett, Penelope K

    2016-12-01

    Both childhood maltreatment and frequent childhood residence changes are associated with poor behavioral outcomes including drug use and delinquency. It is not clear whether a higher number of residences results in poorer outcomes for maltreated adolescents compared to adolescents living in the same community but without child welfare-documented maltreatment. Our study of child welfare-affiliated maltreated youth (n=216) and comparison youth (n=128) from the same community (age M = 18.21, SD = 1.42) examined: 1. whether child/caregiver characteristics and maltreatment status were associated with lifetime number of residences and 2. whether child/caregiver characteristics, residences, and maltreatment status were associated with delinquency and marijuana use. The outcomes of this study, number of residences, delinquency, and marijuana use, were all skewed, and consequently negative binomial regressions were used. Maltreatment status, ever living with a non-parent caregiver, and being older are associated with more residence changes during childhood. More residences and male sex are associated with person offense delinquency and marijuana use. In lower income neighborhoods, such as where the adolescents in this study lived, residence changes are not unusual, but in this study maltreated youth moved more often than youth from the same community. It is important to help caregivers who live in disadvantaged neighborhoods, especially families with child welfare involvement, understand the behavioral consequences of residence changes and provide support for stable long-term housing.

  8. Association of health literacy with health information-seeking preference in older people: A correlational, descriptive study.

    PubMed

    Kim, Su Hyun; Utz, Sonja

    2018-02-28

    Low health literacy has been recognized as a potential barrier to obtaining knowledge and maintaining self-care in older people. However, little is known about information-seeking preference in relation to health literacy among older people. The aim of the present study was to understand the influence of health literacy on the information-seeking preference of older people. A total of 129 community-residing Korean older people completed a survey in 2016. The findings revealed that health literacy was a significant predictor of information-seeking preference in older people after controlling for demographic and illness variables. Our study highlights the important need to incorporate strategies to increase the desire for information seeking in older people, in addition to adopting communication strategies that address low health literacy. © 2018 John Wiley & Sons Australia, Ltd.

  9. Autobiographical Narration as a Tool for the Empowerment of Older Adults' Subjective and Psychological Wellbeing in Nursing Homes.

    PubMed

    Biassoni, Federica; Cassina, Giada; Balzarotti, Stefania

    2017-09-20

    Conceiving narration as a resource to promote older people's wellbeing, the present work aimed to implement a narrative-based intervention to empower the subjective and psychological wellbeing of older adults living in nursing homes. Twenty-one nursing-home residents took part in a narrative training experience consisting of three weekly interview sessions. During each interview, a psychologist helped the participants to construct an autobiographical narrative about their present life in the nursing home based on a Deconstruction-Reconstruction technique. Subjective and psychological wellbeing variables were assessed before and after the intervention. Subjective but not psychological wellbeing increased over the course of the intervention. The participants reported to appreciate the intervention. Although preliminary, the results suggest that brief narrative training based on narrative therapy can positively affect nursing-home residents' subjective wellbeing. Brief narrative interventions implementing deconstruction-reconstruction techniques are feasible for long-term care residents.

  10. Antipsychotic Use and Hospitalization Among Older Assisted Living Residents: Does Risk Vary by Frailty Status?

    PubMed

    Stock, Kathryn J; Hogan, David B; Lapane, Kate; Amuah, Joseph E; Tyas, Suzanne L; Bronskill, Susan E; Morris, Andrew M; Bell, Chaim M; Jeffs, Lianne; Maxwell, Colleen J

    2017-07-01

    To examine associations between baseline frailty measures, antipsychotic use, and hospitalization over 1 year and whether hospitalization risk associated with antipsychotic use varies by frailty level. In this prospective cohort study of 1,066 residents (mean age: 85 years; 77% women) from the Alberta Continuing Care Epidemiological Studies, trained research nurses conducted comprehensive resident assessments at baseline (2006-2007) for sociodemographic characteristics, health conditions, frailty status, behavioral problems, and all medications consumed during the past 3 days. Two separate measures of frailty were assessed, the Cardiovascular Health Study (CHS) phenotype and an 86-item Frailty Index (FI). Time to first hospitalization during follow-up was determined via linkage with the Alberta Inpatient Discharge Abstract Database. Baseline frailty status (both measures), but not antipsychotic use, was significantly associated with hospitalization over 1 year. When stratified by frailty, FI-defined frail residents using antipsychotics showed a significantly increased risk for hospitalization (adjusted HR: 1.54; 95% CI: 1.01-2.36) compared with frail nonusers. CHS-defined frail antipsychotic users versus frail nonusers also showed an elevated risk (adjusted HR: 1.67; 95% CI: 0.96-2.88). Nonfrail residents using antipsychotics were significantly less likely to be hospitalized compared with nonfrail nonusers whether defined by the FI (adjusted HR: 0.62; 95% CI: 0.39-0.99) or CHS criteria (adjusted HR: 0.62; 95% CI: 0.40-0.96). Frailty measures may be helpful in identifying those who are particularly vulnerable to adverse effects and those who may experience benefit with treatment. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  11. Sexual Consent Capacity Assessment with Older Adults.

    PubMed

    Syme, Maggie L; Steele, Debora

    2016-09-01

    Many healthcare providers have a limited knowledge of sexual and intimate expression in later life, often due to attitudinal and informational limitations. Further, the likelihood of an older adult experiencing cognitive decline increases in a long-term care (LTC) setting, complicating the ability of the providers to know if the older adult can make his or her own sexual decisions, or has sexual consent capacity. Thus, the team is left to question if and how to support intimacy and/or sexuality among residents with intimacy needs. Psychologists working with LTC need to be aware and knowledgeable about sexual consent capacity in older adulthood to be prepared to conduct evaluations and participate in planning care. Limited research is available to consult for best practices in sexual consent capacity assessment; however, models of assessment have been developed based on the best available evidence, clinical judgment, and practice. Existing models will be discussed and an integrated model will be illustrated via a case study. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Use of a Geriatric Quality Initiative to Educate Internal Medicine Residents about Delirium and Its Risk Factors.

    PubMed

    Olveczky, Daniele; Mattison, Melissa L P; Mukamal, Kenneth J

    2013-06-01

    Delirium is a common and debilitating complication of inpatient care for many older adults, yet internal medicine residents often do not recognize delirium or its risk factors. Integrating geriatric education (eg, delirium recognition) with inpatient quality improvement (QI) is not well tested. We developed an educational pilot program within an ongoing hospital-wide geriatric QI initiative (Global Risk Assessment and Careplan for the Elderly-Acute Care [GRACE-AC]). GRACE-AC modifies the inpatient computerized provider order entry system to meet the needs of vulnerable older adults and uses a bedside care checklist to identify patients with possible delirium and promote delirium prevention by checking on the need for "tethers" (intravenous fluids, Foley catheters, and telemetry). Residents were assessed before and after each inpatient rotation by using anonymous electronic surveys. A total of 167 eligible residents (91%) completed prerotation surveys, and 102 (56%) residents completed postrotation surveys. All but the first rotating resident group received a standardized 2-minute educational in-service orientation. In a comparison of postrotation responses before and after implementation of the in-service, the proportion of residents who reported improvement in their ability to recall which patients had tethers increased from 17% to 52% for intravenous fluids (P  =  .004), 28% to 75% for Foley catheters (P < .001), and 21% to 50% for telemetry (P  =  .02). Comparing pre- and postrotation surveys, the proportion of correct responses to questions on haloperidol dosing and the characteristics of delirium increased from 26% to 76% and 31% to 63%, respectively (both P < .001). Our pilot program demonstrated that inpatient geriatric QI initiatives can be successfully merged with a brief educational curriculum.

  13. Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions.

    PubMed

    Watts, P; Buck, D; Netuveli, G; Renton, A

    2016-06-01

    Clustering of lifestyle risk behaviours is very important in predicting premature mortality. Understanding the extent to which risk behaviours are clustered in deprived communities is vital to most effectively target public health interventions. We examined co-occurrence and associations between risk behaviours (smoking, alcohol consumption, poor diet, low physical activity and high sedentary time) reported by adults living in deprived London neighbourhoods. Associations between sociodemographic characteristics and clustered risk behaviours were examined. Latent class analysis was used to identify underlying clustering of behaviours. Over 90% of respondents reported at least one risk behaviour. Reporting specific risk behaviours predicted reporting of further risk behaviours. Latent class analyses revealed four underlying classes. Membership of a maximal risk behaviour class was more likely for young, white males who were unable to work. Compared with recent national level analysis, there was a weaker relationship between education and clustering of behaviours and a very high prevalence of clustering of risk behaviours in those unable to work. Young, white men who report difficulty managing on income were at high risk of reporting multiple risk behaviours. These groups may be an important target for interventions to reduce premature mortality caused by multiple risk behaviours. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Central and East European migrant men who have sex with men in London: a comparison of recruitment methods.

    PubMed

    Evans, Alison R; Hart, Graham J; Mole, Richard; Mercer, Catherine H; Parutis, Violetta; Gerry, Christopher J; Imrie, John; Burns, Fiona M

    2011-05-17

    Following the expansion of the European Union, there has been a large influx of Central and East European (CEE) migrants to the UK. CEE men who have sex with men (MSM) represent a small minority within this population that are none-the-less important to capture in sexual health research among the CEE migrant community. This paper examines the feasibility of recruiting CEE MSM for a survey of sexual behaviour in London using respondent driven sampling (RDS), via gay websites and in GUM clinics. We sought CEE MSM to start RDS chain referral among GUM clinic attendees, our personal contacts and at gay events and venues in central London. We recruited CEE MSM (n = 485) via two popular websites for gay men in Britain (March-May 2009) and at two central London GUM clinics (n = 51) (July 2008-March 2009). We found seventeen men who knew other CEE MSM in London and agreed to recruit contacts into the study. These men recruited only three men into the study, none of whom recruited any further respondents, and RDS was abandoned after 7 months (July 2008-January 2009). Half of the men that we approached to participate in RDS did not know any other CEE MSM in London. Men who agreed to recruit contacts for RDS were rather more likely to have been in the UK for more than one year (94.1% vs 70.0%, p = 0.052). Men recruited through gay websites and from GUM clinics were similar. The Internet was the most successful method for collecting data on sexual risk behaviour among CEE MSM in London. CEE MSM in London were not well networked. RDS may also have failed because they did not fully understand the procedure and/or the financial incentive was not sufficient motivation to take part.

  15. The Contribution of a Social Enterprise to the Building of Social Capital in a Disadvantaged Urban Area of London

    PubMed Central

    Bertotti, Marcello; Harden, Angela; Renton, Adrian; Sheridan, Kevin

    2016-01-01

    There has been much enthusiasm over the past 10 years for the potential contribution of social enterprises to the regeneration of disadvantaged urban areas. This enthusiasm has far outstripped the availability of empirical evidence. This paper reports a qualitative study of one social enterprise, a community café, and its contribution to building social capital in a disadvantaged urban area in London. The analysis reveals how the café builds ‘bonding’ and ‘bridging’ social capital whilst also addressing ‘downside’ social capital. Overall, the manager of the social enterprise played a considerable role in facilitating the development of social capital, thus emphasising the importance of individuals and their attitudes, skills, and background in urban regeneration. However, the role of the social enterprise in building ‘linking’ social capital was minor. In this instance, more effective mechanisms of community engagement need to be put in place in order to empower local residents and organisations. PMID:27746483

  16. Independent older adults perspectives on oral health.

    PubMed

    Khabra, K K; Compton, S M; Keenan, L P

    2017-11-01

    The purpose of this study was to explore oral health experiences from the perspective of older adults' living in community dwellings. The two objectives of this study were to identify facilitators and barriers to oral health care, and to determine how utilization of oral health services compares to utilization of other healthcare services. An interpretive descriptive methodology was employed with a purposive sample of 12 adults, aged 70 years or older. The inclusion criterion was English-speaking seniors residing in community dwellings. Community dwellings were defined as any housing outside of long-term care or other supportive living facilities. Semi-structured interviews were 30-80 min, audio-recorded and transcribed verbatim. Three researchers participated in the comparative analysis process to develop codes, generate categories, interpret patterns and construct themes. Three central themes surfacing from the data were as follows: life course influences on oral health, transparency in delivery of oral health services and interrelationships between oral health and overall health. Older adults in this study emphasized the value of establishing collaborative and trusting relationships between oral health practitioners and older adults. Oral health practitioners should be clear and transparent when communicating information about oral health costs and be cognizant of different circumstances from childhood to older adulthood that inhibit or promote routine utilization of oral health services. Including oral health services as part of interdisciplinary care teams could help promote understandings of the reciprocal relationship between oral health and general health and improve oral health status for older adults. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report.

    PubMed

    de Souto Barreto, Philipe; Morley, John E; Chodzko-Zajko, Wojtek; H Pitkala, Kaisu; Weening-Djiksterhuis, Elizabeth; Rodriguez-Mañas, Leocadio; Barbagallo, Mario; Rosendahl, Erik; Sinclair, Alan; Landi, Francesco; Izquierdo, Mikel; Vellas, Bruno; Rolland, Yves

    2016-05-01

    A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. A Community Approach to Youth Work in East London.

    ERIC Educational Resources Information Center

    Cox, Derek M.

    Instituted as part of "Avenues Unlimited" (The Tower Hamlets Youth Project), a community development approach to youth services was attempted in the cosmopolitan inner city slum district of Spitalfields, East London. Efforts began in 1966 with a clean up campaign, a neighborhood club for parents and youth, and other activities by the…

  19. Depression and cognitive impairment among newly admitted nursing home residents in the USA.

    PubMed

    Ulbricht, Christine M; Rothschild, Anthony J; Hunnicutt, Jacob N; Lapane, Kate L

    2017-11-01

    The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment. We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics. Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98). Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  20. The accelerated residency program: the Marshall University family practice 9-year experience.

    PubMed

    Petrany, Stephen M; Crespo, Richard

    2002-10-01

    In 1989, the American Board of Family Practice (ABFP) approved the first of 12 accelerated residency programs in family practice. These experimental programs provide a 1-year experience for select medical students that combines the requirements of the fourth year of medical school with those of the first year of residency, reducing the total training time by 1 year. This paper reports on the achievements and limitations of the Marshall University accelerated residency program over a 9-year period that began in 1992. Several parameters have been monitored since the inception of the accelerated program and provide the basis for comparison of accelerated and traditional residents. These include initial resident characteristics, performance outcomes, and practice choices. A total of 16 students were accepted into the accelerated track from 1992 through 1998. During the same time period, 44 residents entered the traditional residency program. Accelerated resident tended to be older and had more career experience than their traditional counterparts. As a group, the accelerated residents scored an average of 30 points higher on the final in-training exams provided by the ABFP. All residents in both groups remained at Marshall to complete the full residency training experience, and all those who have taken the ABFP certifying exam have passed. Accelerated residents were more likely to practice in West Virginia, consistent with one of the initial goals for the program. In addition, accelerated residents were more likely to be elected chief resident and choose an academic career than those in the traditional group. Both groups opted for small town or rural practice equally. The Marshall University family practice 9-year experience with the accelerated residency track demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential