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Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey. The growing populations of elderlypeople in sub-Saharan Africa are exposed to social changes with potential adverse effects on mental health. Our aim was to estimate the occurrence and effect of major depressive disorder in a large and representative community sample of elderly Africans.Face-to-face interviews with a representative sample of peopleaged 65 years and older (n (...) treatment, and there was a mean delay of 5 years from onset of depression to receipt of first treatment. Low economic status (0.3) and rural residence (1.0) predicted no treatment.Major depressive disorder is common in elderly Nigerians and its occurrence is related to urbanisation. This disorder is a seriously disabling illness in this group but only a few sufferers have ever received treatment. Health-care services need to invest in effective treatment programmes for major depressive disorder.
Post-geriatric evaluation unit follow-up: team versus nonteam. Twenty-six matched pairs of elderly male patients who had been evaluated in an outpatient geriatric evaluation unit (GEU) were assigned randomly to be followed in either a geriatrics clinic with an interdisciplinary team or a general medical clinic without an interdisciplinary team. Patients were medically stable and living in the community. At 12 months no difference was found in cognitive, affective, or functional status. Both (...) groups of patients had similar frequencies of hospitalization, community placement, use of communityservices, and number of deaths. These findings suggest that the major benefit from GEUs may be in the initial assessment and treatment rather than in the subsequent care provided by interdisciplinary teams in geriatrics specialty clinics.
and treated by an interdisciplinary team in a day hospital (treatment group), and 58 were assessed in an inpatient unit or an outpatient clinic or were discharged early with appropriate communityservices (control group).Barthel Index, Rand Questionnaire, Global Health Question and Geriatric Quality of Life Questionnaire (GQLQ).Eight study subjects and four control subjects died; the difference was insignificant. Functional status deteriorated over time in the two groups; although the difference (...) Effectiveness of a geriatric day hospital. To determine whether there is a difference in the quality of life between elderly patients managed in a day hospital and those receiving conventional care.Randomized controlled trial; assessment upon entry to study and at 3, 6 and 12 months afterward.Geriatrician referral-based secondary care.A total of 113 consecutively referred elderly patients with deteriorating functional status believed to have rehabilitation potential; 55 were assessed
Impact of a geriatric assessment unit on subsequent health care charges. In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent (...) health care charges.Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization.The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10,583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs
Evaluation of outpatient geriatric assessment: a randomized multi-site trial. To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.Randomized, controlled clinical trial, with 12-month follow-up.Four hospital-based ambulatory geriatric assessment clinics and community physicians' offices.442 recruited older adults with a health problem or recent change in health status.Outpatient consultative geriatric assessment or usual (...) physician assessment.Identification of health problems, mortality, nursing home admissions, health status, health services utilization, satisfaction with care, and caregiver well-being.Geriatric assessment, in comparison with usual community care, resulted in the identification of a significantly greater number of patients with cognitive impairment (P < .0001), depression (P = .0004) and incontinence (P < .0001). The group receiving a geriatric assessment had greater improvement in anxiety levels at 1
, health education, and preventive care in an urban United States community. The intervention includes yearly in-home CGA by geriatric nurse practitioners (GNPs), who provide, following discussions with physician geriatricians, lists of specific recommendations for health and well-being enhancement. The GNPs provide follow-up visits quarterly and regular telephone contacts to improve compliance. We recruited for our trial 414 home-living subjects aged 75 years and over, 215 randomized (...) A home-based geriatric assessment, follow-up and health promotion program: design, methods, and baseline findings from a 3-year randomized clinical trial. Controlled trials in a number of countries have documented benefits from different types of in-home assessment and treatment programs for various subgroups of elderly persons. We have developed a program to test, using a randomized controlled design, the concepts of in-home comprehensive geriatric assessment (CGA) coupled with follow-up
Influence of diagnostic classification on outcomes and charges in geriatric assessment and rehabilitation. To determine if diagnostic classification is associated with different outcomes from treatment on a geriatric assessment unit (GAU) compared with usual care for elderly patients with acute illnesses.Reanalysis after post-hoc diagnostic classification of a randomized clinical trial with one year follow up.Community hospital with rehabilitation facility.A total of 155 subjects, mean age 78 (...) years and 78% female, of whom 58 subjects had a rehabilitation classification of their diagnoses and 97 had a medical or surgical classification.Mortality, nursing home use, activities of daily living, and charges for subsequent medical services.Mortality was decreased in persons with a rehabilitation classification who had received the GAU intervention. The GAU increased point-prevalence residence in the community for persons with a rehabilitation classification. For persons with a medical-surgical
General practitioners' views on geriatric day hospital care. 2031758 1991 06 24 2018 11 13 0960-1643 41 344 1991 Mar The British journal of general practice : the journal of the Royal College of General Practitioners Br J Gen Pract General practitioners' views on geriatric day hospital care. 126 Williams E S ES Clementson G G eng Letter England Br J Gen Pract 9005323 0960-1643 IM Aged Attitude of Health Personnel Day Care, Medical Family Practice Health Services for the Aged Humans 1991 3 1 (...) 1991 3 1 0 1 1991 3 1 0 0 ppublish 2031758 PMC1371628 Proc R Soc Med. 1974 Jun;67(7):677-80 4851266 Practitioner. 1981 Feb;225(1352):127-31 7267564 Community Med. 1987 Feb;9(1):55-61 3581765 Br Med J (Clin Res Ed). 1986 Jan 18;292(6514):176-8 3080125
therapeutic program while easing the demands on the energy and time of the patient's spouse or family and thus helps the elderly to remain in the community rather than live in an institution. The experience at Sunnybrook has shown that geriatric day hospitals can be a valuable component of the broad spectrum of integrated services and programs that must be developed to provide adequate health care for the growing number of olderpeople in our population. (...) A geriatric day hospital: the Sunnybrook experience. A review of the first 7 years of experience with the geriatric day hospital at Sunnybrook Medical Centre in Toronto revealed the following about the patients attending the day hospital during that time: most were 60 to 79 years old; over 85% attended 1 or 2 days a week; more than two thirds lived with a spouse or relatives; and more than half had diseases of the circulatory system or mental disorders. The day hospital offers a varied
that the costs of these additional medical services would be $473 for the 5 years after the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of $10,600.The CE of this program compares favorably with many common medical interventions. Whether investments should be made in health care resources on treatments that lead to modest improvements in the functioning of community-dwelling elderlypeople remains a societal decision. (...) , elderly subjects with at least one of four geriatric conditions.In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention.The intervention, which prevented functional decline, cost $273 per participant. The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention, but only 1.2 extra visits in the next 32 weeks. We estimate
A randomized clinical trial of outpatient geriatric evaluation and management. To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services.Randomized clinical trial.Ambulatory clinic in a community hospital.A population-based sample of community-dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568).Comprehensive assessment followed (...) by interdisciplinary primary care.Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status.Intention-to-treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47-0.99), to experience increased health-related restrictions
Outcomes of community-based social service interventions in homebound elders. To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change.Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support (...) with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life.Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores
THE IMPACT OF KINSHIP NETWORKS ON OLD-AGE VULNERABILITY IN INDONESIA This article examines the problem of care provision for elderlypeople in Java, a contemporary developing society characterised by lack of formal welfare services, nuclear family organisation and high levels of childlessness. A similar socio-demographic, cultural and economic regime existed in historical Northwest Europe, where it has been seen as having contributed to the early emergence of community based old-age care (...) and low involvement of wider kin networks. Here the role of kin in providing old-age care in a nuclear family system is re-examined by drawing on longitudinal data of elderlypeople's life histories and support networks in a village in East Java. The central argument is that the identification of elders most vulnerable to a lack of care and support in oldage requires understanding the nature and functioning of kin networks over time. The paper discusses three key aspects of networks-network
Elderlypeople's technique in using dry powder inhalers : New inhaler devices are rarely used by olderpeople in the community 11464828 2001 08 09 2018 11 30 0959-8138 323 7303 2001 Jul 07 BMJ (Clinical research ed.) BMJ Elderlypeople's technique in using dry powder inhalers. New inhaler devices are rarely used by olderpeople in the community. 49-50 Dow L L Fowler L L Lamb H H eng Letter Comment England BMJ 8900488 0959-8138 AIM IM BMJ. 2001 Mar 10;322(7286):577-9 11238150 AgedCommunity (...) Health Services Drug Delivery Systems Humans Nebulizers and Vaporizers statistics & numerical data Respiration Disorders drug therapy Self Administration standards 2001 7 24 10 0 2001 8 10 10 1 2001 7 24 10 0 ppublish 11464828 PMC1120678 Thorax. 1999 Dec;54(12):1104-6 10567631 BMJ. 2001 Mar 10;322(7286):577-9 11238150 AgeAgeing. 1999 Sep;28(5):481-4 10529044
Collaboration, facilities and communities in day care services for olderpeople. Similarities and differences between day hospitals, run by the NHS, and day centres, run by local authorities or charitable organisations, have been widely discussed in the literature of gerontology for many years. The authors of this paper have undertaken a single blind, randomised-controlled trial to compare rehabilitation outcomes in the two settings, which was published in 1999. This research project involved (...) augmenting the staff of day centres by visiting therapists. In addition to quantitative findings, their project also generated much qualitative data from interviews with health service and social service staff which provides the thought-provoking content. The themes identified included the reluctance of some patients to accept referral to a day centre, and the difficulties associated with discharging patients. Positive aspects included the opportunity to share skills, knowledge and resources. 29
The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults.The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample (...) use and costs.There were no effects of exercise on gait, balance, or physical health status. Exercise had a protective effect on risk of falling (relative hazard = .53, 95% CI = .30-.91). Between 7 and 18 months after randomization, control subjects had more outpatient clinic visits (p < .06) and were more likely to sustain hospital costs over $5000 (p < .05).Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults. In community-living adults
Caring for olderpeople. Communityservices: health. Many frail or disabled elderlypeople are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for olderpeople in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental (...) , and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.
Collaboration, facilities and communities in day care services for olderpeople. Collaborative working in care for olderpeople is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome (...) rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase
Community geriatricians. Elderlypeople need "high tech" services too. 8038658 1994 08 25 2018 11 13 0959-8138 309 6947 1994 Jul 09 BMJ (Clinical research ed.) BMJ Community geriatricians. Elderlypeople need "high tech" services too. 128 Stewart K K Gill M M eng Letter Comment England BMJ 8900488 0959-8138 AIM IM BMJ. 1994 May 7;308(6938):1184 8180532 AgedCommunity Health Services supply & distribution Deinstitutionalization Health Services for the Aged supply & distribution Humans Length (...) of Stay Medical Laboratory Science United Kingdom 1994 7 9 1994 7 9 0 1 1994 7 9 0 0 ppublish 8038658 PMC2540527 Lancet. 1985 Mar 23;1(8430):683-5 2858628 BMJ. 1994 May 7;308(6938):1184 8180532 AgeAgeing. 1986 Nov;15(6):321-42 3799363
Model to assess communityservices for elderly alcoholic. 7291478 1981 12 15 2018 11 13 0033-3549 96 5 1981 Sep-Oct Public health reports (Washington, D.C. : 1974) Public Health Rep Model to assess communityservices for elderly alcoholic. 458-63 Kola L A LA Kosberg J I JI eng Journal Article United States Public Health Rep 9716844 0033-3549 AIM IM Aged Alcoholism therapy Community Health Services organization & administration Health Services Needs and Demand Health Services Research Health (...) Services for the Aged organization & administration Humans Middle Aged Models, Theoretical Regional Health Planning 1981 9 1 1981 9 1 0 1 1981 9 1 0 0 ppublish 7291478 PMC1424250 Q J Stud Alcohol. 1971 Mar;32(1):53-9 5546053 Alcohol Clin Exp Res. 1978 Jan;2(1):17-21 345847 Alcohol Clin Exp Res. 1978 Jan;2(1):27-9 345849 Alcohol Clin Exp Res. 1978 Jan;2(1):31-8 345850 Health Soc Work. 1978 Aug;3(3):67-90 689556 Health Soc Work. 1979 Nov;4(4):128-43 511021 Soc Work Health Care. 1980 Winter;6(2):69-76