Elderly home care

Fialova, D., Topinkova, E., Gambassi, G., et al. (2005) Potentially inappropriate medication use among elderly home care patients in Europe. JAMA, 293, 1348-1358. 

Patients, in particular the elderly, are moved between different settings in the health care system. Medicines are involved in most of the stages of the journey. This includes home to hospital, home to care home or hospice, home to day centre, hospital to home, hospital to care home or hospice, ward to ward in hospital, hospital to hospital, care home to home, care home to care home. Especially on admission to, and discharge from, hospital there are several factors that can lead to errors. 

Health care services included outpatient visits to physician, psychologist, social worker, sleep specialist, and mental health organization, as well as inpatient care and nursing-home care (when the primary reason for placement was the elders sleep disturbance). The total health care services for 1995 were estimated... 

These usually include patients with chronic diseases requiring low technology. The community center medical team visits the patient at home. Examples of programs applying such schemes are home care programs for diabetes, hypertension, terminally ill patients, physiotherapy at home, and care of elderly. 

Home care in elderly patients can help with the geriatric assessment of disability and functional status and the prevention of complications related or not related to drugs. Stuck et al. conducted a three-year, randomized, controlled trial of the effect of annual in-home comprehensive geriatric assessment and follow-up for people who were 75 years of age or older.The results showed that this intervention can delay the development of disability and can reduce permanent nursing home stays among elderly people living at home. 

Mrs Cooper is an elderly patient who has recently needed treatment. Although she has Parkinson s disease Mrs Cooper still lives at home, being visited regularly by her daughter and has the help of a home care assistant. 

The pharmacist must be aware that other persons play a major role in the administration of medicines to patients. The pharmacist may be asked, or feel morally or legally, obliged to give care and training to the reconstitution of medicines (see Fig. 1.2) on a ward by nurses, at nursing homes or home for the elderly or to home care workers or family of the patient. 

The home care services to the elderly have a rate of injuries of 61% due to the use of excessive force (Faucett et al. 2013). Truthfully the employer adopts an inappropriate posture to meet the requirements of the tasks and the inadequate conditions of the dimensional structure of the equipment, facing the anthropometric conditions. 

Care robots could offer multimedia communication, in combination with operation of home electronics, reading books or playing games, and could guide, assist or support the elderly and disabled. 

I ve always worked. I worked in a nursing home as a nurses aide, then I went into private duty taking care of elderly people in their homes. I was healthy. I went out in public and people came into my home and I didn t have to worry about what anybody was wearing. I had a pretty good life. Then everything changed. 

Pain is a common problem in the elderly, and many elderly people are prescribed painkillers. A report from the American Geriatrics Society found that about one-fourth to one-half of all elderly people not living in nursing homes report pain-related problems, and one in five people over age 65 take painkillers one or more times each week. As many as three in five elderly people have taken prescription pain medication for more than six months. In nursing homes or other care facilities, as many as 80% of elderly patients report some type of pain. 

Many elderly persons, whether demented or cognitively intact, have medical conditions that disrupt sleep. Untreated insomnia and daytime sleepiness have been associated with nursing home placement and mortality. Medically ill older adults admitted to acute care hospitals are particularly vulnerable to sleep disruptions, which appear to be created as much by the various treatments and procedures, unfamiliar routines, and environmental conditions, as by the pain, anxiety, and discomfort associated with their underlying medical condition. Medical conditions especially likely to disrupt sleep are congestive heart failure, chronic obstructive pulmonary disease, Parkinson s disease, gastroesophageal reflux disease, arthritis, and nocturia. 

Health care delivery system affected Hospitals, EMS, psychiatric facilities, long-term care, elderly/ disability services, home health agencies, blood services, assisted living facilities, cemeteries, senior meal sites, pharmacies, medical equipment suppliers, EMS dispatch, urgent care centers, eye care, dialysis units, physician offices, hearing and dental care. Meals on Wheels, and Visiting Nurse Associations. 

The importance of osteoporosis in terms of the misery it causes and its economic impact is underscored by these statistics. About one-third of all women over the age of 70 experience hip fracture. Of those elderly people who fracture a hip, about 15% die of complications secondary to that hip fracture. A large percentage of those who survive are unable to return to their previous level of activity, and many times a hip fracture precipitates a move from self-care to a supervised living situation or nursing home. The yearly cost of osteoporotic injury in the United States is greater than 10 billion. 

Alzheimer s disease is the eighth leading cause of death in the elderly and already affects some 4 million Americans. The incidence rises from 2% at 65 years to 32% at age 85. The National Institute of Health (NIH) estimates that at least half of the people in nursing homes have this disease. A small study of donezil showed that this treatment avoided the need for home nursing care by half compared to those who did not receive the medicine (Small, 1998). 

The most vulnerable elderly population is found in nursing homes or mental institutions and frequently comprises persons of diminished or fluctuating mental ability. Ironically, regulations governing research in these patients were proposed but never voted upon. The NIH established a policy which allowed a patient, when he/she was still in good cognitive condition, to appoint a Health Care Agent . 

Type 2 diabetes is common in the elderly. Most nursing home and assisted living facilities are staffed by Certified Nursing Assistants. These staff need to be trained in the proper care of patients with diabetes. Training on the... 

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