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Characteristics of female 65+ in home care service – at 11 sites in Europe. sorbye@diakonhjemmet.no. The age wave is a female wave. We want to help older females in their surfing on the wave They may need help to cope with up and downs. www.studvest.no. Baby-boomers.

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the age wave is a female wave
The age wave is a female wave

We want to help older females in their surfing on the wave

They may need help to cope with up and downs

www.studvest.no

baby boomers
Baby-boomers

The importance of seniors will accelerate in 2011 until 2031 when the last of the boomers turns 65

Statistics Canada September 2006.

White; interRAI Ottawa 2007

www.linksbuketten.dk

the health politicians rely on women to care for their husbands s rbye 2007
“The health politicians rely on women to care for their husbands.”(Sørbye 2007)
  • In residential care the portion of women is 75-80% – usually widowed (Gabrel 2000).
  • Women in the western world live in average five to six years longer than men (Arias 2002, Kõnig 2004).
man has a wife who cares for the widow
Man has a wife - who cares for the widow?
  • Few significant others are able to undertake a similar care burden as carried out by a wife (Bonke & Koch-Weser 2001).
  • To keep these older women able to live in their own home with an acceptable quality of life is an important socioeconomical concern.
community based care at the margin is a substitute for institutional care

Community-based care at the margin is a substitute for institutional care

Three factors are considered critical:

definitions of eligibility,

assessment procedures and

balance of care

(Challis & Hughes 2002)

the aged in home care project
The Aged in HOme Care project

The data for this presentation are derived form the AdHOC study. Community Care at 11 sites in Europe

Measurement: Resident Assessment Instrument for Home Care (RAI-HC).

(Carpenter et al. 2004, Henrard et al. 2006)

adhoc data female vs male
AdHOC data: Female vs. male
  • Frequency: Female 74.2% vs. male 25.8%
  • Age: in average 2 years older

Female: Mn=82.80 Std 7.20

Male : Mn= 80.88 Std 7.48

  • Lived alone: Female 67.8% vs. male 39.6%

OR=3.2 (2.78-3.72)

activity of daily living adl index 0 8
Activity of Daily Living (ADL) index (0-8)

mobility in bed,

transfer,

eating,

toilet use,

personal hygiene,

dressing upper and lower body,

locomotion inside and outside home,

and bathing 

instrumental activity of daily living index iadl 0 7
Instrumental Activity of Daily Living Index (IADL) (0-7)

meal preparation,

house work,

managing medication,

managing finance,

phone use,

shopping and

transport

cognitive performance scale cps
Cognitive Performance Scale (CPS)

Memory

Cognitive skill of daily decision making

Expressive communication

Eating

CPS measures the level of cognitive performance; it runs from 0 to 6 (6 is worst). Cut off point CPS=3 was chosen to indicate significant cognitive impairment of dementia severity. “3” is equivalent average to 15 points in Mini Mental State Examination (MMSE).

the car is my umbrella to my social life
”The car is my umbrella to my social life”

Many older widows are unnecessarily isolated because their common drivers license was buried together with the husband.

www.vgb.no

In Norway 82% of the men and 29% of women have a driver licence at the age of 75+ (SSB 2006).

it s worth is weight in diamonds
“It's worth is weight in diamonds”
  • Ulla 85, years old had reached the stage when living on her own is becoming difficult. She was frail and had just got a diabetes diagnosis. The visiting nurse asked her if she got sufficient help to make her secure to live by herself. She grabbed her old bony fingers around a security alarm that looked like a necklace. “Do you see this piece of jewellery? It is the most gorgeous jewellery I ever had. It is worth is weight in diamonds.” She had several times been in need of emergency help and her security alarm had worked out nicely.
assistive technology at
Assistive technology (AT)

Sensors can track people and alarms can be activated if something unnatural such as a fall is detected. Neither the old people nor their next of kin have sufficient information about the terminology of AT or the concept of “smart house”.

cost of care
Cost of care

Lansely et al (2004) analysed detailed design studies to measure the cost of technology versus use of formal care. They concluded that “Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence. They can both substitute for traditional formal care services and supplement these services in a cost-effective way.

assistive technology vs institution
Assistive technology vs. institution

Tinker & Lansely (2005) found that older people welcomed AT when it addressed a perceived need. Their personal integrity would still be better taken care of in their own home, than in an institution.

problems with short term memory
Problems with short-term memory

For those cognitive impaired who wish to live in their own homes the main problems are fire prevention or wandering not knowing where they are.

fire prevention
Fire prevention

Fire may be prevented

by installation of heath sensors that automatically cut the electricity before fire gets started.

wandering
Wandering

The GSM bracelet is designed to help Alzheimer's patients by notifying the careers if the wearer wanders outside a pre-defined "secure zone." It is monitored via Assisted GPS and has a GSM/GPRS transmitter/receiver with a SIM card for voice and data.

summary
Summary

In Europe there is a huge variation between northern and southern countries.

The Nordic welfare model allows older people of both sexes to live independently for longer and this is what the majority wants.

slide31
Moderate to severe decline in personal and cognitive functions (ADL & CPS) qualifies Nordic women to an institution bed.

Appropriately selected adaptations and AT can make a significant contribution to the provision of living environments which facilitate independence.

For tailoring the best care a comprehensive assessment is needed.

Summary cont.

eurofellows
EuroFellows

Sørbye LW:

Norway

Finne-Soveri H:

Finland

Schroll M:

Denmark

Jónsson PV:

Iceland

Ljungren G:

Sweden

  • Jean-Claude Henrard

France

  • Topinkova E:

The Czech Republic

  • Ian Carpenter

UK

  • Dinnus Frijters

The Netherlands

  • Vjenka

Garms-Homolová

Germany

  • Bernabei R:

Italy

slide33

Chapter 15

Home, residential and palliative care

 Liv Wergeland Sørbye

Medical Problems in Women over 70 ed. Rees & KeithLondon: Taylor and Frances 2007http://www.rcog.org.uk/index.asp?PageID=73&BookCategoryID=1&BookTypeID=35&BookDetailsID=1857

ISBN:978-0415373524

references
References
  • http://www.linksbuketten.dk/z044.htm
  • Carpenter I, Gambassi G, Topinkova E. et al. Community care in Europe. The Aged in Home Care project (AdHOC). Aging Clin Exp Res 2004;16(4):259-69.
  • Henrard JC, Ankri J, Frijters D, Carpenter I, Topinkova E, Garms-Homolova V, Finne-Soveri H, Sorbye LW, Jonsson PV, Ljunggren G, Schroll M, Wagner C, Bernabei R.Proposal of a service delivery integration index of home care for older persons: application in several European cities. Int J Integr Care. 2006 Jul 6;6:e11.
  • Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I,Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R; AdHOC Project Research Group. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005 Mar 16;293(11):1348-58.
  • Challis D,Hughes J. Frail old people at the margins of care: some recent research findings. The British Journal of Psychiatry. 2002 (180): 126-130.
  • Sørye LW.Home, residential and palliative care. In Medical Problems in Women over 70 ed. Rees M & Keith L. London: Taylor and Francis 2007.
  • Sørbye LW, Schroll M, Finne-Soveri H, Jónnson PV, Ljunggren G, Topinkova E, Bernabei R; The AdHOC Project Research Group. Home care needs of extremely obese elderly European women. Menopause Int. 2007 Jun;13(2):84-7.
references cont
References cont.

Gabrel CS. Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey. Adv Data. 2000 Apr 25;(312):1-15.http://www.cdc.gov/nchs/data/ad/ad312.pdf

Arias E. United States life tables 2002. National vital statistic report volum 53 (6) 2002. http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf

Kõnig B. Life expectancy in the new EU. Federal statistical office Germany. http://www.destatis.de/presse/englisch/pm2004/p2050022.htm

Bonke J, Koch-Weser E. The Welfare State and Time Allocation 9:2001 http://www.sfi.dk/graphics/SFI/Pdf/Working_papers/workingpaper2001_9.pdf.

http://www.vgb.no/keyw.php?blog=7736&keyword=gravst%F8tterhttp://www.engadget.com/2005/06/07/columba-gsm-gps-bracelet-helps-alzheimers-patients/

http://www.globalsources.com/gsol/I/Personal-alarm/p/2000000003844/3000000149681/sm/1000668247.htmhttp://www.studvest.no/reportasjer.php?art_id=5365&seksjon=midten

references cont1
References cont.

Lansley P, McCreadie C, Tinker A. Can adapting the homes of older people and providing assistive technology pay its way? Age Ageing. 2004 Nov;33(6):571-6. Epub 2004 Sep 3.

Tinker A, Lansley P. Introducing assistive technology into the existing homes of older people: feasibility, acceptability, costs and outcomes. J Telemed Telecare. 2005;11 Suppl 1:1.