Aug 16 2010

Prevalence and antifungal drug sensitivity of non-albicans Candida in oral rinse samples of self-caring elderly.

Gerodontology. 2010 Jul 1;
Meurman JH, Pärnänen P, Seneviratne CJ, Samaranayake LP, Saarinen AM, Kari K

Gerodontology 2010; doi: 10.1111/j.1741-2358.2010.00407.x Prevalence and antifungal drug sensitivity of non-albicans Candida in oral rinse samples of self-caring elderly Aim: To assess the prevalence and antifungal drug sensitivity of non-albicans Candida (NAC) species in elderly outpatients. Materials and methods: We investigated oral rinse samples of 194 self-caring elderly population (mean age 83 years) with emphasis on background factors for harbouring NAC. Susceptibility of Candida species to antifungal drugs was determined using standard methodology. Multiple logistic regression analysis was performed taking positive NAC count as the dependent variable and a number of known Candida risk factors as independent variables. Results: Prevalence of candidal carriage of the population was 78.4%, of which 0.5% of the subjects were NAC positive. Candida dubliniensis was the most prevalent NAC species, followed by Candida glabrata and Candida parapsilosis. The NAC positive elderly were more often edentulous with dental prostheses or had fewer teeth than Candida albicans-positive or yeast-negative subjects. Dental caries slightly increased the risk for having NAC strains (odds ratio 1.08), whilst greater age appeared to lower the risk (odds ratio 0.77). Candida species were susceptible to the commonly used antifungal agents in general, but with considerable variation among species. Occasionally, some NAC exhibited lower antifungal susceptibility. Conclusion: The possibility of oral reservoirs of NAC strains which are resistant to common antifungals should be noted in elderly outpatients.

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Aug 15 2010

Geriatric day hospital: opportunity or threat? A qualitative exploratory study of the referral behaviour of Belgian general practitioners.

BMC Health Serv Res. 2010; 10: 202
Vanden Bussche P, Desmyter F, Duchesnes C, Massart V, Giet D, Petermans J, Vyncke V, Ven Den Noortgate N, Willems S

BACKGROUND: In order to address the challenges of an ageing population the Belgian government decided to allocate resources to the creation of geriatric day hospitals (GDHs). Although GDHs are meant to be a strategy to support general practitioners (GPs) caring for the frail elderly, few Belgian GPs seem to refer to a GDH. This study aims to explore the barriers and facilitating factors of GPs’ referral to GDHs. METHODS: A qualitative study using focus group discussions (FGDs) was conducted. Fifteen FGDs were organized in the different Belgian regions (Flanders, Wallonia, Brussels). RESULTS: Contextual factors such as the unsatisfactory cooperation between hospital and GPs and organizational barriers such as the lack of communication on referral procedures between hospital and primary health care (PHC) were identified. Lack of basic knowledge about the concept or the local organization of GDH seemed to be a problem. Unclear task descriptions, responsibilities and activities of a GDH formed prominent points of discussion in all FGDs. Nevertheless a lot of possible advantages and disadvantages of GDHs for the patient and for the GP were mentioned. CONCLUSIONS: In the case of poor referral to GDHs, focusing on improving overall collaboration between primary and secondary health care is essential. This can be achieved by actively delivering adequate information, permanent communication and more involvement of PHC in the organization and functioning of GDHs. The absence of a transparent health care system with delineated role definitions, seems to hinder the integration of new initiatives like GDHs in the care process. Strategies to enhance referral to GDHs should use a comprehensive approach.

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Aug 15 2010

Geriatric vestibulopathy assessment and management.

Curr Opin Otolaryngol Head Neck Surg. 2010 Jul 6;
Furman JM, Raz Y, Whitney SL

PURPOSE OF REVIEW: This review discusses the demographics of dizziness in the older person, the evaluation of the older dizzy patient and how the treatment of dizziness in older patients differs from that in younger individuals. RECENT FINDINGS: Seven percent of all visits to primary care physicians for patients older than 65 years of age are for dizziness, and dizziness is the most common complaint for patients older than 75 years. In a German study, the 12-month prevalence of vertigo in the general population was 5% with an incidence of 1.4% in adults overall. For individuals aged 60-69 the 12-month prevalence was found to be 7.2% and in individuals 70 years of age or older 8.9%. Data from the United States National Health and Nutrition Examination Surveys indicated that the prevalence of vestibular dysfunction for individuals in the seventh decade of life, eighth decade of life, and older was 49.4, 68.7, and 84.8 percent, respectively. Only subtle age effects are seen on caloric and rotational testing whereas vestibular evoked myogenic potentials (VEMPs) change somewhat with age. Particle repositioning for benign paroxysmal positional vertigo combined with vestibular rehabilitation is more effective than only performing the repositioning maneuver. Tai Chi appears to be an effective intervention for older adults at risk for falling. SUMMARY: When caring for an older dizzy patient always assess medication use, perform a Dix-Hallpike maneuver, obtain orthostatic vital signs, discuss fall risk precautions, and consider referral for vestibular rehabilitation.

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Aug 14 2010

Why Choose a Nursing Home in Dorset?

Dorset County located in the south west of England and is widely considered to be one of the most relaxing and quietest counties in the UK. Many people choose to come and retire in Dorset due to the u…

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Aug 14 2010

Serum Cathepsin S Is Associated with Serum C-Reactive Protein and Interleukin-6 Independently of Obesity in Elderly Men.

J Clin Endocrinol Metab. 2010 Jul 7;
Jobs E, Risérus U, Ingelsson E, Helmersson J, Nerpin E, Jobs M, Sundström J, Lind L, Larsson A, Basu S, Arnlöv J

Objective: Cathepsin S has been suggested provide a mechanistic link between obesity and atherosclerosis, possibly mediated via adipose tissue-derived inflammation. Previous data have shown an association between circulating cathepsin S and inflammatory markers in the obese, but to date, community-based reports are lacking. Accordingly, we aimed to investigate the association between serum levels of cathepsin S and markers of cytokine-mediated inflammation in a community-based sample, with prespecified subgroup analyses in nonobese participants. Methods: Serum cathepsin S, C-reactive protein (CRP), and IL-6 were measured in a community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men; mean age 71 years, n = 991). CRP and IL-6 were also measured at a reexamination after 7 yr. Results: After adjustment for age, body mass index, fasting plasma glucose, diabetes treatment, systolic blood pressure, diastolic blood pressure, hypertension treatment, serum cholesterol, serum high-density lipoprotein cholesterol, prior cardiovascular disease, smoking, and leisure time physical activity, higher cathepsin S was associated with higher CRP (regression coefficient for 1 SD increase, 0.13; 95% confidence interval 0.07-0.19; P < 0.001) and higher serum IL-6 (regression coefficient for 1 SD increase, 0.08; 95% confidence interval 0.01-0.14; P = 0.02). These associations remained similar in normal-weight participants (body mass index <25 kg/m(2), n = 375). In longitudinal analyses, higher cathepsin S at baseline was associated with higher serum CRP and IL-6 after 7 yr. Conclusions: These results provide additional evidence for the interplay between cathepsin S and inflammatory activity and suggest that this association is present also in normal-weight individuals in the community.

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Aug 13 2010

Embodied reflection in practice–'touching the core of caring'.

Int J Nurs Pract. 2010 Jun; 16(3): 241-7
Ranheim A, Kärner A, Arman M, Rehnsfeldt AW, Berterö C

A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as ‘coresearchers’ and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of one’s own caring ability that in the long run will benefit the patient.

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Aug 13 2010

'I start my day by thinking about what we're going to have for dinner'- a qualitative study on approaches to food-related activities among elderly men with somatic diseases.

Scand J Caring Sci. 2010 Jul 26;
Kullberg K, Björklund A, Sidenvall B, Aberg AC

Scand J Caring Sci; 2010 ‘I start my day by thinking about what we’re going to have for dinner’- a qualitative study on approaches to food-related activities among elderly men with somatic diseases The aim of this study was to address the question of how older men with somatic diseases living in their own home approach the question of food-related activities (FRA). Further, any adaptations of these activities necessitated by effects of diseases and of altered life circumstances were explored. Interviews were conducted with a purposeful sample of 18 co-living and single-living men, 64-84 years old. They were diagnosed with Parkinson’s disease, rheumatoid arthritis or stroke. In the analysis, a thematic framework was used. The findings revealed three food-related approaches, namely ‘Cooking as a pleasure’, describing joy in cooking; ‘Cooking as a need’, indicating no habits or skills in cooking; and ‘Food is served’, that is, being served meals by a partner. It was found that gender-related roles in particular, but also changed life circumstances, activity limitations, personal interests, and a wish to maintain continuity and independence, affected the men’s approaches to these activities. This knowledge may be useful in attempts to facilitate and support FRA among elderly men with diseases. Health care efforts to promote FRA should preferably be individualised in respect to older men’s approaches to these activities.

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Aug 12 2010

Assisted Living: Making the Right Decision

Most elderly people want to live independently, without checking themselves into assisted living for as long as they can. However, this is not always possible for everyone. The level of service offere…

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Jul 17 2010

Caring For the Elderly

Kimberly C. Smith asked:




There are many things to consider when asked to care for an elderly person. It may surprise you to know that 70% of elderly care is provided by family members and friends. Many think they can take care of an elderly person, but it takes a very special person to do it well. Elderly care is a challenging task - one that is also inevitable. Oftentimes, adult children experience sadness and depression as they watch a parent who was competent and capable become frail and needy.

If the present goal is for the senior to live independently in his or her own home, there are many safeguards to be considered and installed as soon as possible. Among the obvious are grab bars in the bathroom and hallways. Another improvement in the bathroom would be a shower stool. An emergency system needs to be in place in case the elder needs immediate assistance as in the case of a fall.

Senior citizens are finding in these technologically advanced days many issues on their hands that they can’t handle by themselves. Older people are also now living well into their 80s and beyond. At some point, the decision about assistance will need to be made. The determination of the need for senior care services and the choice of a facility is an extremely important decision.

Do your homework. Talk to people who are already taking care of an elderly person. Also check out the many online and community resources geared toward senior care. Whether it’s assisted living or a nursing facility, our seniors deserve caregivers who are compassionate and caring. Learn about LTC (long term care) insurance and all aspects of care (including costs) in the last stage of life. What you learn may even help yourself some day.

Elsie
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Jul 10 2010

The Biggest Problems With Caring for Your Elderly Parents

Christain Cullen asked:

It’s the weekend and time to make the call to your mother back home. But when she answers, her voice is slurred and she’s talking about things that don’t make sense.
Something is wrong.

Strokes can happen at any time. A myriad of medical conditions can happen at any time in men and women over a certain age.

Your mother has suddenly gotten old and you realize the clock has ticked to the time that comes to many of us. It is now she who needs looking after not you.
It is a role reversal that can create headaches, and be a shock to the system.
You can make the job easier by thinking ahead and discussing the options with your parents while they are still in sound mind. This not only helps with planning, but also lets them know that you care and are thinking about their welfare.

At the very least, you can have contact numbers on hand for elderly service providers for when the crisis comes, particularly if you live a long car ride or plane trip away. Know their doctors’ names and have a copy of their medicare numbers, if they have them.
Exchange phone numbers with one of their neighbors for emergencies and make sure you have a set of keys for their home.

Keep a list of their medication, including dosage. This includes non-prescription drugs as well as prescription drugs, as there can be side effects when drugs interact.
Once the shock wears its way out of your system, if it ever does, there are not just emotional, but financial and practical matters to consider.

Where are their important documents, like wills, kept? Someone should be made enduring power of attorney to handle financial and legal matters. All paperwork such as bank statements, records of mortgage or rent, insurance policies, taxation, benefits and welfare, should be in order.

Caring for the elderly is tough, and with life expectancy rising, the chances you will be faced with this dilemma are growing. In fact, as the population ages, caring for the elderly parents while working is set to become one of the biggest challenges facing people all over the world.

What do you do?

If they are no longer capable of looking after themselves, you can move them into your own home, but what about your spouse and children? How will they react? Do you have the space? Are you equipped to look after someone who cannot look after themselves? You may have to consider wheelchair access, and other alterations to your home to make life easier for your parent.

Perhaps the parent doesn’t want to live with you. Maybe they will refuse to leave their own home, where they may have lived all their life, despite what the Doctor orders.
They could be vulnerable if left living on their own though, so keep a close eye on them, and find out about local home care agencies. You could investigate Meals- on-Wheels, transport options, and assisted living. You may be surprised at the community resources that are available.

There could be conflict. Involve siblings in discussions, if you have any, and their husbands or wives.

Share the burden.

There’s a nursing home, or retirement village, but costs can spiral and if you are not well-off then it can be a struggle. Fees are often not included in national health services. And arrangements care can take weeks, if not months.

Will you have to take time off work? Can you take time off work?

There is a mountain of things to consider.

What’s likely to hit hardest s the emotional aspect of seeing a once active and proud parent frail, and in some cases, incapacitated?

Even a slow decline can come as a jolt.

Looking after elderly parents can be a stressful period of your life, an anxious period. And it can arrive suddenly.

Jamie

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