Relations between the quality of adult women's attachments, their well-being, and their strategies for coping with stress were explored. In Study 1, we examined elderly women's (65-87 years of age) attachments to their adult children. No main effect differences were found, but extreme score analyses revealed that women with insecure attachments more often evidenced relatively extreme negative scores on measures of social, psychological, and physical well-being and reported using more strategies in coping with stress. In Study 2, we examined the quality of attachments of young adult (mean age = 20 years) and mature women (mean age = 38 years), respectively, to their closest attachment figure. Again, few main effects were found but extreme score analyses revealed that insecurely attached women more often scored in the clinical range on depression and reported more responses in coping with stress. Further friends independently reported more anxiety among insecurely attached women.
The care of the frail elderly is characterised by fragmentation and discontinuity within and between sectors, resulting in frequent and inappropriate hospitalisations and premature nursing home placement. Integrated models of care in Europe, and North America have proven to be effective in improving health status, satisfaction and utilisation of resources in the frail elderly. The purpose of this article is to describe these programmes and the community geriatrics unit of Geneva, which provides health care to a frail elderly population in collaboration with other partners in the primary care sector. The main objective of the unit is to enable the frail elderly to stay at home using a multidisciplinary comprehensive geriatric approach and coordinated long-term follow-up.
The medical home-care program is a logical and indispensable addition to the comprehensive, multilevel geriatric care offered by the Department of Geriatrics. The home-care program enables the frail and homebound elderly to remain in their home environment and continue to receive comprehensive primary medical care and supportive services. It also serves as a valuable teaching site for medical trainees. Program evaluation through assessment of patient and caregiver satisfaction, estimates of costs of care, and frequency of hospitalization and emergency room visits are ongoing.
Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults. A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously randomized nursing teams into Control (N = 179) and Intervention (N = 122) groups: Controls received usual care by their primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean 16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations, the number and reason of emergency room visits, institutionalization, death, and place of death. The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up (69.8%, CI 59.9 to 79.6 versus 87 · 6%, CI 78 · 2 to 97 · 0; p = .01). Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations (4.1% versus 11.7%, p = .03), lower cumulative incidence for the first emergency room visit, 8.3%, CI 2.6 to 13.9 versus 23.2%, CI 13.1 to 33.3; p = .01), and death occurred more frequently at home (44.4 versus 14.7%; p = .04). No significant differences were found for institutionalization and mortality. Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination and access to care for frail and dependent older adults. Clinical Trials.gov Identifier: NCT02084108 . Retrospectively registered on March 10th 2014.
Elder abuse and in particular material and financial exploitation involving the misappropriation of the older person's money or property is common but rarely identified or managed in clinical practice. It has a direct impact on quality of life, health and social status. Our aim is to assist clinicians by summarizing this frequently unrecognized problem. We discuss risk factors, alerting signs, clinical manifestations, and specific questions that can be used for screening purposes as well as intervention strategies preferably in the context of a multidisciplinary team.
If the collaboration with nurses and physical therapists is frequent for primary care physicians, it is not the case with occupational therapists. This article will describe and contribute to develop interactions between primary care physicians and occupational therapists in the outpatient and home care settings. We will explore the indications for referral to occupational therapy, available techniques and the best appropriate ways to prescribe it.
