Comparative Analysis of Factors Related to Activities of Daily Living, Depression and Cognitive Function Between Elderly Living Alone and Elderly Living with Others
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Abstract:
본 연구는 독거노인과 비독거노인 집단 간의 인구사회학적 특성을 비교하고, 일상생활수행능력, 우울 및 인지기능에 대한 집단 간 차이 및 집단별 관련요인을 비교분석하는데 목적이 있다. 이를 위해 제7차 고령화연구패널의 원자료 중 65세 이상 노인 4,353명의 응답자료를 이용하여 분석하였다. 연구결과, 독거노인과 비독거노인 집단 간에는 성별, 연령, 학력, 거주지역, 주관적 계층의식에 따라 통계적으로 유의한 차이가 있었으며, 독거노인의 우울은 비독거노인보다 높은 반면, 인지기능은 낮은 것으로 나타났다. 또한 인지기능과의 관련요인은 두 집단 모두 동일하였으나, ADL과 IADL, 우울의 관련요인은 집단별로 차이가 있음을 확인하였다. 따라서 각 집단별 특수성을 고려한 차별화된 맞춤형 지원프로그램의 개발 및 제공이 이루어져야 하며, 각 집단별 취약집단에 대한 중점적 지원방안을 모색해야 할 것이다.Keywords:
Depression
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Minimum Data Set data from 15,977 residents were analyzed to investigate the reasons older adults were admitted to skilled nursing facilities from assisted living facilities. Residents admitted from assisted living facilities, private homes, hospitals, and hospitals with previous assisted living facility residence were compared. Findings suggest that residents admitted from assisted living facilities are more likely to be older, to have diagnoses of dementia and depression, and to be placed in Alzheimer's special care units.
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Ambient Assisted Living (AAL) aims to provide services to support elderly people living more independently at their homes. Caregivers have an important role as they can monitor and support the persons, and evaluate if they can still live independently. Informal caregivers are important as well, as
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Terminally ill residents, their families, and care providers were interviewed and observed in 4 assisted living facilities (ALFs). Families supported the residents' desires to die "at home," and dying residents had sustained, caring relationships with some staff. Facilities varied in terms of the services they could provide at the end of life. The staff did not always have sufficient training in care at the end of life, and staffing ratios did not always accommodate the intense care needs of dying people. ALF and hospice staffs did not plan, coordinate, or communicate sufficiently in providing care services. This study suggests that the privacy and autonomy that make ALFs desirable living environments may create challenges when dying residents require increasingly intense monitoring and care.
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Abstract Assisted living (AL) is a term applied to a wide array of residential facilities for older adults. In the broadest sense, AL includes all group residential programs not licensed as nursing homes, which provide personal care in activities of daily living and can respond to unscheduled needs for assistance. In a more restrictive sense, it refers to the values underlying the manner in which that care is provided. Thus, AL has come to refer to both a setting of long-term care that combines housing and supportive services in a homelike environment, and a distinct philosophy of residential care provision. This chapter discusses assisted living as a setting and a philosophy of care, assisted living regulation, assisted living funding, issues in assisted living, and the social worker in assisted living.
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The current study surveyed 74 assisted living facilities to examine the effect of facility type on resident autonomy and the willingness of providers to admit residents requiring complex services. Facility types included adult family homes, residential care facilities, and traditional assisted living facilities. Adult family homes were more willing to admit residents with higher care needs. By contrast, assisted living facilities' policies did not support the provision of intensive services, but their policies promoted higher resident autonomy, suggesting that consumers may have to choose between autonomy and help with complex needs when exploring assisted living for long-term care.
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Background Medical, functional, and behavioral problems are associated with transitions from assisted living (AL), but limited information is available on those at highest risk for transition. Methods We conducted a multidisciplinary geriatric team assessment of individuals newly admitted to 2 dementia-specific AL communities from January 2000 to March 2002. Transitions of individuals to permanent skilled nursing facilities (SNF) was assessed for 9 months. Multidisciplinary assessment on admission included medical and cognitive evaluations, physical function, nutritional status, and psychosocial adjustment. Results Twenty-four men and 24 women with a mean age of 83±6 years were assessed. Mental status score was 15±6. Residents had 2.1±1.7 comorbidities and were prescribed 1.7±1.2 medications. During follow-up, 23 (47.9%) transitioned to SNF and 9 (18.8%) individuals died (censored events). Significant predictors of transfer to nursing home from AL by one-predictor Cox proportional hazards model included depression score [hazard ratio (HR) 1.19; P=0.008], dependent activities of daily living (HR 1.18; P=0.014), gait speed (HR 1.15; P=0.004), modified Berg Balance Score (HR 0.88; P=0.004), and mental status score (HR 0.924, P=0.034). Our multivariate model selected by the forward procedure indicates that the modified Berg Balance Scale score predicted transfer to permanent nursing home with a interquartile HR of 0.91 (95% CI 0.8264, 0.989). Conclusions A significant number of new residents of dementia-specific AL transitioned to SNF over 9 months. In univariate analysis, depression score, walking speed, balance, and mental status score were significantly associated with transition and in multivariate analysis, balance performance predicted transfer. These results suggest that fall risk should receive attention on admission to AL to potentially mitigate the high transfer rate.
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Assisted livings settings are residential settings that provide housing and supportive services for older and disabled adults. Although individuals in assisted living settings are less functionally impaired than those in nursing home settings, they engage in limited amounts of physical activity and decline functionally more rapidly than their peers in nursing homes. Function-focused care for assisted living (FFC-AL) was developed to prevent decline, improve function, and increase physical activity among residents living in these settings. The purpose of this study was to translate the previously established, effective FFC-AL intervention to 20 assisted living facilities. Evidence of our ability to successfully translate function-focused care into these 20 assisted living facilities was determined using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) model. Our findings supported our ability to translate FFC-AL effectively into 18 of these 20 settings, using our dissemination and implementation approach.
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Abstract In this exploratory study, administrators of 14 assisted living facilities in Missouri were asked to describe resident behaviors and other issues that contributed to their decisions to discharge residents with dementia from their assisted living facilities to skilled nursing facilities. While resident behaviors themselves were factors influencing discharge, the interaction of those behaviors with the environment of the assisted living facility also influenced the decision. The interaction of behavior with environment, as much as any isolated behavior, suggested to the staff that it was necessary to consider discharge to a skilled nursing facility.
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