Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

The effectiveness of aphasia-friendly principles for printed health education materials for people with aphasia following stroke

Background: Provision of health information to people with aphasia is inadequate. Current practice in providing printed health education materials to people with aphasia does not routinely take into consideration their language and associated reading difficulties. Aims: This study aimed to investigate if people with aphasia can comprehend health information contained in printed health education materials and if the application of aphasia-friendly principles is effective in assisting them to comprehend health information. It was hypothesised that participants with aphasia would comprehend significantly more information from aphasia-friendly materials than from existing materials. Other aims included investigating if the effectiveness of the aphasia-friendly principles is related to aphasia severity, if people with aphasia are more confident in responding to health information questions after they have read the aphasia-friendly material, if they prefer to read the aphasia-friendly brochures, and if they prefer to read the brochure type that resulted in the greatest increase in their knowledge. Methods & Procedures: Twelve participants with mild to moderately severe aphasia were matched according to their reading abilities. A pre and post experimental design was employed with repeated measures ANOVA (p

People Detection and Tracking using Depth Camera

In this paper we present a method for real-time detection and tracking of people in video captured by a depth camera. For each object to be assessed, an ordered sequence of values that represents the distances between its center of mass to the boundary points is calculated. The recognition is based on the analysis of the total distance value between the above sequence and some pre-defined human poses, after apply the Dynamic Time Warping. This similarity approach showed robust results in people detection.

DEVELOPMENT OF A MECHATRONIC SYSTEM FOR BEDRIDDEN PEOPLE SUPPORT

This work is developed in the context of Ambient Assisted Living (AAL) and has, as main purpose, the development of a mechatronic system that allows caring of bedridden patients with ongoing medical care terminal (MCT), by a single person. This system allows higher autonomy in domiciliary care, safety, comfort and hygiene of bedridden patients. It contributes to a large increase in their quality of life as well as the ease of monitoring by providers of continuous care, which, in many cases, may be the family itself. The product includes an embedded processing interface for acquiring physiological data to support online monitoring. The development of this project was focused on improving the quality of life, autonomy, participation in social life and reducing healthcare costs in the area AAL. The developed societies currently face severe demographic changes: the world is aging at an unprecedented rate. In 2000, about 420 million people, or about 7 percent of the world population were over 65 years old. In 2050, that number will be near 1500 million people, about 16 percent of the world population. This demographic trend will be accompanied by the increase of people with physical limitations. This will impose new challenges for traditional health systems, not only for Portugal but also for all European countries. There is an urgent need to find solutions to improve the lives of people in their preferred environment by increasing their autonomy, self-confidence and mobility. Therefore, in the case of household scenarios, the provision of effective health services is of fundamental importance to the welfare and economic development of each country. This ongoing project aims to develop a mechatronic system to meet the diverse needs, namely: improving life, health care, safety, comfort, and remote monitoring of bedridden person.

Conceptual design of a conveyer system for supporting basic quality of life of bedridden elderly people

With the increasing number of aged people, especially in developed countries, Ambient Assisted Living solutions have become an important subject to be explored and developed. Currently, as specialized Institutions in geriatric care cannot cope with the increasing requests for support of quality of life, patients have to remain at their homes having as caregiver the other member of the couple or a member of close family. A solution for supporting the caregiver, during assisting the bedridden person with some basic tasks as eating, taking a bath and/or hygiene care is of utmost importance. This paper presents an approach for supporting the caregiver in moving and repositioning the bedridden elderly people (BEP) with the assistance of a mechanical system conveyer. The conceptual design of the mechanical system must be devoted to assist the caregiver in the handling and repositioning of the BEP. The proposed mechatronic system must, ideally, minimize the system's handling complexity, reduce the number of caregivers and the amount of spended and needed effort.

Conceptual design of a mechatronic system for supporting basic quality of life of bedridden elderly people

Ambient Assisted Living is an important subject to be explored and developed, especially in developed countries, due to the increasing number of aged people. In this context the development of mechatronic support systems for bedridden elderly people (BEP) living in their homes is essential in order to support independence, autonomy and improve their quality of life. Some basic tasks as eating, taking a bath and/or hygiene cares become difficult to execute, regarding that often the main caregiver is the other element of the aged couple (husband or wife). This paper presents the conceptual design of a mechanical system especially devoted to assist the caregiver in the handling and repositioning of the BEP. Issues as reducing the number of caregivers, to only one, and reducing the system's handling complexity (because most of the time it will be used by an aged person) are considered. The expertise obtained from the visits to rehabilitation centers and hospitals, and from working meetings, are considered in the development of the proposed mechatronic system.

Geographical stratification by socio-economic status: methodology from a household survey with elderly people in S. Paulo, Brazil

Considering that in most developing countries there are still no comprehensive lists of addresses for a given geographical area, there has always been a problem in drawing samples from the community, ensuring randomisation in the selection of the subjects. This article discusses the geographical stratification by socio-economic status used to draw a multistage random sample from a community-based elderly population living in a city like S. Paulo - Brazil. Particular attention is given to the fact that the proportion of elderly people in the total population of a certain area appeared to be a good discriminatory variable for such stratification. The validity of the stratification method is analysed in the light of the socio-economic results obtained in the survey.

Cognitive deficit and depressive symptoms in a community group of elderly people: a preliminary study

Since the number and proportion of old people increases worldwide, health professionals and systems should be made aware and prepared to deal with their problems. Cognitive deficit and symptoms of depression are commom among the elderly, and may occur in relation to various risk factors such as health conditions and psychosocial variables. In order to study cognitive deficit and the presence of signs and symptoms of depression, 62 elderly community subjects enrolled at a Community Health Unit in Porto Alegre, southern Brazil, were interviewed. They were evaluated by means of the Mini Mental State Exam, the Montgomery-Asberg Depression rating scale, and a questionnaire on health conditions, living arrangements and social variables. Higher levels of symptoms of depression were observed among subjects exposed to major risk factors for cerebrovascular diseases (diabetes and coronary disease), while impaired cognitive performance was seen among individuals who could not count on the presence of a confidant (social network variable). The results suggest that the early identification of major risk groups among old people can help to prevent institutionalization and keep individuals in the community.

The importance of the program for the promotion of physical activity in perceived fatigue in people with multiple sclerosis

The aims of the study is to examine for intervention program of physical activity in the perception of fatigue, in patients with multiple sclerosis.

Implication of an intervention program for the promotion of physical activity in the quality of life of people with multiple sclerosis

The aims of this study is to examine the interest for quality of life of an implementation of program physical activity, with patients of multiple sclerosis.

Use of psychoactive drugs and related falls among older people living in a community in Brazil

INTRODUCTION: Population aging in Brazil has increased the prevalence of neurodegenerative diseases (Parkinson's and Alzheimer's disease) and affective disorders (anxiety, depression), all common in old age. A retrospective study was carried out with the purpose of ascertaining if there is an association between falls and psychoactive medication use among older residents of a community in Brazil. METHODS: All residents aged 65+ (n=161) of one neighborhood of Campo Belo, Brazil (population of 48,000) were evaluated regarding the use of psychoactive drugs and the occurrence of falls in the 12 months preceding the study. Vision and hearing screenings were also performed. RESULTS: From the study population, 9.3% were taking prolonged half-life benzodiazepines, 4.4% anticonvulsants (mostly barbiturates), 2.5% antidepressants (all cyclics) and 8.1% alpha-methyldopa. No subject reported use of hypnotics, neuroleptics or drugs to treat Alzheimer's or Parkinson's diseases (except biperiden). As a whole, drugs that increase the risk of falls were used by 1/5 of this population. In the 12-month period preceding the study, 27 residents (16.8%) experienced falls and, of those, 4 (14.8%) had fracture(s). There was an independent association between psychoactive drug use and falls when variables such as age, gender, vision and hearing were controlled (p=0.02). CONCLUSIONS: Although the population of this neighborhood must be considered young (only 4% are 65 years old or more), there are already problems related to the use of psychoactive drugs among people. Prescribed anxiolytics, anticonvulsants, antidepressants and antihypertensives are not appropriate for this age group and their use is associated with falls.

Orientation system for people with cognitive disabilities

In health care there has been a growing interest and investment in new tools to have a constant monitoring of patients. The increasing of average life ex-pectation and, consequently, the costs in health care due to elderly population are the motivation for this investment. However, healthmonitoring is not only important to elderly people, it can be also applied to people with cognitive disabilities. In this article we present some systems, which try to support these persons on doing their day-to-day activities and how it can improve their life quality. Also, we present an idea to a project that tries to help the persons with cognitive disabilities by providing assistance in geo-guidance and keep their caregivers aware of their location.

Quality of life of the caregivers of people with aphasia. A systematic review.

Purpose: Systematic review to identify the factors associated to the quality of life (QOL) of the caregivers of people with aphasia (PWA). Methods: Studies were searched using Medline, Pubmed, Cochrane Library, CINAHL, PsycINFO and Web of Science databases. Peer-reviewed papers that studied the QOL of PWA’s caregivers or the consequences of aphasia in caregivers’ life were included. Findings were extracted from the studies that met the inclusion criteria. Results: No data is available reporting particularly the QOL of PWA caregivers’ or their QOL predictors. Nevertheless, it was possible to extract aspects related to QOL from the studies that report the consequences of aphasia, and life changes in PWA’s caregivers. Nine (9) studies including PWA’s caregivers were found, but only 5 reported data separately on them. Methodological heterogeneity impedes cross-study comparisons, although some considerations can be made. PWA’s caregivers reported life changes such as: loss of freedom; social isolation; new responsibilities; anxiety; emotional loneliness; need for support and respite. Conclusions: Changes in social relationships, in emotional status, increased burden and need for support and respite were experienced by PWA’s caregivers. Stroke QOL studies need to include PWA caregivers’ and report separately on them. Further research is needed in this area in order to determine their QOL predictors and identify what interventions and referrals better suit their needs.