Community living.

A series of broadcasts in social studies planned for grades 7, 8, and 9; on the air every Monday, 2:00-2:30 P.M.

Community living alternatives for persons with developmental disabilities.

Includes bibliographical references.

Minimum standards, rules and regulations for the licensure of community living facilities.

"Effective July 28, 1980."--Cover.

Minimum standards, rules and regulations for licensure of community living facilities : final rules.

Authorized by the Community Living Facilities Licensing Act.

A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham elderly thyroid study

Context: Subclinical hypothyroidism (SCH) and cognitive dysfunction are both common in the elderly and have been linked. It is important to determine whether T4 replacement therapy in SCH confers cognitive benefit. Objective: Our objective was to determine whether administration of T4 replacement to achieve biochemical euthyroidism in subjects with SCH improves cognitive function. Design and Setting: We conducted a double-blind placebo-controlled randomized controlled trial in the context of United Kingdom primary care. Patients: Ninety-four subjects aged 65 yr and over (57 females, 37 males) with SCH were recruited from a population of 147 identified by screening. Intervention: T4 or placebo was given at an initial dosage of one tablet of either placebo or 25 µg T4 per day for 12 months. Thyroid function tests were performed at 8-weekly intervals with dosage adjusted in one-tablet increments to achieve TSH within the reference range for subjects in treatment arm. Fifty-two subjects received T4 (31 females, 21 males; mean age 73.5 yr, range 65–94 yr); 42 subjects received placebo (26 females, 16 males; mean age 74.2 yr, 66–84 yr). Main Outcome Measures: Mini-Mental State Examination, Middlesex Elderly Assessment of Mental State (covering orientation, learning, memory, numeracy, perception, attention, and language skills), and Trail-Making A and B were administered. Results: Eighty-two percent and 84% in the T4 group achieved euthyroidism at 6- and 12-month intervals, respectively. Cognitive function scores at baseline and 6 and 12 months were as follows: Mini-Mental State Examination T4 group, 28.26, 28.9, and 28.28, and placebo group, 28.17, 27.82, and 28.25 [not significant (NS)]; Middlesex Elderly Assessment of Mental State T4 group, 11.72, 11.67, and 11.78, and placebo group, 11.21, 11.47, and 11.44 (NS); Trail-Making A T4 group, 45.72, 47.65, and 44.52, and placebo group, 50.29, 49.00, and 46.97 (NS); and Trail-Making B T4 group, 110.57, 106.61, and 96.67, and placebo group, 131.46, 119.13, and 108.38 (NS). Linear mixed-model analysis demonstrated no significant changes in any of the measures of cognitive function over time and no between-group difference in cognitive scores at 6 and 12 months. Conclusions: This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.

Étude exploratoire des transitions de milieux de vie en communauté des personnes présentant une déficience intellectuelle

Cette étude exploratoire dresse un portrait des transitions de milieux de vie (MDV) dans des Centres de réadaptation en déficience intellectuelle et en troubles envahissants du développement (CRDITED) de la grande région de Montréal. Elle permet d’identifier 1) les pratiques de transition de MDV des intervenants pivots en CRDITED, 2) les critères de succès de la transition de MDV et les moyens de les évaluer selon les personnes présentant une déficience intellectuelle et les intervenants pivots et 3) l’écart entre les pratiques souhaitées et les pratiques actuelles à partir du point de vue des deux types de participants. Des personnes présentant une déficience intellectuelle (N = 9) et des intervenants pivots (N = 19) se sont exprimés sur leurs expériences de transition de MDV en participant à des entretiens de groupe. Une analyse qualitative de contenu a permis d’identifier une typologie des expériences de transition de MDV du point de vue des intervenants pivots. Un seul type de transition de MDV parmi les cinq identifiés, le type préparée, offre des conditions favorisant la réalisation de la transition dans des conditions satisfaisantes pour les intervenants pivots. Les autres types de transitions (types dernière minute, explosive, clé en main et salle d’attente) offrent peu d’occasions pour la personne présentant une déficience intellectuelle de s’impliquer dans le processus de transition. Les propos des intervenants pivots permettent d’identifier les caractéristiques d’une transition de MDV qu’ils jugent idéale (type comme si c’était moi). Les types de transitions sont comparés entre eux sur deux axes, soit sur l’axe représentant un continuum d’implication de la personne présentant une déficience intellectuelle dans sa propre transition et sur l’axe identifiant les grandes étapes de réalisation de la transition. Les résultats permettent de déceler un écart important entre les transitions actuellement effectuées et les politiques, intentions et engagements de l’offre de service auprès de cette clientèle, notamment au regard de l’implication de la personne présentant une déficience intellectuelle dans les décisions relatives à sa transition de MDV. L’étude permet aussi d’identifier trois dimensions importantes de l’évaluation du succès de la transition selon les perspectives des personnes présentant une déficience intellectuelle et des intervenants pivots. Les dimensions identifiées sont : bien-être psychologique et comportement, santé physique et collaboration. Les propos des intervenants pivots permettent de constater qu’il existe parfois un paradoxe entre leurs perceptions du succès de la transition de MDV et celles des personnes présentant une déficience intellectuelle. L’interprétation des résultats a permis d’élaborer des recommandations afin de favoriser de meilleures pratiques de transition.

Étude exploratoire des transitions de milieux de vie en communauté des personnes présentant une déficience intellectuelle

Cette étude exploratoire dresse un portrait des transitions de milieux de vie (MDV) dans des Centres de réadaptation en déficience intellectuelle et en troubles envahissants du développement (CRDITED) de la grande région de Montréal. Elle permet d’identifier 1) les pratiques de transition de MDV des intervenants pivots en CRDITED, 2) les critères de succès de la transition de MDV et les moyens de les évaluer selon les personnes présentant une déficience intellectuelle et les intervenants pivots et 3) l’écart entre les pratiques souhaitées et les pratiques actuelles à partir du point de vue des deux types de participants. Des personnes présentant une déficience intellectuelle (N = 9) et des intervenants pivots (N = 19) se sont exprimés sur leurs expériences de transition de MDV en participant à des entretiens de groupe. Une analyse qualitative de contenu a permis d’identifier une typologie des expériences de transition de MDV du point de vue des intervenants pivots. Un seul type de transition de MDV parmi les cinq identifiés, le type préparée, offre des conditions favorisant la réalisation de la transition dans des conditions satisfaisantes pour les intervenants pivots. Les autres types de transitions (types dernière minute, explosive, clé en main et salle d’attente) offrent peu d’occasions pour la personne présentant une déficience intellectuelle de s’impliquer dans le processus de transition. Les propos des intervenants pivots permettent d’identifier les caractéristiques d’une transition de MDV qu’ils jugent idéale (type comme si c’était moi). Les types de transitions sont comparés entre eux sur deux axes, soit sur l’axe représentant un continuum d’implication de la personne présentant une déficience intellectuelle dans sa propre transition et sur l’axe identifiant les grandes étapes de réalisation de la transition. Les résultats permettent de déceler un écart important entre les transitions actuellement effectuées et les politiques, intentions et engagements de l’offre de service auprès de cette clientèle, notamment au regard de l’implication de la personne présentant une déficience intellectuelle dans les décisions relatives à sa transition de MDV. L’étude permet aussi d’identifier trois dimensions importantes de l’évaluation du succès de la transition selon les perspectives des personnes présentant une déficience intellectuelle et des intervenants pivots. Les dimensions identifiées sont : bien-être psychologique et comportement, santé physique et collaboration. Les propos des intervenants pivots permettent de constater qu’il existe parfois un paradoxe entre leurs perceptions du succès de la transition de MDV et celles des personnes présentant une déficience intellectuelle. L’interprétation des résultats a permis d’élaborer des recommandations afin de favoriser de meilleures pratiques de transition.

Living a managed community lifestyle : lessons from Queensland

Purpose - The paper aims to improve consumer awareness of the complexities of community living. It does this by clarifying how living in a managed community is different from a ‘traditional’ neighbourhood; and identifying matters that can become disputes Design/methodology/approach - The paper builds on research by other authors into strata scheme disputes by examining recent Queensland cases. Findings - Many disputes appear to result from a lack of understanding of the complexities of community living. Matters that should be able to be easily resolved are therefore escalated to formal disputes. Research limitations/implications - The paper considers law and cases from Queensland. The types of matters considered, however, are relevant for any managed community and therefore the research is relevant for all jurisdictions. The research will be of particular interest to jurisdictions looking to boost living density by increasing the development of managed communities. Practical implications - The research will assist in consumer transactions by providing guidance as to the matters to be considering prior to moving into a managed community. More informed decision making by prospective residents will lead to a decreased likelihood of disputes arising. Originality/value - The paper is an up-to-date consideration of the issues arising from community living. It highlights the benefits arising from increased consumer awareness of the complexities of community living and the potential for consumer education to reduce the number of disputes.

Sensorimotor and postural control factors associated with driving safety in a community-dwelling older driver population

Background. To establish whether sensorimotor function and balance are associated with on-road driving performance in older adults. Methods. The performance of 270 community-living adults aged 70–88 years recruited via the electoral roll was measured on a battery of peripheral sensation, strength, flexibility, reaction time, and balance tests and on a standardized measure of on-road driving performance. Results. Forty-seven participants (17.4%) were classified as unsafe based on their driving assessment. Unsafe driving was associated with reduced peripheral sensation, lower limb weakness, reduced neck range of motion, slow reaction time, and poor balance in univariate analyses. Multivariate logistic regression analysis identified poor vibration sensitivity, reduced quadriceps strength, and increased sway on a foam surface with eyes closed as significant and independent risk factors for unsafe driving. These variables classified participants into safe and unsafe drivers with a sensitivity of 74% and specificity of 70%. Conclusions. A number of sensorimotor and balance measures were associated with driver safety and the multivariate model comprising measures of sensation, strength, and balance was highly predictive of unsafe driving in this sample. These findings highlight important determinants of driver safety and may assist in developing efficacious driver safety strategies for older drivers.

Modelling the economic benefits of gold standard care for chronic wounds in a community setting

Chronic leg ulcers are costly to manage for health service providers. Although evidence-based care leads to improved healing rates and reduced costs, a significant evidence-practice gap is known to exist. Lack of access to specialist skills in wound care is one reason suggested for this gap. The aim of this study was to model the change to total costs and health outcomes under two versions of health services for patients with leg ulcers: routine health services for community-living patients; and care provided by specialist wound clinics. Mean weekly treatment and health services costs were estimated from participants’ data (n=70) for the twelve months prior to their entry to a study specialist wound clinic, and prospectively for 24 weeks after entry. For the retrospective phase mean weekly costs of care were $AU130.30 (SD $12.64) and these fell to $AU53.32 (SD $6.47) for the prospective phase. Analysis at a population level suggests if 10,000 individuals receive 12 weeks of specialist evidence-based care, the cost savings are likely to be AU$9,238,800. Significant savings could be made by the adoption of evidence-based care such as that provided by the community and outpatient specialist wound clinics in this study.

Nature or nurture BMI and blood pressure at 90. Findings from the Belfast Elderly longitudinal free-living aging study Belfast

Hypertension is a key risk factor for stroke, cardiovascular disease and dementia. Although the link between weight, sodium and hypertension is established in younger people, little is known about their inter-relationship in people beyond 80 years of age. Associations between blood pressure, anthropometric indices and sodium were investigated in 495 apparently healthy, community-living participants (age 90, SD 4.8; range 80–106), from the cross-sectional Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST) study. In age-sex-adjusted logistic regression models, blood pressure =140/90 mmHg significantly associated with body mass index (BMI) [odds ratio (OR)?=?1.28/ kg/m2], with weight (OR?=?1.22/kg) approaching significance (P?=?0.07). In further age-sex-adjusted models, blood pressure above the 120/80 mmHg normotensive reference value significantly associated with BMI (OR?=?1.44/kg/m2), weight (OR?=?1.36/kg), skin-fold-thickness (OR?=?1.33/mm) and serum sodium (OR?=?1.37 mmol/l). In BELFAST participants over 80 years old, blood pressure =140/90 mmHg is associated with BMI, in apparently similar ways to younger groups.

Deinstitutionalization and community inclusion of individuals with intellectual disabilities in Ontario : a case analysis

In the last few decades, there have been significant changes in the way people with intellectual disabilities (ID) live in many countries around the world. Large isolated institutions have been replaced by community-based housing. This study examined the deinstitutionalization process in Ontario and it's effects on the lives of three individuals with ID. A case analysis approach was used allowing for in depth evaluation of the quality of life of these participants following their discharge with a focus on family involvement, community engagement, and choice making. A discrepancy analysis between the Essential Elements Plan (EEP), constructed when they were entering the community placement, and the current living arrangements was also done. The results of this study suggested that with community living comes improvements in family interactions, community engagement, and decision-making. However, these improvements were found to be minimal. Also, little discrepancy was found between the EEPs and their actual placements.

Effectiveness of personal planning for residents re-entering the community during the facility initiative in Ontario

This paper reports on the relocation of people with intellectual disabilities (ID) from large-scale provincially run institutions that took place in Ontario as part of the Facility Initiative. Three case studies were examined in order to report on this process as experienced by those who lived and worked through it. Specifically, the planning process conducted by the Ministry of Community and Social Services (MCSS) to assist each person with hislher transition to community living was examined using the current standard of practice in person- centered planning approaches. Effectiveness was evaluated as the ability to apply a person-centered approach across settings and people, as well as what factors facilitated or hindered its application. Results show that, in general, the personal plans do not appear to reflect the pre-transition experience of the person. Also, the transitional planning process did not appear person-centered nor facilitate further person-centered planning in the community.

Évolution des profils d'état de santé et utilisation des services sociosanitaires chez les personnes âgées

Réalisé en cotutelle avec l'Université de Paris-Sud