Tromsø: June 2007
www.interrai.org
Tromsø: June 2007
Characteristics of female 65+ in home
care service – at 11 sites in Europe
[email protected]
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Tromsø: June 2007
The age wave is a female wave
• We want to help
older females in
their surfing on
the wave
• They may need
help to cope with
up and downs
www.studvest.no
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Tromsø: June 2007
Baby-boomers
• The importance of
seniors will accelerate in
2011 until 2031 when
the last of the boomers
turns 65
Statistics Canada September 2006.
White; interRAI Ottawa 2007
www.linksbuketten.dk
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Tromsø: June 2007
Bad prognosis for
Southern -Europe
www.ssb.no (EU-data)
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Tromsø: June 2007
“The health politicians rely on
women to care for their husbands.”
(Sørbye 2007)
• In residential care the portion of women is
75-80% – usually widowed (Gabrel 2000).
• Women in the western world live in
average five to six years longer than men
(Arias 2002, Kõnig 2004).
www.interrai.org
Tromsø: June 2007
Man has a wife who cares for the widow?
• Few significant others are able to
undertake a similar care burden as carried
out by a wife (Bonke & Koch-Weser 2001).
• To keep these older women able to live in
their own home with an acceptable quality
of life is an important socioeconomical
concern.
www.interrai.org
Tromsø: June 2007
Community-based care at the
margin is a substitute for
institutional care
Three factors are considered critical:
• definitions of eligibility,
• assessment procedures and
• balance of care
(Challis & Hughes 2002)
www.interrai.org
Tromsø: June 2007
The Aged in HOme Care project
The data for this presentation are derived
form the AdHOC study. Community Care
at 11 sites in Europe
Measurement: Resident Assessment
Instrument for Home Care (RAI-HC).
(Carpenter et al. 2004, Henrard et al. 2006)
www.interrai.org
Tromsø: June 2007
2974 females 65+ in Home Care Service
Reykjavik (IS)
N=301
Amsterdam (NL)
N=153
Maidstone Ashford
(UK) N=215
Copenhagen
(DK) N=371
Oslo
(N) N=278
Helsinki
(FIN) N=152
Stockholm (S)
N=179
Prague
(CZ) N=337
Amiens
(F) N=274
Monza
N=259
Nurnberg
Bayreuth (G)
N=454
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Tromsø: June 2007
AdHOC data: Female vs. male
• Frequency: Female 74.2% vs. male 25.8%
• Age: in average 2 years older
Female: Mn=82.80 Std 7.20
Male : Mn= 80.88 Std 7.48
• Lived alone: Female 67.8% vs. male 39.6%
OR=3.2 (2.78-3.72)
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Tromsø: June 2007
AdHOC: Selected conditions
Conditions
N (%)
Daily pain
1377 (45.3)
Use of incontinence pads
1292 (43.4)
Problems with short-term memory
977 (32.9)
Self rated bad health
903 (30.4)
Loneliness
672 (22.9)
Use of antidepressants
412 (14.6)
Unintended weight loss
370 (13.1)
Extremely obese
120 (4.0)
Signs of abuse
138 (4.6)
www.interrai.org
Tromsø: June 2007
Activity of Daily Living (ADL)
index (0-8)
•
•
•
•
•
•
•
•
mobility in bed,
transfer,
eating,
toilet use,
personal hygiene,
dressing upper and lower body,
locomotion inside and outside home,
and bathing
www.interrai.org
Tromsø: June 2007
ADL>3
Total
21,7 %
UK
21,4 %
Sweden
Norway
Netherlands
3,4 %
9,4 %
5,9 %
68,7 %
Italy
Iceland
3,7 %
Germany
29,3 %
France
Finland
Denmark
Czech rep.
0,0 %
67,3 %
5,3 %
5,9 %
6,8 %
10,0 %
20,0 %
30,0 %
40,0 %
50,0 %
60,0 %
www.interrai.org
70,0 %
80,0 %
Tromsø: June 2007
Instrumental Activity of Daily Living
Index (IADL) (0-7)
•
•
•
•
•
•
•
meal preparation,
house work,
managing medication,
managing finance,
phone use,
shopping and
transport
www.interrai.org
Tromsø: June 2007
IADL>3
Total
66,3 %
UK
78,6 %
Sweden
38,8 %
Norway
51,4 %
Netherlands
47,7 %
Italy
86,9 %
Iceland
57,1 %
Germany
77,5 %
France
86,4 %
Finland
50,0 %
Denmark
46,1 %
Czech rep.
0%
84,0 %
20 %
40 %
60 %
80 %
100 %
www.interrai.org
Tromsø: June 2007
Cognitive Performance Scale (CPS)
•
•
•
•
•
Memory
Cognitive skill of daily decision making
Expressive communication
Eating
CPS measures the level of cognitive
performance; it runs from 0 to 6 (6 is worst). Cut
off point CPS=3 was chosen to indicate
significant cognitive impairment of dementia
severity. “3” is equivalent average to 15 points in
Mini Mental State Examination (MMSE).
www.interrai.org
Tromsø: June 2007
CPS>3
Total
9,2 %
UK
Sweden
11,2 %
2,2 %
Norway
3,6 %
Netherlands
4,6 %
Italy
Iceland
22,4 %
1,7 %
Germany
11,7 %
France
Finland
31,8 %
0,7 %
Denmark
Czech rep.
0%
4,6 %
2,1 %
5%
10 %
15 %
20 %
25 %
30 %
www.interrai.org
35 %
Tromsø: June 2007
Total
UK
Sweden
Norway
Netherlands
CPS>3
Italy
IADL>3
Iceland
ADL>3
Germany
France
Finland
Denmark
Czech rep.
0%
20 %
40 %
60 %
80 %
100 %
www.interrai.org
Tromsø: June 2007
Living alone
100 %
90 %
80 %
87,5 %
81,4 %
69,8 %
86,0 %
81,7 %
75,1 %
70,0 %
70 %
65,4 %
70,7 %67,8 %
60 %
50 %
45,2 %
40 %
30 %
20 %
17,0 %
10 %
To
ta
l
UK
Ita
Ne
ly
th
er
la
nd
s
No
rw
a
Sw y
ed
en
Cz
ec
h
re
p.
De
nm
ar
k
Fi
nl
an
d
Fr
an
ce
G
er
m
an
y
Ic
el
an
d
0%
www.interrai.org
Tromsø: June 2007
”The car is my umbrella to my social life”
Many older widows are
unnecessarily isolated
because their common
drivers license was
buried together with the
husband.
www.vgb.no
In Norway 82% of the men and 29% of women have a
driver licence at the age of 75+ (SSB 2006).
www.interrai.org
Tromsø: June 2007
Security alarm
80 %
71,9 %
70 %
60,5 %
60 %
50 %
40,8 %
38,0 %
40 %
36,9 %
34,9 %
27,4 %
30 %
19,0 %
20 %
8,4 %
10 %
12,3 %
1,2 %
0,0 %
To
ta
l
UK
Ita
Ne
ly
th
er
la
nd
s
No
rw
ay
Sw
ed
en
Fr
an
ce
G
er
m
an
y
Ic
el
an
d
nl
an
d
Fi
ar
k
De
nm
Cz
ec
h
re
p.
0%
www.interrai.org
Tromsø: June 2007
“It's worth is weight in diamonds”
• Ulla 85, years old had reached the stage when
living on her own is becoming difficult. She was
frail and had just got a diabetes diagnosis. The
visiting nurse asked her if she got sufficient help
to make her secure to live by herself. She
grabbed her old bony fingers around a security
alarm that looked like a necklace. “Do you see
this piece of jewellery? It is the most gorgeous
jewellery I ever had. It is worth is weight in
diamonds.” She had several times been in need
of emergency help and her security alarm had
worked out nicely.
www.interrai.org
Tromsø: June 2007
Assistive technology (AT)
• Sensors can track people and alarms can
be activated if something unnatural such
as a fall is detected. Neither the old people
nor their next of kin have sufficient
information about the terminology of AT or
the concept of “smart house”.
www.interrai.org
Tromsø: June 2007
Cost of care
• Lansely et al (2004) analysed detailed design
studies to measure the cost of technology versus
use of formal care. They concluded that
“Appropriately selected adaptations and AT can
make a significant contribution to the provision of
living environments which facilitate
independence. They can both substitute for
traditional formal care services and supplement
these services in a cost-effective way.
www.interrai.org
Tromsø: June 2007
Assistive technology vs.
institution
• Tinker & Lansely (2005) found that older
people welcomed AT when it addressed a
perceived need. Their personal integrity
would still be better taken care of in their
own home, than in an institution.
www.interrai.org
Tromsø: June 2007
Problems with short-term memory
• For those cognitive impaired who wish to
live in their own homes the main problems
are fire prevention or wandering not
knowing where they are.
www.interrai.org
Tromsø: June 2007
Fire prevention
Fire may be
prevented
by installation of
heath sensors
that automatically
cut the electricity
before fire gets
started.
www.interrai.org
Tromsø: June 2007
Wandering
The GSM bracelet is designed
to help Alzheimer's patients by
notifying the careers if the
wearer wanders outside a predefined "secure zone." It is
monitored via Assisted GPS
and has a GSM/GPRS
transmitter/receiver with a SIM
card for voice and data.
www.interrai.org
Tromsø: June 2007
Summary
• In Europe there is a huge variation
between northern and southern
countries.
• The Nordic welfare model allows older
people of both sexes to live
independently for longer and this is
what the majority wants.
www.interrai.org
Tromsø: June 2007
Summary cont.
• Moderate to severe decline in personal
and cognitive functions (ADL & CPS)
qualifies Nordic women to an institution
bed.
• Appropriately selected adaptations and
AT can make a significant contribution
to the provision of living environments
which facilitate independence.
• For tailoring the best care a
comprehensive assessment is needed.
www.interrai.org
EuroFellows
•
•
•
•
Sørbye LW:
Norway
Finne-Soveri H:
Finland
Schroll M:
Denmark
•
Jónsson PV:
Iceland
•
Ljungren G:
Sweden
Tromsø: June 2007
•
Jean-Claude Henrard
France
•
Topinkova E:
The Czech Republic
•
Ian Carpenter
UK
•
Dinnus Frijters
The Netherlands
•
Vjenka
Garms-Homolová
Germany
•
Bernabei R:
Italy
www.interrai.org
Tromsø: June 2007
Medical Problems in Women over 70
ed. Rees & Keith
London: Taylor and Frances 2007
http://www.rcog.org.uk/index.asp?PageID=73&BookCategoryID=1&B
ookTypeID=35&BookDetailsID=1857
Chapter 15
Home, residential and
palliative care
Liv Wergeland Sørbye
ISBN:978-0415373524
www.interrai.org
Tromsø: June 2007
References
•
http://www.linksbuketten.dk/z044.htm
•
Carpenter I, Gambassi G, Topinkova E. et al. Community care in Europe. The Aged
in Home Care project (AdHOC). Aging Clin Exp Res 2004;16(4):259-69.
Henrard JC, Ankri J, Frijters D, Carpenter I, Topinkova E, Garms-Homolova V,
Finne-Soveri H, Sorbye LW, Jonsson PV, Ljunggren G, Schroll M, Wagner C,
Bernabei R. Proposal of a service delivery integration index of home care for older
persons: application in several European cities. Int J Integr Care. 2006 Jul 6;6:e11.
Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter
I,Schroll M, Onder G, Sorbye LW, Wagner C, Reissigova J, Bernabei R; AdHOC
Project Research Group. Potentially inappropriate medication use among elderly
home care patients in Europe. JAMA. 2005 Mar 16;293(11):1348-58.
Challis D,Hughes J. Frail old people at the margins of care: some recent research
findings. The British Journal of Psychiatry. 2002 (180): 126-130.
Sørye LW. Home, residential and palliative care. In Medical Problems in Women
over 70 ed. Rees M & Keith L. London: Taylor and Francis 2007.
Sørbye LW, Schroll M, Finne-Soveri H, Jónnson PV, Ljunggren G, Topinkova E,
Bernabei R; The AdHOC Project Research Group. Home care needs of extremely
obese elderly European women. Menopause Int. 2007 Jun;13(2):84-7.
•
•
•
•
•
www.interrai.org
Tromsø: June 2007
References cont.
•
•
•
•
•
•
Gabrel CS. Characteristics of elderly nursing home current residents
and discharges: data from the 1997 National Nursing Home Survey. Adv
Data. 2000 Apr 25;(312):1-15.http://www.cdc.gov/nchs/data/ad/ad312.pdf
Arias E. United States life tables 2002. National vital statistic report
volum 53 (6) 2002.
http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf
Kõnig B. Life expectancy in the new EU. Federal statistical office
Germany. http://www.destatis.de/presse/englisch/pm2004/p2050022.htm
Bonke J, Koch-Weser E. The Welfare State and Time Allocation 9:2001
http://www.sfi.dk/graphics/SFI/Pdf/Working_papers/workingpaper2001_9
.pdf.
http://www.vgb.no/keyw.php?blog=7736&keyword=gravst%F8tterhttp://
www.engadget.com/2005/06/07/columba-gsm-gps-bracelet-helpsalzheimers-patients/
http://www.globalsources.com/gsol/I/Personalalarm/p/2000000003844/3000000149681/sm/1000668247.htm
http://www.studvest.no/reportasjer.php?art_id=5365&seksjon=midten
www.interrai.org
Tromsø: June 2007
References cont.
•
•
Lansley P, McCreadie C, Tinker A. Can adapting the homes of older people
and providing assistive technology pay its way? Age Ageing. 2004
Nov;33(6):571-6. Epub 2004 Sep 3.
Tinker A, Lansley P. Introducing assistive technology into the existing homes
of older people: feasibility, acceptability, costs and outcomes. J Telemed
Telecare. 2005;11 Suppl 1:1.
www.interrai.org