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BACKGROUND: This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services ("home and community care services" for short) among older adults in China and to investigate the inequity in services utilization. METHODS: Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity. RESULTS: About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit. CONCLUSIONS: This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.
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Servicios de Salud Comunitaria , Servicios de Atención de Salud a Domicilio , Humanos , Anciano , China/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Servicios de Salud Comunitaria/tendencias , Anciano de 80 o más Años , Limitación de la Movilidad , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Estudios Longitudinales , Aceptación de la Atención de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Older patients with lower limb amputation, categorised as having "limited community mobility", are under-researched. Understanding their experience with a new prosthetic ankle-foot is important when designing clinical trials. The aim of this qualitative study was to explore the adjustments they made after amputation and the acceptability of a self-aligning ankle-foot (SA-AF) to older adults. METHODS: Fourteen participants, who took part in the STEPFORWARD randomised controlled feasibility trial (ISRCTN15043643), were purposively recruited; nine were intervention participants and five were standard care participants. They were asked to reflect on their life prior to and consider the adjustments they made following their amputation. Participants in the intervention group were also asked about their views of the new SA-AF compared to their standard non-SA-AF. A thematic analysis was undertaken. RESULTS: Three broad themes were identified: The impact of the amputation; Role of clinical support; and Experiences of the SA-AF. The findings tell a narrative of the long-term impact that amputation has on these individuals' lives. Participants randomised to receive the SA-AF were very positive about it, reporting less pain, greater mobility and being able to do more. CONCLUSION: Participants who used the SA-AF found it an acceptable intervention. These findings suggest that a full-scale RCT is warranted.
There is a high degree of acceptability among an older patient group with a transtibial amputation to use a self-aligning ankle foot.Patients reported experiencing better mobility and more prosthetic comfort with the self-aligning ankle-foot.Key outcomes important to participants include engagement in social and daily activities and balance confidence.
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Tobillo , Miembros Artificiales , Anciano , Humanos , Amputación Quirúrgica , Articulación del Tobillo , Extremidad Inferior/cirugía , CaminataRESUMEN
El objetivo fue analizar la percepción que tienen las personas amputadas de los efectos que el aislamiento social, consecuente a la pandemia de la COVID 19, ha provocado en su movilidad. Es un estudio cualitativo realizado a través de un formulario electrónico con dos ejes temáticos: movilidad física y las preocupaciones y soluciones relacionadas con ésta, antes y después de la pandemia. El proceso de análisis consistió en la organización de los testimonios, separación por ejes temáticos e identificación de las palabras clave. La representación del análisis de datos se realizó utilizando la metodología descriptiva de construcción del diagrama lógico de Ishikawa. Se incluyeron 10 participantes, 9 no estaban infectados por el virus SARS-CoV-2. Las palabras clave que más impactaron en la movilidad física: movimiento, actividad física, ayuda para salir y dolor. Entre los términos secundarios, destacaron: fisioterapia y actividades realizadas en el hogar. Las principales repercusiones del aislamiento fueron la disminución de la movilidad y la resistencia a caminar con más agarrotamiento y problemas musculares, dificultad en los movimientos y en las actividades diarias. También revelaron reducción de la actividad física, estilo de vida sedentario, aumento del peso, falta de ayuda externa para salir y desplazarse y aumento del dolor. Las soluciones para los problemas de movilidad fueron volver a la fisioterapia y la actividad física y adelgazar. Se señala la idoneidad, para las personas amputadas aisladas, de intervenciones a distancia que les permitan recibir de forma integral una atención completa, rehabilitando tanto la salud física como la psicológica. (AU)
The objective was to analyze the perception that people with amputation have of the effects of social isolation caused by the COVID-19 pandemic on physical mobility. It is qualitative research was obtained through an electronic form that contained two thematic axes: physical mobility, concerns, and solutions related to physical mobility before and after the pandemic. The analysis process consisted of the organization of the testimonies, separation by thematic axes, and identification of the content keywords. The representation of the data analysis was carried out using the descriptive methodology of construction of the Ishikawa logic diagram. 10 participants were included, being 9 declared had not yet been infected with the SARS-CoV-2. The keywords that most impacted physical mobility were movement; physical activity, help getting out, and pain. Regarding the secondary keywords physiotherapy and activities performed at home stood out. The greatest repercussions of social isolation were decreased mobility and resistance to walking more stiffness and muscle problems, and difficulty in movements and daily activities. They also revealed stopping physical activities and a sedentary lifestyle, weight gain, no outside help to get out and move, and increased pain. The solutions for the mobility problems were to return to physiotherapy and physical activity and lose weight. Importance is given to remote intervention in people isolated with amputations in a comprehensive way to receive complete care rehabilitating both the physical and psychological health condition. (AU)
O objetivo deste estudo foi analisar a percepção das pessoas com amputação sobre os efeitos do isolamento social causado pela pandemia COVID-19 na mobilidade física. Foi um estudo qualitativo, realizado por meio de formulario eletrônico contendo dois eixos temáticos: mobilidade física e preocupações e soluções relacionadas antes e depois da pandemia. O processo de análise consistiu na organização dos testemunhos, separação por eixos temáticos e identificação de palavras-chave. A representação da análise dos dados foi realizada por meio da metodologia descritiva de construção do diagrama lógico de Ishikawa. Foram incluídos 10 participantes, 9 não infectados pelo vírus SARS-CoV-2. As palavras-chave que mais impactaram na mobilidade física foram movimento, atividade física, ajuda para sair e a dor. Em relação às palavras-chave secundárias destacaram fisioterapia e atividades realizadas em casa. As maiores repercussões do isolamento foram a diminuição da mobilidade e resistência à marcha, maior rigidez e problemas musculares, dificuldade de movimentos e atividades diárias. Também destacaram a interrupção da atividade física e estilo de vida sedentário, ganho de peso, nenhuma ajuda externa para sair e o aumento da dor. As soluções para os problemas de mobilidade foram retornar à fisioterapia e a atividade física, bem como perder peso. É importante a intervenção de forma remota de maneira integral em pessoas com amputações em isolamento para receber cuidados completos, reabilitando a sua saúde física e psicológica. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Pandemias , Infecciones por Coronavirus/epidemiología , Amputación Quirúrgica/psicología , Salud Mental , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , España , Limitación de la MovilidadRESUMEN
Introduction: The demographic development in Germany, especially in Saxony-Anhalt (SA), also poses challenges for vascular surgery, as the incidence of vascular diseases has increased following demographic change. For example, the prevalence of peripheral arterial occlusive disease (PAOD) in industrialised countries is estimated at around 10-20% in people over 60 years of age; thus, the number of people affected will also increase here with demographic change. Especially in rural areas, it seems to be more difficult for patients to reach appropriate specialist treatment. Material and methods: A compact narrative brief review, based on selective references from the current medical-scientific literature and our own experiences from daily practice in setting up a vascular surgery department in a rural area. Results: In 2020, the population in the rural district of Jerichower Land (SA) was approximately 89,403 (male: 44,489; female: 44,914). The age distribution in the age groups relevant for PAOD is as follows: 65-74 years-total, 12.38%; 75 years and older-total, 13.85%; average age, 48.36 years (population density, 56.4/km2). According to the SA Association of Statutory Health Insurance Physicians, there were 605 patients for every doctor in Burg (SA) in 2019.There was a total of 5087 people in need of long-term care in the district in 2019. With such a low population density, low doctor density, high mean age, high proportion of people over 75 years of age and a high number of people in need of care, limited mobility and accessibility to vascular surgery care are to be expected, which was also reflected in the high number of PAOD of stage IV (FONTAINE) in the initial patient clientele.Every establishment of a vascular surgery department is associated with a considerable financial and material investment, which the provider of the facility must be prepared to make.In addition to the material investment, the availability of appropriately qualified staff to implement and maintain continuity of care must also be seriously considered. Conclusion: The high proportion of residents at risk of and suffering from PAOD in a rural area with low population and doctor density allows investment in the establishment of a new vascular surgery department to ensure local care in this patient group with limited mobility and self-help, thus, ultimately from an appropriate health policy perspective but also from the perspective of a relevant revenue outlook.
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INTRODUCTION: People with impaired mobility face difficulty accessing dental care. One solution is portable dentistry, which includes delivering dental care in homes or residential institutions. Dentists, however, appear reluctant to offer such services. Our objective was to understand how dentists perceived portable dentistry and potential challenges to its implementation. METHODS: We conducted a qualitative descriptive study based on semi-structured interviews with a sample of dentists in Quebec, Canada. We employed a combination of maximum variation and snowball sampling strategies to recruit 14 participants. The interviews were conducted and audio-recorded through Zoom and lasted approximately 40 minutes. After transcribing them, we performed a thematic analysis with a combination of inductive and deductive coding. RESULTS: Despite perceiving portable dentistry as a valuable practice model, participants showed little interest in adopting this approach, arguing it was not every dentist's "job" to provide portable services. They believed portable dentistry must be financially burdensome and difficult to integrate into their daily work due to lack of time and portable equipment. Accordingly, participants considered it was the duty of governments, professional organisations overseeing dentistry education and practice, and dental schools to develop portable dentistry programs and hire dentists to deliver such services. CONCLUSIONS: To promote portable dentistry, it may be necessary to improve the knowledge and competencies of dentists, but also to challenge their professional identity as well as the current model of dental clinics as the standard of care delivery. To achieve this, we need strong leadership from dental schools, professional organisations and government.
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Atención a la Salud , Odontólogos , Humanos , Quebec , Investigación Cualitativa , Odontología , Actitud del Personal de SaludRESUMEN
INTRODUCTION AND OBJECTIVES: Pediatric patients with limited lower extremity mobility may be at increased risk of developing nephrolithiasis due to bone mineral metabolic derangements. This study sought to assess whether nephrolithiasis management and related outcomes differ between ambulatory versus non-ambulatory pediatric patients. METHODS: This was a retrospective review of ambulatory and non-ambulatory pediatric patients with nephrolithiasis from 2010 to 2021 from a single tertiary care center. Demographics, surgical history, stone compositions, and 24-h urine data were reviewed. Adjusted logistic and linear regression models were utilized to assess whether mobility status was associated with nephrolithiasis-related management and outcomes, including: age at first stone; requiring surgical intervention for stones; number of surgeries; stone compositions; urine culture results; and completion of 24-h urine studies. RESULTS: Among 339 pediatric patients with nephrolithiasis, 67 (19.8%) were non-ambulatory. In adjusted analyses, non-ambulatory patients had 3.24 times greater odds of requiring surgical intervention for stones (95% CI: 1.93-6.84; p < 0.0001); among those who required surgery, non-ambulatory patients required an average of 0.82 more surgical interventions (95% CI: 0.35-1.30; p = 0.0008) than ambulatory patients. Additionally, non-ambulatory patients had 5.28 times greater odds of having a positive urine culture at the time of surgery (95% CI: 2.35-14.08; p = 0.0001) and were significantly less likely to undergo 24-h urine studies (OR: 0.35; 95% CI: 0.15-0.83; p = 0.02). Stone composition significantly varied by mobility status, with non-ambulatory patients being significantly more likely to form calcium apatite (OR: 5.1; 95% CI: 2.18-11.93; p = 0.0002) or struvite (OR 3.72; 95% CI: 1.18-11.74; p = 0.03) stones, and significantly less likely to form calcium oxalate stones (OR: 0.19; 95 CI: 0.08-0.47; p = 0.0003). Among all patients, age at first stone occurred at a median age of 13.4 years (IQR: 8.2-16.4) and did not significantly differ by mobility status (p = 0.92). CONCLUSIONS: Patients with limited mobility required surgery for nephrolithiasis at significantly higher rates and had different stone compositions than ambulatory patients. Obtaining a 24-h urine study in patients with comorbidities affecting ambulation was uncommon, compared to ambulatory patients. Similarly to ambulatory patients, pediatric patients with limited mobility who develop nephrolithiasis tend to first present with stones in early adolescence.
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Cálculos Renales , Nefrolitiasis , Adolescente , Humanos , Niño , Nefrolitiasis/complicaciones , Nefrolitiasis/cirugía , Cálculos Renales/metabolismo , Oxalato de Calcio , Estudios Retrospectivos , UrinálisisRESUMEN
Introduction: The progressive and chronic characteristics of knee osteoarthritis imply the presence of symptoms, such as pain, stiffness, and functional capacity difficulty to varying degrees. However, asso-ciated psychosocial phenomena, such as kinesiophobia, may also arise, impeding the patient's recov-ery. The aim of this study is to determine the association among pain, stiffness, functional capacity, and kinesiophobia in patients with knee osteoarthritis at Hospital Nacional Hipolito Unanue, Peru, in the first two months of 2020. Materials and methods: An observational, correlational, cross-sectional study was conducted on 88 patients with knee osteoarthritis who were selected by census sampling. The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire and the Tampa Scale for Kinesiophobia were used to measure pain, stiffness, functional capacity and kinesiophobia, respectively. Pearson's chi-square test (p < 0.01) was used for bivariate analysis. Results: The results showed a mean age of 66.38 years and a higher frequency in the female sex (68.2 %), current occupation without physical workload (56.8 %), secondary level education (40.9 %), time of illness of 15 years (51.1 %), bilateral lower limb involvement (68.18 %), moderate pain (51.1 %), moderate stiffness (51.1 %), functional capacity dif-ficulties (61.4 %), and a high level of kinesiophobia (60.2 %). A relationship was found between the vari-ables of pain, stiffness, and functional capacity associated with kinesiophobia (0.000). Conclusions: Pain, stiffness, and functional capacity are associated with kinesiophobia in patients with knee osteoarthritis. The degree of symptomatology increases with the increasing level of kinesiophobia.
Introducción: la característica progresiva y crónica de la gonartrosis supone la presencia de síntomas como el dolor, la rigidez y la dificultad de la capacidad funcional en diferentes grados; sin embargo, pueden también surgir fenómenos psicosociales asociados como la kinesiofobia, que impiden la recuperación del paciente. El objetivo del estudio es determinar la asociación entre dolor, rigidez, capacidad funcional y kinesiofobia en pacientes con gonartrosis del Hospital Nacional Hipólito Unanue (Perú), en los primeros dos meses de 2020. Materiales y métodos: estudio observacional, correlacional y de corte transversal realizado en 88 pacientes con gonartrosis seleccionados por muestreo censal. Se empleó el Cuestionario womac y la Escala Tampa para Kinesiofobia (tsk-11) y se utilizó el estadístico chi cuadrado de Pearson (p < 0.01) para el análisis bivariado. Resultados: una edad media de 66.38 años y una mayor frecuencia del sexo femenino (68.2 %), ocupación actual sin carga física (56.8 %), grado de instrucción secundaria (40.9 %), tiempo de enfermedad de 1-5 años (51.1 %), afectación bilateral de miembros inferiores (68.18 %), grado moderado de dolor (51.1 %), grado moderado de rigidez (51.1 %), grado con dificultades de capacidad funcional (61.4 %) y nivel alto de kinesiofobia (60.2 %). Se halló relación entre las variables dolor, rigidez y capacidad funcional con la kinesiofobia (0.000). Conclusiones: el dolor, la rigidez y la capacidad funcional están asociadas con la kinesiofobia en pacientes con gonartrosis. A mayor grado de sintomatología, mayor kinesiofobia.
Introdução: a característica progressiva e crônica da gonartrose supõe a presença de sintomas como dor, rigidez e dificuldade na capacidade funcional em diferentes graus, porém, fenômenos psicosso-ciais associados como a cinesiofobia também podem surgir, impedindo a recuperação do paciente. O objetivo do estudo é determinar a associação entre dor, rigidez, capacidade funcional e cinesiofobia em pacientes com gonartrose do Hospital Nacional Hipólito Unanue, no Peru, nos dois primeiros meses de 2020. Materiais e métodos: estudo observacional, correlacional e de corte transversal realizado em 88 pacientes com gonartrose selecionados por amostragem censitária. Foram utilizados o Questionário womac e a Escala Tampa para Cinesiofobia (tsk-11) e a estatística Qui-quadrado de Pearson (p < 0,01) para análise bivariada. Resultados: idade média de 66,38 anos e maior frequência do sexo feminino (68,2 %), ocupação atual sem carga física (56,8 %), ensino médio (40,9 %), tempo de doença de 1 a 5 anos (51,1 %), acometimento bilateral de membros inferiores (68,18 %), grau moderado de dor (51,1 %), grau moderado de rigidez (51,1 %), grau com dificuldades de capacidade funcional (61,4 %) e alto nível de cinesiofobia (60,2 %). Foi encontrada relação entre as variáveis dor, rigidez e capacidade funcional com cinesiofobia (0,000). Conclusões: dor, rigidez e capacidade funcional estão associadas à cinesiofobia em pacientes com gonartrose. Maior grau de sintomatologia, maior nível de cinesiofobia.
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Humanos , Dolor , Enfermedad , Osteoartritis de la Rodilla , Educación , HospitalesRESUMEN
The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures.
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Casas de Salud , Estudios Transversales , Femenino , Alemania/epidemiología , Humanos , Masculino , Prevalencia , Factores de RiesgoRESUMEN
Resumo O objetivo do estudo foi verificar a ocorrência de mudanças na capacidade funcional e no desempenho físico de idosos comunitários e seus fatores determinantes, em um período de dois anos. Foi realizado estudo quantitativo, do tipo inquérito domiciliar, observacional e longitudinal, em 2014 e 2016, com 380 idosos residentes em Uberaba, Minas Gerais. Foram utilizados os instrumentos: Mini Exame do Estado Mental e questionários com dados sociodemográficos/econômicos, clínicos e de hábito de vida. A capacidade funcional foi avaliada por meio do Índice de Katz e da escala de Lawton e Brody. O desempenho físico foi verificado através da Short Physical Performance Battery. Procedeu-se a análise descritiva, bivariada e de regressão linear múltipla, com nível de significância de α < 0,05. Os resultados mostraram que no período de dois anos ocorreu redução da capacidade funcional para as atividades instrumentais da vida diária e do desempenho físico. Os fatores determinantes comuns aos desfechos foram: faixa etária, atividade profissional e prática de atividade física. A escolaridade foi específica somente para as atividades instrumentais da vida diária, e o sexo e o número de medicamentos para o desempenho físico.
Abstract This study aimed to verify the occurrence of changes in the functional capacity and physical performance of community-dwelling elderly and its determining factors over a two-year period. This is a quantitative, observational and longitudinal household survey conducted in 2014 and 2016, with the participation of 380 elderly from Uberaba, Minas Gerais. The following instruments were used: The Mini-Mental State Examination and questionnaires with sociodemographic/economic, clinical and life habits data. The functional capacity was evaluated through the Katz Index and Lawton-Brody's scale. Physical performance was verified through the Short Physical Performance Battery. A descriptive, bivariate and linear multiple regression analysis was conducted, with a significance level of α < 0.05. The results showed reduced functional capacity for the instrumental activities of daily living and physical performance in a two-year period. The determining factors for both outcomes were age group, occupational activity, and physical activity. Schooling was a specific factor only for the instrumental activities of daily living, and gender and the number of medicines used, for physical performance.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Actividades Cotidianas , Vida Independiente , Rendimiento Físico Funcional , Evaluación Geriátrica/métodos , Estudios Longitudinales , Persona de Mediana EdadRESUMEN
Urban parks should be inclusive for all. Availability and accessibility of urban parks determine the quality of life in cities. The importance of access increases for residents with limited mobility who, facing obstacles due to inadequate adjustment of the surrounding physical space, are exposed to social exclusion. Five groups of respondents completed a survey questionnaire revealing their attitudes towards green areas and indicating barriers to parks' accessibility. The groups were designed to include blind and vision impaired people, those who use a wheelchair, have a physical disability of any kind, their carers/assistants and parents pushing strollers. The results revealed more similarities than differences among the five groups (the differences included preferences towards the neighbourhood and destination parks, physical barriers in parks, as well as using assistive technology devices and mobile assistive applications). Overall, city residents with mobility difficulties find those green public spaces as an important element of their life quality.
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This handbook draws on the work of the many people around the world dedicated to the care and support of older people. The primary intended audience for this handbook is health and social care workers in the community and in primary care settings. The guidance in this handbook will help community health and care workers to put the ICOPE recommendations into practice. It ofers care pathways to manage priority health conditions associated with declines in intrinsic capacity loss of mobility, malnutrition, visual impairment, hearing loss, cognitive decline, depressive symptoms. These pathways start with a screening test to identify those older people who are most likely to be experiencing some losses in intrinsic capacity already. Health and social care workers can easily carry out this screening in the community. This is the doorway to a more in-depth assessment of the health and social care needs of older people. This assessment leads, in turn, to a personalized care plan that integrates strategies to reverse, slow or prevent further declines in capacity, treat diseases and meet social care needs. The person-centred assessment and the development of the care plan usually require trained health professionals in a primary health-care setting, such as primary care physicians and nurses.
Ce manuel s'adresse principalement aux professionnels de santé et au personnel chargé des soins dans la communauté et dans les établissements de soins primaires. Ces conseils doivent également informer les agents de santé dont les connaissances spécialisées seront sollicitées, au besoin, pour évaluer et planifier les soins pour les personnes dont les capacités intrinsèques et les capacités fonctionnelles sont réduites. Les conseils contenus dans le présent manuel aideront les professionnels de santé et le personnel chargé des soins au niveau communautaire à mettre en pratique les recommandations ICOPE. Ces conseils présentent des filières pour prendre en charge les affections prioritaires associées au déclin des capacités intrinsèques - perte de mobilité, malnutrition, déficience visuelle, déficience auditive, déclin cognitif, symptômes dépressifs. Ces filières commencent par un test de dépistage visant à identifier celles des personnes âgées qui sont les plus susceptibles de subir déjà des pertes de capacités intrinsèques. Les professionnels de santé et le personnel chargé des soins peuvent facilement effectuer ce dépistage dans la communauté. C'est la porte ouverte à une évaluation plus approfondie des besoins des personnes âgées en matière de santé et de services sociaux. Cette évaluation mène, à son tour, à un plan de soins personnalisés qui intègre des stratégies pour inverser, ralentir ou prévenir d'autres diminutions de capacités, traiter les maladies et répondre aux besoins en matière de soins et de services sociaux. L'évaluation centrée sur la personne et l'élaboration du plan de soins exigent habituellement des professionnels de santé formés dans un contexte de soins de santé primaires, tels que des médecins et des infirmières en soins primaires.
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Humanos , Anciano , Anciano de 80 o más Años , Atención Primaria de Salud , Evaluación Geriátrica/métodos , Salud del Anciano , Cuidadores , Práctica Integral de Atención , Servicios de Salud para Ancianos/normas , Trastornos de la Visión/rehabilitación , Atención Dirigida al Paciente , Desnutrición/terapia , Trastorno Depresivo/terapia , Limitación de la Movilidad , Disfunción Cognitiva/terapia , Envejecimiento Saludable , Pérdida Auditiva/rehabilitaciónRESUMEN
BACKGROUND: Latrine access is one of the challenges faced by people with physical disabilities that limit their mobility (PPDs) in their home and working environments. Latrines should be designed, built and located such that they are easily accessible and utilizable by PPDs. Therefore, the aim of this study was to determine latrine access and utilization, and explore the challenges in latrine use among PPDs in Bahir Dar city, northwest Ethiopia. METHODS: A cross-sectional study design was conducted from July 15 to August 15, 2014. Data were collected using a structured and pre-tested questionnaire, and focus group discussions. Four hundred nineteen participants were included using a systematic random sampling technique. SPSS version 20 was used for data entry and analysis. Binary logistic regression was used to identify factors associated with latrine utilization. Qualitative data were analyzed using themes. RESULTS: Of 419 participants, 142 (33.9 %) had access to latrines and 173 (41.3 %) had satisfactory latrine utilization. Family support while using latrine (AOR = 4.7, 95 % CI (2.7, 8.3), latrine accessibility (AOR = 2.1, 95 % CI (1.2, 3.7) and past latrine modification (AOR = 3.1, 95 % CI (1.8, 5.4) were factors associated with latrine utilization. Presence of steps at the latrine entrance, privacy while using latrine, absence of handrails, unavailability of family support, narrower latrine door, distant latrine, unclean floor of the latrine and elevated foot rests were challenges mentioned by PPDs. CONCLUSIONS: Latrine access and utilization were low among PPDs. Family members should encourage and support PPDs when they need to use latrine, designing accessible latrines, modifying existing latrines to accommodate PPDs are the areas of interventions to increase latrine accessibility and utilization among PPDs.
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BACKGROUND: Sarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance. MATERIAL AND METHODS: This study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go" test (TUG) was performed as a functional parameter to reflect mobility. RESULTS: The prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029-p <0.0001). CONCLUSION: In BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.