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Tromsø: June 2007

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Tromsø: June 2007

Characteristics of female 65+ in home care service – at 11 sites in Europe

sorbye@diakonhjemmet.no

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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).

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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.

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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)

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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)

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Tromsø: June 2007

2974 females 65+ in Home Care Service

Monza N=259

Prague(CZ) N=337

Helsinki (FIN) N=152

Amiens(F) N=274

Copenhagen(DK) N=371

Maidstone Ashford(UK) N=215

Amsterdam (NL) N=153

Reykjavik (IS) N=301

Oslo (N) N=278

Stockholm (S) N=179

NurnbergBayreuth (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 conditionsConditions 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)

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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 

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Tromsø: June 2007

ADL>3

6,8 %

5,9 %

5,3 %

67,3 %

29,3 %

3,7 %

68,7 %

5,9 %

9,4 %

3,4 %

21,4 %

21,7 %

0,0 % 10,0 % 20,0 % 30,0 % 40,0 % 50,0 % 60,0 % 70,0 % 80,0 %

Czech rep.

Denmark

Finland

France

Germany

Iceland

Italy

Netherlands

Norway

Sweden

UK

Total

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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

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Tromsø: June 2007

IADL>3

84,0 %

46,1 %

50,0 %

86,4 %

77,5 %

57,1 %

86,9 %

47,7 %

51,4 %

38,8 %

78,6 %

66,3 %

0 % 20 % 40 % 60 % 80 % 100 %

Czech rep.

Denmark

Finland

France

Germany

Iceland

Italy

Netherlands

Norway

Sweden

UK

Total

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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).

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Tromsø: June 2007

CPS>3

2,1 %

4,6 %

0,7 %

31,8 %

11,7 %

1,7 %

22,4 %

4,6 %

3,6 %

2,2 %

11,2 %

9,2 %

0 % 5 % 10 % 15 % 20 % 25 % 30 % 35 %

Czech rep.

Denmark

Finland

France

Germany

Iceland

Italy

Netherlands

Norway

Sweden

UK

Total

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Tromsø: June 2007

0 % 20 % 40 % 60 % 80 % 100 %

Czech rep.

Denmark

Finland

France

Germany

Iceland

Italy

Netherlands

Norway

Sweden

UK

Total

CPS>3

IADL>3

ADL>3

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Tromsø: June 2007

Living alone

69,8 %

81,4 %87,5 %

45,2 %

70,0 %75,1 %

17,0 %

65,4 %

81,7 %86,0 %

70,7 %67,8 %

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

90 %

100 %

Czech

rep.

Denmar

k

Finlan

d

Franc

e

Germ

any

Icela

ndIta

ly

Nether

lands

Norway

Sweden UK

Total

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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.

In Norway 82% of the men and 29% of women have a driver licence at the age of 75+ (SSB 2006).

www.vgb.no

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Tromsø: June 2007

Security alarm

0,0 %

38,0 %40,8 %

8,4 %12,3 %

34,9 %

1,2 %

19,0 %

71,9 %

36,9 %

60,5 %

27,4 %

0 %

10 %

20 %

30 %

40 %

50 %

60 %

70 %

80 %

Czech

rep.

Denmar

k

Finlan

d

Franc

e

Germ

any

Icela

ndIta

ly

Nether

lands

Norway

Sweden UK

Total

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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.

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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”.

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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.

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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.

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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.

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Tromsø: June 2007

Fire prevention

Fire may be prevented by installation of heath sensors that automatically cut the electricity before fire gets started.

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Tromsø: June 2007

Wandering

The GSM bracelet is designed to help Alzheimer's patients by notifying the careers if the wearer wanders outside a pre-defined "secure zone." It is monitored via Assisted GPS and has a GSM/GPRS transmitter/receiver with a SIM card for voice and data.

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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.

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Tromsø: June 2007

• 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.

Summary cont.

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Tromsø: June 2007EuroFellows

• Sørbye LW: Norway

• Finne-Soveri H: • Finland

• Schroll M: Denmark

• Jónsson PV: Iceland

• Ljungren G: Sweden

• Jean-Claude Henrard France

• Topinkova E:The Czech Republic

• Ian CarpenterUK

• Dinnus Frijters The Netherlands

• Vjenka Garms-HomolováGermany

• Bernabei R:

Italy

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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&BookTypeID=35&BookDetailsID=1857

Chapter 15Home, residential and

palliative care Liv Wergeland Sørbye

                               

ISBN:978-0415373524

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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.

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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-helps-alzheimers-patients/

• http://www.globalsources.com/gsol/I/Personal-alarm/p/2000000003844/3000000149681/sm/1000668247.htm http://www.studvest.no/reportasjer.php?art_id=5365&seksjon=midten

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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.