Differences between risk factors for falling in homebound diabetics and non-diabetics

The purpose of this study was to identify the differences in fall risk factors between diabetic and non-diabetic homebound adults in a population identified at high risk for falls. The sample compared 210 non-diabetic homebound adults to 74 diabetic homebound adults. Five research hypotheses supported this study. It was hypothesized that, 1) incidence and severity of somatosensory changes in the feet of diabetics surpassed that of non-diabetics; 2) incidence of lower leg and foot pain in diabetics surpassed that of non-diabetics; 3) deficits in sensory integration would be greater in diabetics than non-diabetics; 4) balance deficits were more evident in diabetics and non-diabetics; and 5) fear of falling was more prominent in diabetics than in non-diabetics. An one-way ANOVA showed a significant difference in sensation between groups, with diabetics reporting less sensation than non-diabetics in all age categories. A small effect size limited external validity. No other significant differences emerged for the other fall risk factors. Gender and age category failed to influence differences between diagnostic groups

The Self-Perceived Impact of a Food Recovery-Meal Delivery Program on Homebound Seniors’ Food Security, Nutrition Health, and Well-Being

For many senior citizens, meeting nutritional needs is essential to good health and daily function. Studies indicate that many American older adults are not meeting their nutrition needs and often suffer from food insecurity. Meals on Wings (MOW) is a food recovery-meal delivery program that attempts to decrease the influence of food insecurity among older adults. This study aims to explore the self-perceived impact of a food recovery-meal delivery program on homebound seniors’ nutrition health, food security, and well-being. Semi-structured interviews were administered to adults age 55 and older on the waitlist for Meals on Wheels America in Duval County who received meals for three months or longer from MOW (n=10). Themes related to food security, nutrition health, and well-being were identified using inductive thematic analysis based on participants’ responses. Ten major themes were revealed: 1) healthier eating, 2) balanced meals meet needs, 3) feel happier and/or worry less, 4) decreased feelings of isolation and loneliness, 5) food always available, 6) worry less about food running out, 7) food and SNAP benefits last longer, 8) less need for food pantries and/or food assistance programs, 9) more money available, and 10) coronavirus disease (COVID-19) pandemic makes it harder to leave home to buy food and meet nutrition needs. All the participants reported that receiving meals help them worry less or feel happier, make the food they buy last longer, and help them pay for other things including medications, rent or utilities. It was discovered that factors including transportation, physical capability, economic burdens, and awareness of community resources available may impact access to food. Homebound senior adults perceive that food recovery-meal delivery programs may improve their nutrition health, food security, and well-being to some degree. The food recovery-meal delivery model can be considered a solution to hunger in homebound seniors in the future

The Efficacy of a House Call Provider Service

Problem: Many individuals who are disabled, homebound from chronic disease or are of advanced age have difficulty seeking medical services from an outpatient medical provider. Unnecessary or preventable hospital readmissions/ER visits from congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) exacerbations are costly and these individuals would benefit from a house call program. The PICO format is as follows: P) Elderly and adult population with COPD and/or CHF. I) Adult and elderly population with COPD and/or CHF receiving house call visits by a nurse practitioner. C) Adult and elderly population with COPD and/or CHF receiving medical care at a clinic. O) Measurement of hospital admission and/or ER visits with those who receive house call visits compared to those who do not. Purpose: To assess the efficacy of house call visits made by a nurse practitioner in seeing individuals with COPD and/or CHF compared to those who receive their care at a medical care clinic in determining if there a difference in the rate of hospital readmission and/or ER visits. Goals: Providing in-home medical care to the adult and elderly population with chronic disease will decrease the strain in the medical clinics, ER and hospital systems by minimizing health exacerbations and these patients can remain at home. Objectives: Comparing two groups of people with like-diagnoses of CHF and/or COPD to assess the benefit of receiving their health care at home versus those who receive their health care in a clinic. Plan: 50 participants were selected ages 50 and over with CHF and/or COPD. Participants selected for this study were those who received a yearly physical exam from their insurance company and those who received home-medical visits from a house call provider group. 25 participants were selected for each group, those who received their medical care at a clinic and those who received their medical care at home. All the participants were seen in their home and were asked 3 questions. 1) Do you have COPD? 2) Do you have CHF? 3) Have you been in the hospital and/or ER in the last 12 months due to a CHF and/or COPD exacerbation? Their answers were documented on a context-specific data sheet. Those participants who answered yes to having COPD and/or CHF were selected for the study. Outcomes and Results: Of the 25 participants who received their care at a medical clinic, 15 went to the hospital/ER in the last 12 months, totaling a hospitalization/ER rate of 65%. Of the 25 participants who received their care at home, 8 went to the hospital/ER in the last 12 months, totaling a hospitalization/ER rate of 35%. The results showed that those participants who received home medical visits by a nurse practitioner had a decrease in medical exacerbations resulting in a hospitalization/ER visit compared to those participants who received their care at a medical clinic. House call visits are beneficial in providing a cost-effective medical care model that support those with chronic illness in being able to remain in their homes

Design for a mobile meals program through home health care

The purpose of this project was to establish criteria for design and implementation of a mobile meals program. Mr. Carmel Home Health Care decided to develop such a program to service patients and other individuals within the commu­nity who were unable to prepare or obtain meals themselves. Mobile meal programs through other agencies provided a valu­able community service, yet the development of a program would eliminate referrals to these competitive services. The program was feasible, because many resources were available for use thr0ugh Mt. Carmel Health Care Center

The Only Way Out Is To Die: Perceptions and Experiences of Rural, Homebound, Older Diabetics

The purpose of this phenomenological study was to investigate the meaning of diabetes, as perceived and experienced by rural, homebound, 65-year and older, diabetics requiring insulin. The sixty-five year and older persons are disproportionately affected by diabetes. They are more likely than younger diabetics to have co-morbidities, disabilities and difficulty preventing diabetic complications. Guidelines for diabetes management and treatment developed by the American Diabetes Association are not specifically targeted for the 65-year and older population. Phenomenological research was used to examine and describe the understanding of diabetes from perspectives of older diabetics. A purposive sample of participants was recruited from Senior Agencies referrals in a Southern State, following University of Tennessee Institutional Review Board approval. Participants were 65 years of age or older, female, required insulin, homebound, lived alone, lucid, English speaking, and willing to participate. Unstructured, audiotaped, face-to-face interviews were conducted individually in each person’s home. Thomas and Polio’s (2002) phenomenological method, which begins with bracketing, was used for collecting and analyzing the qualitative data in this study. Data was reviewed by the researcher and selected transcripts were read aloud to members of an interpretive, interdisciplinary, phenomenology research group at The University of Tennessee, Knoxville, to determine emerging themes described by the participants. The group assisted the researcher in identifying thematic structures from the data. This phenomenological study revealed that diabetes had forever changed lives. Four figural themes emerged; the predominant theme was “you just go on.” Remaining themes were: “your body will let you know: if you miss it you’ll wind up in a coma;” I thought I was fine, but I wasn’t;” and “only way out is to die.” Participants seemed pleased to have the opportunity to describe their experiences to a professional health care provider. Their perceptions and experiences of living with diabetes led to introspection and existential questioning. The participant’s experiences were unique in quality and meaning. Based on the outcome of this study, this population requires a different approach to diabetes self-management. Understanding an older person’s perceptions and experiences with diabetes may provide a foundation for considering new diabetic protocols. Nursing interventions could include diabetes regimens planned with consideration of the context of the person’s life, which could be more efficacious than conventional regimens

Preventing Recurrent Falls In Elderly Home Bound Health Plan Members

Falls have become a major public health concern. As the population ages, the prevalence of falls among older adults continues to increase, as does mortality and morbidity. Evidence-based assessment and intervention tools are widely available, though in practice, providers experience challenges utilizing them. Homebound older adults are at particular risk since they have mobility and transportation barriers that prevent access to community fall screening and primary care sites. This project focused on the provision of fall assessment, interventions, and coordination of fall-prevention services for community-dwelling, homebound older adults covered by a managed health plan. A standardized fall assessment and intervention pilot program using evidenced based tools was successful in reducing recurrent falls in this population by 50%. Based on the data analysis, a multidisciplinary approach with tailored care plans to mitigate recurrent falls in an older adult homebound population proved beneficial to members. The project provides a model for scalable adoption by managed care plans that coordinate care for medically complex, homebound older adults. Providing an adoptable multidisciplinary fall management model for managed care plans that coordinate members care will address the multifactorial risks and causes of falls, and tailor appropriate interventions

Oral status of residents of long-term care facilities in Kentucky.

Oral health is a critical component of every individual\u27s general health and well-being. There is evidence that consistently demonstrates that age, poverty, education levels, minority status, and living in a rural area are risk factors for poorer oral status. In Kentucky, it is projected that there will continue to be an increase in the rural population and a decrease in the urban population; this projection is more pronounced for the aged 65 and over cohort. In 2005, a state-wide oral health survey (KEOHS) which assessed the oral health status and treatment needs of residents aged 65 and over was completed. The KEOHS gathered information on homebound residents, long-term care facility residents, and independently-living adults. To date, only data pertaining to the homebound residents have been analyzed. The focus of this study, therefore, was on data involving residents of long-term case facilities and assisted living facilities. Specifically, it will be determined if there is a relation between actual oral health and self-reported oral health as well as the nature of the relationship between oral health status and the type of community. The study group was comprised of a total of 912 individuals from 27 nursing homes and assisted living facilities around the state. Every elder who participated was given the questionnaire (or interviewed by the research team) and the clinical examination performed by a trained and calibrated dentist. The first study question concerned the agreement between an individual\u27s self-reported oral health status (excellent, good, fair, or poor) and the examiner evaluation of that same individual\u27s oral health status. Analyses revealed a significant correlation between an individual\u27s self-reported oral status and the examiner-reported oral health status of the same individual. The second research question concerned the relation between the examiner-reported oral health status and place of residence prior to entering a nursing home. Analyses indicated that there was not a significant difference in oral health based upon place of residence prior to entering a nursing home. Further research is necessary to determine the change in oral health status of the individuals who were examined in 2005. If it were shown that individuals who had higher clinician-rated oral health status at admission maintained their oral health better than individuals with lower clinician-rated oral health status, there would be additional support for development of policy that mandated a minimal level of oral health at admission to a long-term care facility