Towards more elder friendly hospitals : final report - studies 3b and 3c

Deconditioning and loss of functional status occurs at high rates among elderly persons admitted to hospitals, independent of their medical condition. Design of the physical environment is one of several explanations as to why this may occur. The two pilot studies described in this report tested selected environmental modifications designed to overcome some of the physical barriers to safe independent transfer, mobility, and toileting identified in Studies 1 and 2 of the Towards More Elder Friendly Acute Hospitals Research Project. One pilot study (Study 3b) took place in two originally identical bedrooms at Burnaby Hospital, a community hospital located in Burnaby, British Columbia. The second (Study 3c) took place in two adjacent bathrooms. In both Studies 3b and 3c, one room remained "as is " and the other was modified; 36 community-dwelling volunteers aged 75+ performed a series of tasks in both the original and the modified bedrooms and the two toilet areas. Order of exposure to the "typical" and modified rooms was counterbalanced. Three types of data were collected: subjective, physiological and video. The environment modifications of interest were rated by participants for ease of use, for helpfulness, and/or for appeal and they were asked to respond to questions such as "what did you like most/least about the rooms and why"? Heart rate was measured as participants rested in each bedroom and postural sway was recorded as they transferred from the bedroom to the bathroom and while they pretended to use the toilet and "freshen up" at the sink. To document gross movement, gestures, coping actions and facial expressions, high resolution webcams were mounted in the bedrooms and bathrooms and a camcorder followed the participants throughout the study. A number of lessons were learned from the study about relatively inexpensive design features that if implemented in new construction and retrofitting, have the potential to increase the elder friendliness of FH hospitals (e.g. movement activated lighting at the entrance to the bathroom). A number of useful lessons were also learned concerning equipment and procedures for remote monitoring of physiological functioning and stress. The report ends with a series of recommendations that include recognizing the diversity of the frail elder population of British Columbia and designing physical space in hospitals to meet the needs of patients with multiple chronic physical and/or cognitive impairments. NOTE: The following thesis constitutes Study 3a of this report series: Love, T. (2007). Modifications to the hospital physical environment: Effect on older adults\u27 retention of post-discharge instructions. M.A. Thesis, Department of Gerontology (Supervisor: G. Gutman)

The Effects of Boron on the Range of Motion of Dexterity Related Joints: A Patient with Rheumatoid Arthritis

Rheumatoid arthritis is a progressive, destructive and chronic, inflammatory disease of the joint synovium. Signs and symptoms include pain, limited range of motion, swelling, and tenderness, which may progress to deformity. These manifestations may limit dexterity, independent living, and the overall well being of an individual. Living with daily restrictions proves to be a psychologically distressing experience. An increase in the dietary boron level of laboratory rats has shown to have a positive effect on the range of motion in their involved joints. This concept was tested on a human subject at the United States Department of Agriculture\u27s Human Nutrition Research Center in Grand Forks, North Dakota over a six-month period from January 9th to June 19th, 2001. Joint involvement was assessed using goniometric measurements, a Poly Arthritis form, along with palpation of 16 fibromyalgic points. Subjective information was compiled regarding subject\u27s level of pain, stiffness, bogginess, and soreness. The subject was measured on a consistent day and time each week. The study was conducted under the direction of Dr. Curtiss Hunt at the Human Nutrition Research Center and Beverly Johnson PT, MS at the University of North Dakota Department of Physical Therapy. Institutional Review Board approval was obtained, and inter-rater and intra-rater reliability were established prior to testing. A standardized verbal instruction regimen, to guide the subject and to encourage her to give her maximal effort during measurements, was used. With an increased intake of boron, a significant influence on the range of motion was predicted. It was found, however, the active number of joints for this subject remained relatively constant, proving bogginess and soreness/sensitivity to palpation to still be present. However, the subjective rating of pain, fibromyalgic points, and hours of morning stiffness decreased with boron deprivation. By analyzing the range of motion statistics, 21 out of 64 tested motions were found to display changes in the measurements of dexterity-related joints for an individual with rheumatoid arthritis between boron supplementation and deprivation. A general increase was noted with boron supplementation, whereas a decrease was noted in the range of motion with boron deprivation. The purpose of this case report was to analyze the effect of boron supplementation and deprivation and to aid in improving the pathological related signs and symptoms of an individual with rheumatoid arthritis. The potential to decrease the clinical manifestations and reduce the psychological stress of living with a chronic illness would benefit individuals with rheumatoid arthritis