Public telesurveillance service for frail elderly living at home, outcomes and cost evolution: a quasi experimental design with two follow-ups

BACKGROUND: Telesurveillance is a technologically based modality that allows the surveillance of patients in the natural setting, mainly home. It is based on communication technologies to relay information between a patient and a central call center where services are coordinated. Different types of telesurveillance systems have been implemented, some being staffed with non-health professionals and others with health professional, mainly nurses. Up to now, only telesurveillance services staffed with non-health professionals have been shown to be effective and efficient. The objective of this study was to document outcomes and cost evolution of a nurse-staffed telesurveillance system for frail elderly living at home. METHODS: A quasi experimental design over a nine-month period was done. Patients (n = 38) and caregivers (n = 38) were selected by health professionals from two local community health centers. To be eligible, elders had to be over 65, live at home with a permanent physical, slight cognitive or motor disability or both and have a close relative (the caregiver) willing to participate to the study. These disabilities had to hinder the accomplishment of daily life activities deemed essential to continue living at home safely. Three data sources were used: patient files, telesurveillance center's quarterly reports and personal questionnaires (Modified Mini-Mental State, Functional Autonomy Measurement System, Life Event Checklist, SF-12, Life-H, Quebec User Evaluation of Satisfaction with Assistive Technology, Caregiver Burden). The telesurveillance technology permitted, among various functionalities, bi-directional communication (speaker-receiver) between the patient and the response center. RESULTS: A total of 957 calls for 38 registered clients over a 6-month period was recorded. Only 48 (5.0%) of the calls were health-related. No change was reported in the elders' quality of life and daily activity abilities. Satisfaction was very high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months. CONCLUSION: The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient

Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

<p>Abstract</p> <p>Background</p> <p>Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations.</p> <p>Methods</p> <p>Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model.</p> <p>Results</p> <p>Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources.</p> <p>Conclusion</p> <p>Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.</p

Impact des nouveaux milieux d'hébergement en soins longue durée sur la prise de repas chez les personnes âgées ayant des atteintes cognitives

Plusieurs facteurs de risque de malnutrition sont reliés à l'environnement en milieu d'hébergement. Cette étude s'est intéressée à la présence des facteurs de risque de malnutrition liés à l'environnement dans deux milieux adaptés (prothétique et alternatif). Elle traite des composantes environnementales (physique, sociale, organisationnelle) et du déroulement des repas. Des données ont été colligées par observation pour trois repas chez dix résidents. Les résultats suggèrent que le niveau d'adaptation de l'environnement est très variable. Le milieu alternatif offre un environnement favorable à la prise de repas optimale. Les composantes organisationnelles s'avèrent un élément clé. Cette étude a permis de proposer un cadre théorique mettant en relation les facteurs de risque liés au résident et à l'environnement. Ce cadre innove dans sa présentation globale des différents facteurs et dans la description des composantes. Il pourrait supporter les organisations en facilitant l'identification des facteurs de risque présents dans leur milieu

Bilan de pratiques évaluatives des apprentissages à distance en contexte de formation universitaire

The development of distance learning in higher education raises the question of the nature and validity of evaluation practices of teachers in a context where the nature of the collected data, the scope and credibility of their interpretation and the procedures to communicate results to the students remain subject to requirements framed by collective standards. To enlighten the institutional choices about distance learning evaluation in the faculties of the Université de Sherbrooke, a survey of evaluation practices was conducted through focus groups of 25 participants from its nine faculties, and who agreed to participate in the research. The results of this survey are presented along with their analysis in the light of a review of writings concerning the typology of the instruments used

Bilan de pratiques évaluatives des apprentissages à distance en contexte de formation universitaire

Le développement de dispositifs de formation à distance en enseignement supérieur soulève la question de la nature et de la pertinence des pratiques évaluatives des enseignantes et enseignants, dans un contexte où la nature des données recueillies, la portée et la crédibilité de leur interprétation ainsi que les modalités de communication des résultats restent assujetties à des exigences de certification encadrées par des normes collectives. Afin d’éclairer les choix institutionnels en matière d’évaluation des apprentissages à distance au sein des facultés de l’Université de Sherbrooke, un relevé de pratiques évaluatives a été effectué au moyen de groupes de discussion auprès de 25 intervenants provenant des neuf facultés, et ayant accepté de participer à la recherche. Les résultats de ce relevé sont présentés ainsi que leur analyse à la lumière d’une recension d’écrits portant sur la typologie des instruments utilisés.The development of distance learning in higher education raises the question of the nature and validity of evaluation practices of teachers in a context where the nature of the collected data, the scope and credibility of their interpretation and the procedures to communicate results to the students remain subject to requirements framed by collective standards. To enlighten the institutional choices about distance learning evaluation in the faculties of the Université de Sherbrooke, a survey of evaluation practices was conducted through focus groups of 25 participants from its nine faculties, and who agreed to participate in the research. The results of this survey are presented along with their analysis in the light of a review of writings concerning the typology of the instruments used

The Disability Creation Process, conceptual scheme (Fougeyrollas, Cloutier, Bergeron, Côté, Côté & St-Michel, 1998)

<p><b>Copyright information:</b></p><p>Taken from "Rehabilitation needs for older adults with stroke living at home: perceptions of four populations"</p><p>http://www.biomedcentral.com/1471-2318/7/20</p><p>BMC Geriatrics 2007;7():20-20.</p><p>Published online 13 Aug 2007</p><p>PMCID:PMC1994951.</p><p></p> CRIPPH 1998. . 1(418)529-9141, p.6202. *Authors of this manuscript have added subcategories to the original scheme to facilitate the understanding of text