Vanhuksen pitkäaikaisen kivun hoito on räätälin ja salapoliisin sarkaa

Vanhusikään ehtineet muodostavat heterogeenisen joukon, jonka kivunhoito edellyttää asiallista diagnosointia, yksilöllisten tarpeiden tunnistusta ja realistisia hoidon tavoitteita

Suositus palliatiivisen hoidon palveluiden tuottamisesta ja laadun parantamisesta Suomessa : Palliatiivisen hoidon asiantuntijaryhmän loppuraportti

Kaikilla on oikeus tarpeenmukaiseen palliatiiviseen hoitoon. Työryhmien loppuraportissa kuvataan terveyden- ja sosiaalihuollon palliatiivisen hoidon nykytila, kehittämistarpeet, valtakunnallinen palveluketjumalli ja annetaan suositus palveluiden tuottamisesta ja laadun parantamisesta. Terveydenhuollon osalta esitetään erityisvastuualueittain ja sairaanhoitopiireittäin laatukriteereiden mukainen suositus palliatiivisen hoidon kokonaisuudesta. Lisäksi kuvataan palveluketjun integraatio päivystys- ja ensihoidon ja lasten ja nuorten palveluiden sekä iäkkäiden ihmisten sosiaalipalveluiden kanssa. Sosiaalipalvelujen nykytilan kartoituksessa todettiin iäkkäiden ihmisten runsas akuuttipalveluiden käyttö ennen kuolemaa sekä hoitohenkilöstön puutteellinen palliatiivisen hoidon osaaminen, joka korostui erityisesti kotihoidossa. Puutteita havaittiin myös asumispalveluiden kilpailutusasiakirjoissa. Raportissa annetaan iäkkäiden ihmisten palveluihin 21 elämän loppuvaiheen laatukriteeriä perusteineen sisältäen suositukset ulkoistetuille palveluille. Vammaisten henkilöiden sekä kulttuuristen ja etnisten vähemmistöjen palliatiivisen hoidon järjestäminen vaatii vielä tarkempaa selvittelyä. Palliatiivisen hoidon osaamisvajeen korjaamiseksi suositellaan ammattilaisten systemaattisen perusopetuksen sekä täydennys- ja erikoistumiskoulutuksen järjestämistä

The health and well-being of older adults with dual sensory impairment (DSI) in four countries

Objectives Dual sensory impairment (DSI) is a combination of vision and hearing impairments that represents a unique disability affecting all aspects of a person’s life. The rates of DSI are expected to increase due to population aging, yet little is known about DSI among older adults (65+). The prevalence of DSI and client characteristics were examined among two groups, namely, older adults receiving home care services or those residing in a long-term care (LTC) facility in four countries (Canada, US, Finland, Belgium). Methods Existing data, using an interRAI assessment, were analyzed to compare older adults with DSI to all others across demographic characteristics, functional and psychosocial outcomes. Results In home care, the prevalence of DSI across the four countries ranged from 13.4% to 24.6%; in LTC facilities, it ranged from 9.7% to 33.9%. Clients with DSI were more likely to be 85+, have moderate/severe cognitive impairment, impairments in activities of daily living, and have communication difficulties. Among residents of LTC facilities, individuals with DSI were more likely to be 85+ and more likely have a diagnosis of Alzheimer’s disease. Having DSI increased the likelihood of depression in both care settings, but after adjusting for other factors, it remained significant only in the home care sample. Conclusions While the prevalence of DSI cross nationally is similar to that of other illnesses such as diabetes, depression, and Alzheimer’s disease, we have a limited understanding of its affects among older adults. Raising awareness of this unique disability is imperative to insure that individuals receive the necessary rehabilitation and supportive services to improve their level of independence and quality of life

Medication of older people admitted to acute care -

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnIntroduction: The Inter RAI Minimal Data Set for Acute Care (MDS-AC) is a geriatric assessment tool designed for use in acute medicine care. We used data from a study on the MDS-AC to evaluate the medication use of 75+ year old patients (n=730) admitted to selected acute care hospitals in five Nordic countries. Associations of medication use with: Preadmission Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Cognitive Performance Scale (CPS) , walking, memory, continence, falls, chronic pain, admission delirium, length of stay in hospital (LOS) and 12 months survival after discharge, were analyzed. Special focus was on polyphamacy, inappropriate medications, psychotropic medication use and cardiovascular medications. Results: Average number of drugs was 6.2(SD+/-3.7). Polypharmacy (five or more medications) was found among 66% of patients and 16% used inappropriate medications. Women used on average more medications than men, 6.6 vs 5.7 respectively (p < .05). Polypharmacy was associated with worse IADL function and pain (p<.001) and better cognitive function and less falls (p < .05). Inappropriate medications were associated to increased length of stay (p<.05). Psychotropic medications had the most pronounced association with worse function and outcomes in a variety of variables. Cardiovascular drugs were associated with better functional outcome. Conclusion: Polypharmacy, use of inappropriate medications and psychotropic medication use were prevalent in this study. Associations were found between these factors and negative functional outcomes. Individual tailoring of pharmacotherapy of acutely ill older patients with concomitant chronic illnesses combined with functional impairment is important