Développement d'un système de gestion clinico-administratif basé sur l'autonomie fonctionnelle des personnes âgées

Afin d'améliorer sa performance, le réseau de santé québécois recherche différentes solutions lui permettant de répondre avec efficience, qualité et continuité, à la clientèle des personnes âgées en perte d'autonomie. C'est en réponse à cette préoccupation qu'un système de gestion axé sur la classification des besoins des usagers en profil type d'autonomie fonctionnelle a été conçu. Les données proviennent d'un échantillonnage stratifié de 1 977 personnes âgées en perte d'autonomie vivant dans différents milieux de vie (domicile, ressource intermédiaire et institution) et provenant de plusieurs régions du Québec (zones métropolitaine, urbaines et rurales). Une évaluation clinique et une estimation des coûts des services requis (soins, hébergement, support administratif) ont été réalisées. Une procédure systématique et des analyses de classification automatisée (cluster analysis)ont été utilisées afin de déterminer les différents profils d'autonomie (profils ISO-SMAF). Les 29 items du Système de mesure de l'autonomie fonctionnelle (SMAF) ont servi à développer la classification. Après avoir examiné les données, plusieurs solutions ont été analysées à l'aide de différentes méthodes et une procédure de validation croisée a été effectuée afin d'évaluer la stabilité des diverses solutions. La variation dans les ressources entre les profils a été calculée par une analyse de variance utilisant les Profils ISO-SMAF comme variable indépendante et les ressources requises comme variables dépendantes. La même procédure a été utilisée pour évaluer dans quelle mesure la variation des coûts totaux (soins, infrastructure, fonctionnement, support administratif) était expliquée par les Profils ISOSMAF. Des tests de signification sur des variables indépendantes n'ayant pas servi à la classification ont également été réalisés. Lorsque toutes les analyses ont été complétées, une description des profils ISO-SMAF des différentes solutions (de 5 à 15 groupes), selon les 29 items du SMAF, a été dégagée et chaque groupe a été décrit en regard des variables socio-démographiques (âge, sexe) et d'autres variables comme l'atteinte cognitive, les heures requises de soins infirmiers et d'assistance, de surveillance et de soutien ainsi que les coûts des services. Ensuite, tous ces résultats ont été transmis à un comité d'experts cliniciens et chercheurs en gérontologie. Une technique combinant la méthode Delphi et celle du groupe de discussion focalisée a été utilisée afin de permettre aux membres de choisir la meilleure solution. Cette procédure a permis le développement d'un système de gestion composé de 14 groupes iso-ressources, nommés Profils ISO-SMAF".--Résumé abrégé par UMI

Low-Income Caregivers with Young Children Experience Risk and Resilience Through Pandemic-Related Stressors

In March 2020, United States government implemented health and safety mandates, including school closures, to prevent the spread of the coronavirus disease (COVID-19). As a result, some caregivers with young children were forced to take on new roles. Low-income households with young children appeared to be more highly impacted than other groups, experiencing acute pandemic-related stressors on top of previous vulnerabilities. Using qualitative analysis, this study examined how low-income caregivers with young children adapted to pandemic-related stressors and how stressors may have altered relationships and well-being in the household (Daks et al., 2020). Two research questions were examined: (1) how have relationships been altered by the pandemic, and (2) how have pandemic-related resource disruptions impacted well-being? Low-income caregiver responses (N= 38) to two open-response questions were analyzed using a thematic analysis approach. Researchers extracted four themes answering the research questions. Findings delineate that low-income caregivers with increased resources appeared to build stronger relationships with their child/ren, whereas caregivers who encountered more stressors reported reduced feelings of well-being. Additionally, young children experienced feelings of isolation, as they missed relationships outside of the household. When lockdowns were lifted, their relationships outside the household were reported to have improved. These findings can be used to support families and young children in areas where they are most vulnerable post-pandemic

Experiences of Burnout Among Adolescent Female Gymnasts: Three Case Studies

Within the current study, the process of adolescent burnout is considered in relation to perceived contributors, symptoms, consequences, and subsequently, effective and ineffective coping strategies. Through case studies, the researchers sought the burnout experiences of three competitive female gymnasts. Participants were selected based on scores obtained from Raedeke and Smith’s (2001) Athlete Burnout Questionnaire. To gain a comprehensive understanding of the process, athlete data were considered in tandem with interviews from at least one parent and one coach. Transcribed data were segmented into meaning units, coded into a hierarchy of themes and verified by each respondent. Despite common trends among the participants, differences were also found in relation to symptoms, contributors, and the progression of the condition. Implications are provided for the athlete/parent/coach triad and also for sport psychologists

Exploring levels of student-athlete burnout at two Canadian universities

The purpose of the current study was to examine the levels of burnout among student-athletes at two Canadian universities and to investigate whether there were significant differences related to gender, sport, year of university sport participation, academic year, and academic program. Burnout was measured by administering Raedeke and Smith’s (2001) Athlete Burnout Questionnaire to 145 student-athletes from various sports. Overall, 1.4% of the student-athletes had elevated burnout scores on all three subscales, and 17% scored high on two of the three subscales. No significant differences emerged with regards to year of varsity sport participation, academic year, or program. However, women had significantly higher levels of emotional and physical exhaustion than men. Significant differences also emerged in relation to levels of emotional and physical exhaustion, and of sport devaluation, when comparing various sports.  Le but de cette étude était d’évaluer le niveau d’épuisement d’étudiants athlètes fréquentant deux universités canadiennes et de déterminer s’il y avait des différences significatives liées au sexe, au sport, au nombre d’années de participation au sport universitaire, ainsi qu’à l’année universitaire et au programme d’étude. L’épuisement a été mesuré en distribuant le « Athlete Burnout Questionnaire » (Raedeke & Smith, 2001) à 145 étudiants athlètes universitaires de différentes disciplines sportives. En somme, 1,4 % des participants ont affiché des scores élevés sur chacune des trois sous-échelles et 17 % ont fait de même sur deux d’entre elles. Aucune différence marquée n’a été identifiée quant au nombre d’années de participation au sport universitaire, ni à l’année universitaire ou au type de programme d’étude. Cependant, les femmes ont affiché un niveau d’épuisement émotif et physique significativement plus élevé que celui des hommes. En outre, on a noté des différences marquées en comparant les sports entre eux en ce qui a trait au niveau d’épuisement émotif et physique et au niveau de dévalorisation des disciplines

PRISMA: a new model of integrated service delivery for the frail older people in Canada

PURPOSE: PRISMA is an innovative co-ordination-type Integrated Service Delivery System developed to improve continuity and increase the efficacy and efficiency of services, especially for older and disabled populations. DESCRIPTION: The mechanisms and tools developed and implemented by PRISMA include: (1) co-ordination between decision-makers and managers, (2) a single entry point, (3) a case management process, (4) individualised service plans, (5) a single assessment instrument based on the clients' functional autonomy, and (6) a computerised clinical chart for communicating between institutions for client monitoring purposes. PRELIMINARY RESULTS: The efficacy of this model has been tested in a pilot project that showed a decreased incidence of functional decline, a decreased burden for caregivers and a smaller proportion of older people wishing to be institutionalised. CONCLUSION: The on-going implementation and effectiveness study will show evidence of its real value and its impact on clienteles and cost

The effectiveness of the PRISMA integrated service delivery network: preliminary report on methods and baseline data

Purpose: The PRISMA study analyzes an innovative coordination-type integrated service delivery (ISD) system developed to improve continuity and increase the effectiveness and efficiency of services, especially for older and disabled populations. The objective of the PRISMA study is to evaluate the effectiveness of this system to improve health, empowerment and satisfaction of frail older people, modify their health and social services utilization, without increasing the burden of informal caregivers. The objective of this paper is to present the methodology and give baseline data on the study participants. <br><br> Methods: A quasi-experimental study with pre-test, multiple post-tests, and a comparison group was used to evaluate the impact of PRISMA ISD. Elders at risk of functional decline (501 experimental, 419 control) participated in the study. <br><br> Results: At entry, the two groups were comparable for most variables. Over the first year, when the implementation rate was low (32%), participants from the control group used fewer services than those from the experimental group. After the first year, no significant statistical difference was observed for functional decline and changes in the other outcome variables. <br><br> Conclusion: This first year must be considered a baseline year, showing the situation without significant implementation of PRISMA ISD systems. Results for the following years will have to be examined with consideration of these baseline results

Scoping study of definitions and instruments measuring vulnerability in older adults

Abstract: It is important to foster social participation and health equity especially for older adults in situations of vulnerability Despite growing interest in the concept of vulnerability there is no consensus regarding how to define or measure it This paper provides an inventory and synthesis of definitions and instruments measuring vulnerability in older adults Using a scoping study framework eight databases Abstracts in Social Gerontology Academic Search Complete AgeLine CINAHL MEDLINE SocINDEX PsycInfo Scopus were searched with relevant keywords Vulnerab AND Concept Defin Meaning Terminology Measurement Assessment Indicator Instrument Scale Questionnaire OR Test AND Aging Ageing Elder Gerontolog Older OR Senior Thirty-one original definitions and five measurement instruments were identified content-analyzed and compared Vulnerability definitions mostly focused on people under conditions that increased their risk of being harmed because of individual physical factors or the social environment Considering these definitions experts in the field of aging including two representing older adults took part in a workshop and a consensus was reached to define a situation of vulnerability as a set of circumstances in which one or more individuals experience at a specific moment in time one or multiple physiological psychological socioeconomic or social difficulties that may interact to increase their risk of being harmed or having coping problems that lead to negative consequences on their life Although none of the measures fully targeted this definition the Perceived Vulnerability Scale PVS was judged best at operationalizing the concept with 22 items considering feelings of vulnerability toward personal and environmental factors it also has good psychometric properties The proposed definition and the PVS help to provide a common language and measure in health and social sciences research policy and practice identifying and reaching older adults in situations of vulnerability and intervening to foster social participation and health equity

Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review

Background Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs. Objective This review aimed at identifying variables associated with frequent ED use by older adults. Methods For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence. A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. Conclusion Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty

Comparing the resident populations of private and public long-term care facilities over a fifteen-year period: a study from Quebec, Canada

In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: privately-owned facilities in which care is privately financed and delivered, and publicly-subsidised accredited facilities. There are few comparative data on the residents served by the private and public sectors, and none on whether their respective population has changed over time. Such knowledge would help plan services for older adults who can no longer live at home due to increased disabilities. This study compared 1) the resident populations currently served by private and public facilities and 2) how they have evolved over time. The data come from two cross-sectional studies conducted in 1995-2000 and 2010-2012. In both studies, we randomly selected care settings in which we randomly selected older residents. In total, 451 residents from 145 settings assessed in 1995-2000 were compared to 329 residents from 102 settings assessed in 2010-2012. In both study periods, older adults housed in the private sector had fewer cognitive and functional disabilities than those in public facilities. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities while it remained over 80% in their public counterparts. Findings indicate that private facilities care today for less-disabled older adults, leaving to public facilities the heavy responsibility of caring for those with more demanding needs. These trends may impact both sectors’ ability to deliver proper residential care

Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

<p>Abstract</p> <p>Background</p> <p>The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community.</p> <p>Methods</p> <p>Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study.</p> <p>Results</p> <p>On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r²= 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications.</p> <p>Conclusions</p> <p>In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.</p