Südamehaiguste iseärasused eakatel

Vanemaealiste südamekaebustega haigete arstlikus käsitluses on palju rohkem eksimusi võrreldes noorematega. Nii on Eestis vanemaealistel inimestel põhjendamatult palju diagnoositud südame isheemiatõbe ja südamepuudulikkust ning raviks määratud ülemäära sageli digoksiini. Seevastu arteriaalse hüpertensiooni ravi on Eesti eakate hulgas vähemalt ravimi tarvitajate arvu osas adekvaatne. Artiklis on käsitletud diagnoosimise ja ravi põhimõtteid eakatel südamekaebustega inimestel ning analüüsitud nimetatud probleemi Eesti oludes. Eesti Arst 2003; 82 (3): 208–21

Rasvumise paradoks: kehamassiindeksist uute uuringute valguses

Kaaluprobleeme – rasvumist ja ülekaalulisust – peetakse tänapäeval üleilmseks epideemiaks, mis võib kaasa tuua olulisi terviseriske. Viimasel ajal on aga paljud uuringud näidanud, et kõige väiksem suremus on inimestel, kelle kehamassiindeks jääb kehtivate normide kohaselt ülekaalu alasse. Artikli sihiks on tutvustada uuemaid kehamassiindeksi ja suremusega seotud uuringuid ning arutleda, milliseid praktilisi järeldusi nende tulemustest teha.Eesti Arst 2018; 97(3):138–14

Tervishoid ja hoolekanne arenevad kumbki omas mullis

Eesti Arst 2023; 102(3):177–17

Geriaatria – kellele, milleks, kuidas?

Geriaatria mõiste on kasutusel juba üle sajandi, geriaatriline meditsiin aga üle poole sajandi. Eestis pole need mõisted üheselt arusaadavad, kuna arstide õppekavas geriaatriat ei ole. Artikli eesmärgiks on ühtlustada arusaamist geriaatriast kui arstlikust erialast ja selle võimalikust kohast Eesti tervishoiusüsteemis. Eesti Arst 2010; 89(7−8):464−46

Rahvusvahelise geriaatrilise hindamise meetodi kohandamine Eestis

Toimetulekudefitsiidiga isikutele hoolduse ja edaspidiste toimetulekumeetmete planeerimiseks on vajalik eelnev isiku seisundi täpne hindamine. RAI on rahvusvaheliselt tunnustatud valiidne seisundi hindamise meetod, mille süsteemne kasutamine loob võimalused isiku konkreetsetest vajadustest lähtuvaks hoolduse kavandamiseks, hoolduse kvaliteedi hindamiseks ja ressursside planeerimiseks. Rahvusvahelise hindamismeetodi kasutuselevõtuks on vajalik selle tõlkimine ja riigi kultuurikeskkonnaga kohandamine rahvusvaheliselt aktsepteeritud metoodika kohaselt. Artiklis on käsitletud RAI kohandamist ja juurutamist Eestis. Eesti Arst 2005; 84 (6):408-41

Eluga rahulolu mudel Eesti eakatel inimestel

Elukvaliteeti mõjutab väga palju erinevaid tegureid, mida Ruut Veenhoveni järgi (1) võib tinglikult jagada neljaks rühmaks: välised tegurid kui võimalused ehk keskkonna elukõlblikkus (näiteks kliima, keskkonna turvalisus, kogukonna jõukus, kultuuri arengutase, teenuste kättesaadavus); sisemised tegurid kui võimalused ehk inimese eluvõime (näiteks kehaline ja vaimne tervis, haridus, intelligentsus, elustiil); välised tegurid kui tulemus ehk rolli kasulikkus ühiskonnale (näiteks laste kasvatamine, kodanikukohuste täitmine, loominguline panus) ja sisemised tegurid kui tulemus ehk eluga rahulolu (näiteks rahulolu tööga, hea meeleolu)

A meta‐analysis of change in applicants' perceptions of fairness

Using an event‐triggered multi‐stage framework, this random‐effects meta‐analysis examined the changes in applicants' perceptions of fairness between consecutive stages and throughout the entire personnel selection process. We integrated findings of studies with at least two measurement points, resulting in 45 effect sizes (overall N = 3,038). Trajectories of perceptions of fairness decreased nonlinearly across the process, with a steeper decrease for people who held high levels of initial fairness expectations. Unjust treatment produced a decrease in perceptions of fairness from pretest to posttest and an increase from posttest to postdecision. Furthermore, the length of the time interval moderated the changes in fairness perceptions between the posttest and postdecision stage. Practical implications and an agenda for future research are discussed

Formal support for informal caregivers to older persons with dementia through the course of the disease: an exploratory, cross-sectional study

Background: In European countries, knowledge about availability and utilization of support for informal caregivers caring for older persons (>= 65 years) with dementia (PwD) is lacking. To be able to evaluate and develop the dementia support system for informal caregivers to PwD, a survey of European support systems and professionals involved is needed. The aim of this study was to explore support for informal caregivers to PwD in European countries. We investigated the availability and utilization of support in each of the participating countries, and the professional care providers involved, through the dementia disease. Methods: A mapping system was used in 2010-2011 to gather information about estimations of availability, utilization, and professional providers of support to informal caregivers caring for PwD. Data collected was representing each country as a whole. Results: There was high availability of counselling, caregiver support, and education from the diagnosis to the intermediate stage, with a decrease in the late to end of life stage. Utilization was low, although there was a small increase in the intermediate stage. Day care and respite care were highly available in the diagnosis to the intermediate stage, with a decrease in the late to end of life stage, but both types of care were utilized by few or no caregivers through any of the disease stages. Professionals specialized in dementia (Bachelor to Master's degree) provided counselling and education, whereas caregiver support for informal caregivers and day care, respite care, and respite care at home were provided by professionals with education ranging from upper secondary schooling to a Master's degree. Conclusions: Counselling, caregiver support, and education were highly available in European countries from diagnosis to the intermediate stage of the dementia disease, decreasing in the late/end of life stages but were rarely utilized. Countries with care systems based on national guidelines for dementia care seem to be more aware of the importance of professionals specialized in dementia care when providing support to informal caregivers. Mapping the systems of support for informal caregivers of PwD is a valuable tool for evaluating existing systems, internationally, nationally and locally for policy making

A European study investigating patterns of transition from home care towards institutional dementia care: the protocol of a RightTimePlaceCare study

<p>Abstract</p> <p>Background</p> <p>Health care policies in many countries aim to enable people with dementia to live in their own homes as long as possible. However, at some point during the disease the needs of a significant number of people with dementia cannot be appropriately met at home and institutional care is required. Evidence as to best practice strategies enabling people with dementia to live at home as long as possible and also identifying the right time to trigger admission to a long-term nursing care facility is therefore urgently required. The current paper presents the rationale and methods of a study generating primary data for best-practice development in the transition from home towards institutional nursing care for people with dementia and their informal caregivers. The study has two main objectives: 1) investigate country-specific factors influencing institutionalization and 2) investigate the circumstances of people with dementia and their informal caregivers in eight European countries. Additionally, data for economic evaluation purposes are being collected.</p> <p>Methods/design</p> <p>This paper describes a prospective study, conducted in eight European countries (Estonia, Finland, France, Germany, Netherlands, Sweden, Spain, United Kingdom). A baseline assessment and follow-up measurement after 3 months will be performed. Two groups of people with dementia and their informal caregivers will be included: 1) newly admitted to institutional long-term nursing care facilities; and 2) receiving professional long-term home care, and being at risk for institutionalization. Data will be collected on outcomes for people with dementia (e.g. quality of life, quality of care), informal caregivers (e.g. caregiver burden, quality of life) and costs (e.g. resource utilization). Statistical analyses consist of descriptive and multivariate regression techniques and cross-country comparisons.</p> <p>Discussion</p> <p>The current study, which is part of a large European project 'RightTimePlaceCare', generates primary data on outcomes and costs of long-term nursing care for people with dementia and their informal caregivers, specifically focusing on the transition from home towards institutional care. Together with data collected in three other work packages, knowledge gathered in this study will be used to inform and empower patients, professionals, policy and related decision makers to manage and improve health and social dementia care services.</p

Caring for a Person With Dementia on the Margins of Long-Term Care: A Perspective on Burden From 8 European Countries

© 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine Objectives To explore associations between carer burden and characteristics of (1) the informal carer, (2) the person with dementia, and (3) the care support network in 8 European countries. Design Cross-sectional study. Setting People with dementia judged at risk of admission to long-term care (LTC) facilities in 8 European countries (Estonia, Finland, France, Germany, Netherlands, Spain, Sweden, United Kingdom). Participants A total of 1223 people with dementia supported by community services at home or receiving day care or respite care and their informal carers. Measurements Variables regarding the informal carer included familial relationship and living situation. Variables relating to the person with dementia included cognitive functioning (S-MMSE), neuropsychiatric symptoms (NPI-Q), depressive symptoms (Cornell depression scale), comorbidity (Charlson Comorbidity Index), and physical functioning (Katz Activity of Daily Living [ADL] Index). The care support network was measured using hours of caregiving (ADLs, instrumental ADLs [IADLs], supervision), additional informal care support, and service receipt (home care, day care). Experience of carer burden was recorded using the Zarit Burden Interview. Logistic regression analysis was used to determine factors associated with high carer burden. Results Carer burden was highest in Estonia (mean 39.7/88) and lowest in the Netherlands (mean 26.5/88). High burden was significantly associated with characteristics of the informal carer (family relationship, specifically wives or daughters), of the person with dementia (physical dependency in ADLs; neuropsychiatric symptoms, in particular nighttime behaviors and irritability), the care support network (hours of caregiving supervision; receipt of other informal care support) and country of residence. Conclusion A range of factors are associated with burden in informal carers of people with dementia judged to be on the margins of LTC. Support for informal carers needs to take account of gender differences. The dual challenges of distressed behaviors and difficulties in ADLs by the person with dementia may be addressed by specific nonpharmacological interventions focusing on both elements. The potential protective effect of additional informal support to carers highlights the importance of peer support or better targeted home support services. The implementation of appropriate and tailored interventions to reduce burden by supporting informal carers may enable people with dementia to remain at home for longer