Younger adults in long-term care facilities : a review of the literature concerning their characteristics and environmental design, staffing and programming needs

Concern over provision of long-term care for an increasing seniors\u27 population has tended to obscure the fact that younger persons may also require this level of care. This report focuses on the non-geriatric population in long-term care: specifically, on adults between the aged of 20-64. Within this group, the emphasis is on those requiring facility care. While there is general consensus (Ontario Medical Association Committee on Rehabilitation, 1980a and b; Reinecke, 1979; Nichols, 1978) that everything possible should be done to enable younger adult disabled persons to live out their lives in the community, it is recognized that for some individuals with severe congenital or accident-caused disabilities, community living is impossible. Others require periodic admission to an institution in order to continue to live most of the time in the community. Still others enter an institution at the late stages of a progressive deteriorating illness which they and/or their family caregivers can no longer manage in a community setting. For all of these groups, the objective must be to construct institutions that will best meet their physical and psycho-social needs -- that is, that provide the best possible physical care in the least restrictive, most emotionally and intellectually satisfying environment possible.Table of Contents: I INTRODUCTION. II CHARACTERISTICS OF YOUNGER ADULTS IN LONG-TERM CARE FACILITIES: Diagnosis; Age Distribution; Sex and Marital Status; Functional Abilities; Age at Onset of Disability. III ADMISSION CRITERIA AND TURNOVER RATES IN YOUNG DISABLED UNITS: Age; Mental Status and Physical Condition; Turnover Rates; Average Length of Stay. IV GOALS AND OBJECTIVES OF YOUNG DISABLED UNITS. V DESIGN RECOMMENDATIONS: Size of Unit; Location of Unit; Type of Rooms; Other Recommendations. VI STAFFING REQUIREMENTS: Type of Staff Needed; Staff-to-Patient Ratio; Volunteers; Selection and Training. VII THERAPEUTIC PROGRAMS: General Recommendations; Recommendations Concerning Recreational/Leisure Programs; Recommendations Concerning Counselling; a) Educational and occupational; b) Sex; c) Marital and family; d) Counselling aimed at countering resentment and fostering acceptance of disability. VIII DISCUSSION. REFERENCES

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)

Special care units for dementia : staff and family perceptions : report of a study undertaken for the Pacific Health Care Society

The study described in this report and the literature review of the environmental design, programming and staffing needs of dementia victims in institutions that preceded it (Gutman, 1989) were undertaken to provide the Pacific Health Care Society with information that would assist it in evaluating the need for and feasibility of expanding its service to include a Special Care Unit

Rethinking retirement

Four of the seven chapters in this volume are based on papers originally presented at the 6th Annual John K. Friesen Lecture Series in Gerontology held at Simon Fraser University April 3-4, 1995. The impetus for the symposium and the volume was provided by the profound changes that are taking place in Canada and throughout the developed world in the way retirement is being conceptualized, timed, and reflected in corporate and public policy.\u27 A systematic examination of these changes seemed warranted.TABLE OF CONTENTS: 1. Introduction. 2. Population Aging: A Contested Terrain of Social Policy/ Ellen M. Gee; 3. Rethinking Retirement: Issues for the Twenty-First Century / Victor W. Marshall; 4. The Older Worker in Canadian Society: Is There a Future? / Victor W Marshall; 5. Security for Social Security - Raise the Age of Entitlement? / Robert L. Brown; 6. Work, Retirement and Women in Later Life / Susan A. McDaniel; 7. Women\u27s Retirement: Shifting Ground / Lynne MacFadgen and Lillian Zimmerman

Progressive accommodation for seniors : interfacing shelter and services

The purpose of this book is to explore the reasons why clients, agencies and governments are considering options that blend shelter and care, the barriers impeding their development and how these have or may be overcome at both the policy and the practice level. New ways of measuring person-environment fit and the potential of maximizing it via enabling technologies are also examined. The target readership includes researchers, architects, policy makers, developers, care providers and operators of existing seniors housing, all of whom can benefit from a better understanding of the multiple issues involved in interfacing shelter and services.TABLE OF CONTENTS: Introduction / Gloria M. Gutman and Andrew V. Wister; Part I: Changing Clients, Economics and Expectations in Housing for Seniors: Chapter 1- Current Demographics and Living Arrangements of Canada\u27s Elderly / Gordon E. Priest; Chapter 2- Choice, Control, and the Right to Age in Place / Veronica Doyle. Part II: Problems in Providing Service within Existing Seniors Housing: Chapter 3- Current Realities and Challenges in Providing Services to Seniors: The Home Care Perspective / Lois Borden and Joan McGregor; Chapter 4 - Difficulties in Providing Support Services in Buildings Constructed Under Shelter-Only Housing Policies / Reg Appleyard. Part III: Transcending Barriers to Combining Shelter and Services: Chapter 5- Public, Private and Non-Profit Partnerships: The CCPPPH Link / C.W. Lusk; Chapter 6- Group Homes: The Swedish Model of Care for Persons with Dementia of the Alzheimer\u27s Type / Elaine Gallagher; Chapter 7- Supportive Housing for Elderly Persons in Ontario / Garry Baker; Chapter 8- Social Policy Models for Shelter and Services: An International Perspective / Satya Brink. Part IV: Measuring and Maximizing Person-Environment Fit: Chapter 9- Measuring Person-Environment Fit Among Frail Older Adults Using Video / Andrew V. Wister and James R. Watzke; Chapter 10- Assessing the Client\u27s Perception of Person-Environment Fit Using the Canadian Occupational Performance Measure / Anne Carswell. Part V: Enabling Technologies in Housing for Seniors: Chapter 11- Personal Response Systems: Canadian Data on Subscribers and Alarms / James R. Watzke; Chapter 12- Older Adults\u27 Response to Automated Environmental Control Devices / James R. Watzke and Gary Birch; Chapter 13- Use and Potential Use of Assistive Devices by Home-Based Seniors / William C. Mann; Chapter 14 - Necessary Elements of a Cost-Effectiveness Analysis of Technical Aids for the Elderly / George Abrahamsohn, Gloria M. Gutman and Andrew V. Wister; Chapter 15- Bridging the Technology Gap - The Links Between Research, Development, Production and Policy for Products Supporting Independent Living / Satya Brin

Aging in place: Housing adaptations and options for remaining in the community

This volume builds on two previous joint publications of the CAG/Acg and the Simon Fraser University Gerontology Research Centre. One, by Statistic Canada\u27s Gordon Priest (1985), entitled "Living Arrangements of Canada\u27s Elderly: Changing Demographic and Economic Factors", examines the current housing characteristics and living arrangements of elderly Canadians with a view to identifying the scenarios which are likely to unfold in the future. The second, "Innovations in Housing and - Living Arrangements for Seniors" (Gutman and Blackie, 1985), describes the process involved in developing new units under cooperative and nonprofit sponsorship, barrier free and prosthetic design issues, innovative financial solutions such as home equity conversion plans as well as several physical solutions (e.g., shared housing; retirement communities)not covered in this volume

Focus group study of older drivers

The report describes findings from a study exploring the driving practices and driving-related beliefs and attitudes of older persons. The methodology employed was a modified focus group technique. Participants, 162 currently licensed drivers aged 56-86 living in five different geographic locations in British Columbia met in 31small groups (mean size 5.2 persons) to discuss eight topics. These topics concerned their driving practices; attitudes and I beliefs about their own and other older persons\u27 driving behaviour; their driving difficulties; ways in which road or traffic signs and signals could be changed to make driving easier for them; their feelings about a series of questions relating to the retesting of older drivers, criteria for licence renewal and driving cessation; concerning driver education courses for older persons, traffic violations they most frequently commit and their experience of medication affecting their driving. Throughout the report data are presented separately for respondents aged 55-65, 66-75 and 76 and over. Where noticeable, differences between the three age groups are highlighted

Health promotion for older Canadians : knowledge gaps and research needs

INTRODUCTION; 1. Potentials and Pitfalls in Evaluating Nutrition and Nutrition Interventions in Older Adults / Helene Payette; 2. The Effectiveness of Exercise Programs for Osteoporotic Women / Gina Bravo; 3. Health Promotion Among Older Persons with Direct and Personal Experience of the Mental Health System / Joseph A Tindale & Susan Hardie; 4. Evaluating Self-Help and Mutual Aid Programs for Older Canadians / Joan Norris, Adam Davey & Stephanie Kuiack; 5. Health Promotion Research for Older Canadians: Priorities from a Community Health Unit Perspective / Nancy Hall; 6. Evaluation of the "Living Well" Health Promotion Program for Older Adults / Dorothy Craig & Carol Timmings; 7. Using Large Data Sets to Study Health Promotion for Older Adults / Andrew Wister & Gloria Gutman; 8. Priorities for Health Promotion and Aging Research in Canada: Discussion and Recommendations / Andrew Wister & Gloria Gutman; AUTHORS\u27 BIOGRAPHIES; FRENCH ABSTRACT

Health systems and aging in selected Pacific Rim countries : cultural diversity and change

Aging, ethnicity and health policy in Australia -- Health status of Japanese seniors and the new directions of health services -- Filial piety and co-residence in Japan -- Health care in China and Hong Kong -- Health care for the Korean elderly: emerging trends and issues -- First Nations elders in Canada: issues, problems and successes in health care policy -- Older refugees in Canada: profile, health needs and social service issues

Psychogeriatric client identification project : phase 1 - final report

The Psychogeriatric Client Identification Project, contracted by the Continuing Care Division and conducted by the Gerontology Research Centre at Simon Fraser University, provides a comprehensive description of the diverse client groups that are typically included under the umbrella term, "psychogeriatric." Traditionally, psychogeriatric clients have been categorized according to medical diagnoses. The current research project adopted a different approach to identifying client needs by using an inclusive definition of the psychogeriatric population and by describing clients in relation to both behavioural characteristics and diagnosis. The focus of the project was on identifying the unique characteristics, behaviours and corresponding needs of client subgroups for the purpose of planning and delivering appropriate services. The specific project objectives were to: 1. describe the characteristics of the various psychogeriatric subgroups, with particular emphasis on behaviours that pose significant care and management challenges within facility and community settings; 2. summarize statistical information on prevalence and projected numbers for British Columbia for the various subgroups; and 3. identify the availability of a model of psychogeriatric care and services that could be applied to policy development and resource planning.Table of Contents: Executive Summary; INTRODUCTION 1: A. Background and Project Objectives; B. Definition of Terms and Behavioural Classification Scheme; C. Report Organization. LITERATURE REVIEW & EPIDEMIOLOGIC/STATISTICAL DATA: A. Introduction; B. PART 1 - Problem Behaviours; Multi-Category Studies: Community; Multi-Category Studies: Institution; Agitated! Aggressive Behaviour; Physical; Verbal; Agitated/Non-Aggressive-Physical; Agitated/Non-Aggressive-Verbal; Ideational; Emotional/Affective Disturbance; Socially Unacceptable Behaviour; Problematic ADLs/Coping Strategies. C. PART 2 - Client Identification by Psychiatric Diagnosis: Prevalence of Psychiatric Disorders: Dementia; Delirium; Mood Disorders; Anxiety Disorders; Schizophrenia and Paranoia; Substance Dependence/Abuse. D. Summary and Conclusions. CONSULTATION PROCESS: A. Research Design/Methods; B. The Sample: Key Informant Survey Participants; Focus Group Participants; C. Data Collection and Analysis. IV RESEARCH FINDINGS: Key Informant Survey: A. Characteristics of Survey Respondents; B. Agency Characteristics; C. Description of Client Characteristics/Behavioural Disturbances and Service Response; D. Most Problematic Client Behaviours; E. Assessment of Facility and Community-Based Resources/Needs; F. Description of Behavioural Disturbance Categories/Groupings; G. Behavioural Disturbance Frequency Ratings; H. Behavioural Disturbance Difficulty Ratings; I. Behaviour Management Difficulty Ratings; J. Specialized Programs/Approaches and Suggested Improvements; K. Utility of Behavioural Classification Scheme; L. Suggested Program Improvements; Focus Group Sessions; M. Summary of Focus Group Results: BC Caregivers\u27 Support Group; Frontline Direct Care Nursing Staff. V CONCLUSIONS AND RECOMMENDATIONS: A. BC Prevalence Estimates by Diagnoses; B. Recommendations Related to Client Subgroups and Resource Needs; C. Recommendations for Future Study. REFERENCES; APPENDICE