Adverse Life Events: Do Home Care Clients Have Resources for Mastering Them?

Objectives: Research on life stressors and adverse life events has a long tradition. Few studies have addressed this topic in connection to very old people. Life stressors, especially major life stressors (MLSs) experienced by clients of home care services in the community have rarely been the subject of studies. Considering this gap, we investigated the prevalence of MLSs in home care clients. We examined the effects that MLSs have on their mood and health status as well as the impact of clients’ social resources on MLSs and their outcomes. Method: We used assessment data from 2,884 home care clients in six European countries. The methodological basis was the comprehensive and standardized interRAI Home Care Assessment (interRAI HC). Results: Fifteen point four percent of the sample—that consisted of women and men with an average age of 82.89 years–experienced an MLS in the last 6 months before the assessment. They were more depressed than persons without these experiences, and their health status indicated a higher level of instability and deterioration. At reassessment after 6 months, the situation changed. Despite the fact that both outcomes of the MLSs, depression and health status became worse in the reassessment-sample, home care clients without MLS were more affected by the worsening, especially that of depression. The expected buffering impact of social resources was low. Discussion: Although this study worked with limited information on MLSs, it could contribute to closing various knowledge gaps. The study shows that the MLSs represent a prevalent problem in a population of home care clients and that this problem has negative consequences for their mood and the stability of their health status. Furthermore, this research took up the situation of very old and vulnerable adults, who have previously rarely been considered in studies on major critical life events and stressors. Conclusion and Research Perspective: Future research on MLSs has to take up the issue of the time passage between the MLS and the impact on health and well-being of individuals dependent on care. It has to determine immediate as well as later consequences and identify those factors that are appropriate to reduce the MLS-effects on very old people dependent on care

Development and Validation of a Prediction Model for 6-Month Societal Costs in Older Community Care-Recipients in Multiple Countries; the IBenC Study

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThis study aims to develop and validate a prediction model of societal costs during a period of 6-months in older community care-recipients across multiple European countries. Participants were older community care-recipients from 5 European countries. The outcome measure was mean 6-months total societal costs of resource utilisation (healthcare and informal care). Potential predictors included sociodemographic characteristics, functional limitations, clinical conditions, and diseases/disorders. The model was developed by performing Linear Mixed Models with a random intercept for the effect of country and validated by an internal-external validation procedure. Living alone, caregiver distress, (I)ADL impairment, required level of care support, health instability, presence of pain, behavioural problems, urinary incontinence and multimorbidity significantly predicted societal costs during 6 months. The model explained 32% of the variation within societal costs and showed good calibration in Iceland, Finland and Germany. Minor model adaptations improved model performance in The Netherland and Italy. The results can provide a valuable orientation for policymakers to better understand cost development among older community care-recipients. Despite substantial differences of countries' care systems, a validated cross-national set of key predictors could be identified.European Commission European Commission Joint Research Centr

Benchmarking European Home Care Models for Older Persons on Societal Costs: The IBenC Study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThis study aims to benchmark mean societal costs per client in different home care models and to describe characteristics of home care models with the lowest societal costs. In this prospective longitudinal study in 6 European countries, 6-month societal costs of resource utilization of 2060 older home care clients were estimated. Three care models were identified and compared based on level of patient-centered care (PCC), availability of specialized professionals (ASP) and level of monitoring of care performance (MCP). Differences in costs between care models were analyzed using linear regression while adjusting for case mix differences. Societal costs incurred in care model 2 (low ASP; high PCC & MCP) were significantly higher than in care model 1 (high ASP, PCC & MCP, mean difference €2230 (10%)) and in care model 3 (low ASP & PCC; high MCP, mean difference €2552 (12%)). Organizations within both models with the lowest societal costs, systematically monitor their care performance. However, organizations within one model arranged their care with a low focus on patient-centered care, and employed mainly generalist care professionals, while organizations in the other model arranged their care delivery with a strong focus on patient-centered care combined with a high availability of specialized care professionals. Keywords: Home care models; international benchmarking; older adults; societal costs.European Commissio

Development of a novel benchmark method to identify and characterize best practices in home care across six European countries: design, baseline, and rationale of the IBenC project.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBACKGROUND: Europe's ageing society leads to an increased demand for long-term care, thereby putting a strain on the sustainability of health care systems. The 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care' (IBenC) project aims to develop a new benchmark methodology based on quality of care and cost of care utilization to identify best practices in home care. The study's baseline data, methodology, and rationale are reported. METHODS: Home care organizations in Belgium, Finland, Germany, Iceland, Italy, and the Netherlands, home care clients of 65 years and over receiving home care, and professionals working in these organizations were included. Client data were collected according to a prospective longitudinal design with the interRAI Home Care instrument. Assessments were performed at baseline, after six and 12 months by trained (research) nurses. Characteristics of home care organizations and professionals were collected cross-sectionally with online surveys. RESULTS: Thirty-eight home care organizations, 2884 home care clients, and 1067 professionals were enrolled. Home care clients were mainly female (66.9%), on average 82.9 years (± 7.3). Extensive support in activities of daily living was needed for 41.6% of the sample, and 17.6% suffered cognitive decline. Care professionals were mainly female (93.4%), and over 45 years (52.8%). Considerable country differences were found. CONCLUSION: A unique, international, comprehensive database is established, containing in-depth information on home care organizations, their clients and staff members. The variety of data enables the development of a novel cost-quality benchmark method, based on interRAI-HC data. This benchmark can be used to explore relevant links between organizational efficiency and organizational and staff characteristics.7th Framework Programme of the European Commissio

Die Bedeutung der Laien in der Notfallversorgung

Garms-Homolová V, Schaeffer D. Die Bedeutung der Laien in der Notfallversorgung. Bundesgesundheitsblatt. 1987;30(1):5-11.Die Bedeutung der Laienhilfe für die Notfallversorgung steigt. Die Laienintervention am Notfallort ist eine der zentralen Determinanten für die Effektivität professioneller Rettungsdienste. Es ist jedoch erforderlich, die Handlungsbereitschaft von Laien in Notfallsituationen zu erhöhen. Dies und auch epidemiologische Fakten sprechen für die Veränderung der Aufklärungs- und Ausbildungskonzepte. Zu den vorrangigen Aufgaben gehört die Lösung der Frage, wie die Bevölkerungsgruppen erreicht werden könnten, in denen die potentiellen Notfallzeugen stark vertreten sind. Diese Gruppen (z.B. Personen ohne Führerschein, Jugendliche vor dem Führerscheinerwerb, Frauen etc.) werden bisher von den Ausbildungsmaßnahmen nur unzureichend angesprochen.The relevance of intervention by lay-bystanders in emergencies is increasing. This interaction is an important determinant of the effectiveness of professional emergency service. New concepts of informational and educational work are necessary to stimulate the willingness to help. Epidemiological facts also call for a change of the information and training measures; they show that first aid is necessary not only in the case of traffic accidents but also in cardial emergencies, which occur more often. The most pressing question is how to reach and train particular groups of the population with high probability to be witness of a emergency situation. These groups (e.g. old people, persons without drivers licence, adolescents before acquiring their drivers licence, women etc.) so far were addressed only insufficiently by education in first aid

Konzepte und Voraussetzungen der Kooperation

Garms-Homolová V, Maurer M, Schaeffer D. Konzepte und Voraussetzungen der Kooperation. In: Garms-Homolová V, Schaeffer D, eds. Medizin und Pflege. Berlin: Ullstein Mosby; 1998: 1-6

Mehr Ausbildung aber: weniger Kompetenz: eine Sekundärevaluation eines traditionellen Bereichs der Gesundheitserziehung

Garms-Homolová V, Schaeffer D. Mehr Ausbildung aber: weniger Kompetenz: eine Sekundärevaluation eines traditionellen Bereichs der Gesundheitserziehung. Zeitschrift für erziehungswissenschaftliche Forschung. 1988;22(3):163-187

Die Rolle der Selbsthilfegruppen im Netzwerk der gesundheitlichen Versorgung – aufgezeigt am Beispiel der Krebsnachsorge

Schaeffer D, Garms-Homolová V. Die Rolle der Selbsthilfegruppen im Netzwerk der gesundheitlichen Versorgung – aufgezeigt am Beispiel der Krebsnachsorge. Das öffentliche Gesundheitswesen. 1985;47(11):543-559.Coping with stigma, strengthening the ability to use available services, removing obstacles to care, and providing service and care to others: these are the most important functions of self-help groups of cancer patients. This article focuses on the analysis of these functions. It is shown that the self-help groups are no longer seen as competing with the professional system. Rather, efforts to establish them as a part of this system are increasing. However, the fixing of functions and incorporation of the self-help groups generates problems whose extent cannot yet be foreseen.Wichtige Funktionen in Selbsthilfegruppen im Krebsnachsorgebereich liegen im Management des Stigma "Krebs", in der Stärkung der Kompetenz der Selbsthilfegruppenmitglieder für die Nutzung der Versorgung, der Beseitigung von Barrieren im Zugang zur Versorgung und der Übernahme eigener Versorgungsaufgaben. Diese werden im vorliegenden Artikel näher untersucht. Es wird aufgezeigt, dass Selbsthilfegruppen mittlerweile nicht mehr als Konkurrenz des professionellen Systems angesehen werden. Vielmehr verstärken sich Bemühungen, sie zum festen Bestandteil des Versorgungssystems zu machen. Doch bringt diese Funktionsfestschreibung und Vereinnahmung der Selbsthilfegruppen Probleme mit sich, deren Reichweite noch nichtabgesehen werden kann

Intergenerational relationships: approaches in theory and research

Schaeffer D. Intergenerational relationships: approaches in theory and research. In: Garms-Homolová V, ed. Intergenerational relationships. Lewiston, N.Y.: Hogrefe; 1984: 1-9

Probleme der Handlungsbereitschaft und der Kompetenz von Laien in Notfallsituationen

Garms-Homolová V, Schaeffer D. Probleme der Handlungsbereitschaft und der Kompetenz von Laien in Notfallsituationen. Das öffentliche Gesundheitswesen. 1988;50(1):46-50