Jos P. M. Diederiks

Effects of preventive home visits to elderly people living in the community: systematic review

Abstract Objective: To assess the effects of preventive home visits to elderly people living in the community. Design: Systematic review. Setting: 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register. Main outcome measures: Physical function, psychosocial function, falls, admissions to institutions, and mortality. Results: Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects. Conclusions: No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.

Sickness impact profile: The state of the art of a generic functional status measure

The Sickness Impact Profile (SIP) is a widely used health status measure, known to be valid and reliable. After the final development and testing in 1978, however, in which several methodological aspects were investigated, no descriptions of research projects that systematically evaluate the methodological and theoretical aspects of the instrument were found. In this article a review is presented of literature on the SIP. This review is the first step taken in a project that evaluates the SIP. The instrument appears to be a reliable instrument with sufficient content validity. It shows good correlations with other health status and functional status measures. Yet a number of questions about the SIP remain unanswered. Theoretical implications of the construct of sickness, the effect of age and gender on SIP scores, the construct validity judged by factor analysis, the responsiveness of the instrument, and the possibilities to use proxy-respondents or to shorten the list and to simplify the scoring procedure still have to be studied. If the instrument is to be used as an international standard measure of functional status, these topics should be thoroughly examined.

The development of a short generic version of the sickness impact profile

This study concerns the development of a short version of a well-known and much used clinimetric instrument called the Sickness Impact Profile (SIP). The SIP is a generic measure of functional status. Based on findings of a principal components analysis of over 800 SIPs from a multi-diagnostic population, a selection of 68 items divided over 6 dimensions was made and initially tested. As no support was found for the statistical validity of the categorical structure of the original SIP, a new structure, discovered through principal components analysis, was used as the basis for selecting items. Comparison of the scores on the selection with information provided by the original SIP showed very promising results: the 68 item selection may serve as a valid short SIP-version.

Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial

Abstract Objective: To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community. Design: Randomised controlled trial with 18 months of follow up. Setting: Six general practices in Hoensbroek, the Netherlands. Participants: 316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls. Intervention: Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards. Main outcome measures: Falls and impairments in mobility. Results: No differences were found in falls and mobility outcomes between the intervention and usual care groups. Conclusion: Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.

The sickness impact profile: SIP68, a short generic version. First evaluation of the reliability and reproducibility

In previous research a short version of the Sickness Impact Profile (SIP136) was developed, containing 68 items. This SIP68 is intended as a short generic alternative to the original SIP. High reliability of the SIP68 was reported when it was extracted from the SIP136. This paper is a report on the first reliability testing of the SIP68 administered as an independent instrument without the context of the SIP136. To establish the test-retest reliability and the internal consistency of the new instrument, 51 patients of an outpatient department of rheumatology completed the SIP68 twice, with an interval of 48 hours. To compare the performance of the independent SIP68 with the SIP68 extracted from the SIP136, the SIP136 also was completed two times by the same 51 respondents. Test-retest reliability for both administration types was assessed by means of the intraclass correlation coefficient and the Jaccards similarity ratio. Internal consistency was assessed by means of Cronbachs alpha. The reliability appears to be high in both the independent SIP68 as well as the extracted SIP68. Moreover, the reliability of the independent SIP68 appears to be as high as for the SIP136. These findings were very encouraging, indicating that the SIP68 may very well serve as a generic alternative to the SIP136.

The Competing Demands of Paid Work and Parent Care Middle-Aged Daughters Providing Assistance to Elderly Parents

This article investigates the potentially competitive relationship between paid work and parent care provided by daughters and daughters-in-law. In line with the scarcity hypothesis of role theory, four subhypotheses were formulated and tested empirically. In a population-based probability sample of middle-aged women (n = 581), only partial empirical support was found for the scarcity or role conflict hypothesis. It appeared that employment significantly reduces the chances of becoming a caregiver. However, parent care and employment are not conflicting in time as the amount of care provided to parents was not affected by out-of-home employment. Parent care has only a small impact on work decisions, and employed caregivers do not experience more caregiver role strain. It was hypothesized that employed women not yet providing care anticipate a role conflict when a parent becomes frail and needs help. Consequently, a self-selection process takes place whereby the nearest living daughter with the least competing demands is most likely to accept the caregiver role. Once the caregiver role is accepted, both role strain and the time spent on parent care are determined by factors other than employment status or work hours.

Impact of gait problems and falls on functioning in independent living persons of 55 years and over: a community survey

In a cross-sectional, population-based study among community-dwelling persons of 55 years and over the incidence of falls, risk indicators for falls, specifically age, and the impact of gait problems, falls and other risk factors on functioning was determined. A randomly age-stratified sample (n = 655) was taken from all independent living persons of 55 years and over (n = 2269) and registered in a primary health care centre. They received a mail questionnaire concerning demographic data, history of falls and injuries due to falls, physical and mental health status, gait problems, functional status, including social activities. The response rate was 62% (n = 405). Of the subjects aged 55 years and of those aged 65 years and over, 25% and 31% respectively fell at least once in the previous year. Half of the people reporting falls fell more than once. Serious injury occurred in 9% of the fallers, with 4% fractures. There is a significant association between falling and age and, even more clearly, between gait problems and age. The main risk factors of single and recurrent falls were female gender, physical health status and gait problems. Logistic regression analysis reveals that the main determinants of falling in general are gait problems and female gender and, of recurrent falling female gender, physical complaints and gait problems. Falls have some negative effect on functioning, i.e. mobility range and social activities, but this is overshadowed by mental status indicators and gait problems.

Women of a middle generation and parent care.

This article addresses women who are caring for both parents and children, the so called sandwich generation or women-in-the-middle. Gerontological studies on this topic reflect controversies on the concept as well as on the size of the phenomenon. Our study attempts to demonstrate empirically to what extent middle-aged women respond to the care demands of both the generation ahead as well as the generation behind them. A population-based sample among women aged forty to fifty-four in the Netherlands (N = 933) is utilized. The study indicates the prevalence of women-in-the-middle and presents analyses of their socio-demographic characteristics as well as of patterns of parent care. Further, the potential for a cross-cultural comparison between the Netherlands and other countries is discussed regarding parent care as a normative experience and the chances of middle-aged women getting “caught” between care demands from two generations.

Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk.

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year. During the home visits the participants were screened for risk factors potentially influencing falls and mobility. The screening was followed by recommendations, referrals, and other actions aimed at dealing with the hazards observed. Data regarding the intervention process were gathered by means of interviews with nurses and participants, and by means of structured forms and questionnaires administered by the nurses during the intervention period. We conclude that our 1-year multifactorial home visit programme consisting of five home visits is feasible for nurses and participants. Despite this, it seems to be an unsuitable intervention technique to reduce falls and mobility impairments among elderly people at risk.

Subjective complaints and blood pressure

The relationship between blood pressure and subjective complaints concerning physical well-being has been investigated. The complaints have been measured by means of the Inventory of Subjective Health. The total number of complaints are the summation of 39 items. Hypertension is assumed to have no clear-cut symptoms. This statement gives rise to the hypothesis that there is no relationship between blood pressure and subjective complaints. The hypothesis was refuted after several tests. We found a curvilinear relationship between diastolic blood pressure and subjective complaints in representative groups of men of 21-65 and 31-50 years old, valid for the total number of complaints and dizziness. This curvilinear relationship is found again after a matching procedure in order to exclude possible confounding effects of age, cigarette smoking and knowledge about elevated blood pressure status. The total number of complaints of males with a diastolic pressure higher than 95 mmHg are not significantly higher than the total number of complaints of males with a lower diastolic pressure, but the difference is significant for dizziness.