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Study Finds Flu Vaccines For Nursing Home Workers Effective In Reducing Outbreaks

Higher flu vaccination rates for health care personnel can dramatically reduce the threat of flu outbreak among nursing home residents, according to a study published in the October issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The study, which focused on nursing homes in New Mexico, found that when a facility had between 51 and 75 percent of its health care personnel with direct patient care vaccinated, the chances of a flu outbreak in that facility went down by 87 percent.

“The Centers for Disease Control and Prevention have long recommended that health care personnel in nursing homes get vaccinated against the flu, but we didn’t know just how much help these recommendations might be in reducing flu outbreaks among residents,” said Aaron Wendelboe of the University of Oklahoma, the lead author of the study. “We found strong evidence to support the CDC’s recommendation that to protect residents of nursing homes, health care personnel should be vaccinated annually.”

In association with the New Mexico Department of Health, Wendelboe and his team surveyedinfluenza rates at the state’s 75 long-term care facilities during the 2006-2007 and 2007-2008 flu seasons. They then looked for correlations between vaccination rates at each facility and whether there was an influenza outbreak.

While increased vaccination of direct care healthcare workers was associated with fewer flu outbreaks, the study found that vaccination rates among residents did not discourage outbreaks. In fact, higher resident vaccination was correlated with a higher probability of an outbreak. That result was unexpected and hard to explain, the researchers say. “While the explanation is likely multi-factorial, we suspect a large factor is that facilities with high resident vaccination rates may over-rely on the direct protection bestowed by vaccinating the residents and under-value the indirect protection bestowed by vaccinating employees,” Wendelboe and his team write.

Despite recommendations by the CDC and the Society for Healthcare Epidemiology of America, vaccination rates among U.S. healthcare workers still hover under 65 percent.

“That vaccinating health care personnel provided more protection to residents than vaccinating residents themselves underscores the importance of these recommendations,” Wendelboe said.

Source: MedicalNewsToday.com

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New Video Gaming Technology Helps To Detect Illness, Prevent Falls In Older Adults

Many older adults lose their independence as their health declines and they are compelled to move into assisted care facilities. Researchers at the University of Missouri and TigerPlace, an independent living community, have been using motion-sensing technology to monitor changes in residents’ health for several years. Now, researchers have found that two devices commonly used for video gaming and security systems are effective in detecting the early onset of illness and fall risk in seniors.

Marjorie Skubic, professor of electrical and computer engineering in the MU College of Engineering, is working with doctoral student, Erik Stone, to use the Microsoft Kinect, a new motion-sensing camera generally used as a video gaming device, to monitor behavior and routine changes in patients at TigerPlace. These changes can indicate increased risk for falls or early symptoms of illnesses.

“The Kinect uses infrared light to create a depth image that produces data in the form of a silhouette, instead of a video or photograph,” said Stone. “This alleviates many seniors’ concerns about privacy when traditional web camera-based monitoring systems are used.”

Another doctoral student, Liang Liu, is collaborating with Mihail Popescu, assistant professor in the College of Engineering and the Department of Health Management and Informatics in the MU School of Medicine, to develop a fall detection system that uses Doppler radar to recognize changes in walking, bending and other movements that may indicate a heightened risk for falls. Different human body parts create unique images, or “signatures,” on Doppler radar. Since falls combine a series of body part motions, the radar system can recognize a fall based on its distinct “signature.”

“Falls are especially dangerous for older adults and if they don’t get help immediately, the chances of serious injury or death are increased,” said Liu. “If emergency personnel are informed about a fall right away, it can significantly improve the outcome for the injured patient.”

Both motion-sensing systems provide automated data that alert care providers when patients need assistance or a medical intervention. The systems currently are used for monitoring residents at TigerPlace in Columbia. Skubic says the system allows residents to maintain their independence and take comfort in knowing that illnesses or falls may be detected early.

Stone’s study, “Evaluation of an Inexpensive Depth Camera for Passive In-Home Fall Risk Assessment,” won the best paper award at the Pervasive Health Conference, in Dublin, Ireland in May. Liu’s study, “Automatic Fall Detection Based on Doppler Radar Motion,” received the best poster award at the conference. Liu’s paper was a collaboration with GE Global Research and co-authored by Tarik Yardibi and Paul Cuddihy. TigerPlace is a joint project of the Sinclair School of Nursing and AmErikare, a long-term care company.

The research is part of Mizzou Advantage, the five unique areas that set MU apart from other universities. The project contributes to the “Managing Innovation: Navigating Disruptive and Transformational Technologies” initiative that will touch on virtually every part of the university to explore areas in which existing technologies are changing rapidly.

Source: MedicalNewsToday.com

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Emotional and Financial Strain Suffered by Caregivers

Family members or friends caring for aging or disabled individuals in California are under both financial and emotional strain and are likely to face even greater burdens, given recent cuts in state support for programs and services that support in-home care, write the authors of a new policy brief by the UCLA Center for Health Policy Research.

The study looked at California’s estimated 6 million-plus informal caregivers of all ages and found higher levels of serious psychological distress and negative health behaviors, such as smoking, compared with the general population. Of particular concern are an estimated 2.6 million caregivers between the ages of 45 and 64 who may be setting themselves up for an unhealthy future due to higher rates of poor health behaviors, compared with both non-caregivers in the same age range and older caregivers.

“This is the ‘sandwich generation,’ the group of people struggling to meet the needs of both growing children and aging parents, often alone and while holding down full-time jobs,” said Geoffrey Hoffman, the brief’s lead author. “Caregivers need help, especially as baby boomers age and place even greater strains on their and their families’ abilities to cope.”

Using data from the 2009 California Health Interview Survey (CHIS), the authors found that California caregivers provide an average of 20 hours of care per week for a friend or relative who can no longer do certain things for themselves, such as bathing, shopping, managing medications or paying bills.

Few caregivers are paid for their work or use state services that might help alleviate both financial and psychological burdens. And with the U.S. Census projecting that the population of those 65 and older will more than double in the next 30 years, the magnitude of largely uncompensated care by family and friends will rapidly increase.

“We may be seeing an association between caregiving and stress, where caregivers are both more likely to be seriously depressed and to exhibit certain health behaviors that put them at risk,” Hoffman said. “These effects on caregivers’ overall health merit attention from policymakers.”

Among the findings:

• Caregivers under stress

  Mental health: More than 1 million caregivers report moderate or serious distress levels, with almost one-third reporting that their emotions interfere a lot with their household chores (29.9 percent) or their social lives (32.9 percent).

  Middle-aged caregivers struggling: Compared with both older caregivers and non-caregivers of the same age, middle-aged caregivers are more likely to binge drink (25.5 percent), smoke (15.9 percent) and/or be obese (30.1 percent).

  Stress and smoking: Caregivers of all ages who reported serious psychological distress were 208 percent more likely to smoke than non-caregivers with serious psychological distress – an exceptional amount.

• Middle-aged caregivers lack support

  Nearly one-third (29.0 percent) of middle-aged caregivers are single, divorced or widowed, and more than two-thirds (67.1 percent) hold down full- or part-time jobs. Nearly one-quarter (22.5 percent) are low-income.

• Caregiving is time-intensive

  Approximately one-third of caregivers who live with care recipients spend an average of 36 hours on caregiving – almost as much as a full-time job. A majority (62.0 percent) of caregivers of all ages work full or part time.

• Caregivers of all ages under financial strain

  Only 7.4 percent of informal caregivers reported being paid for the help they provide. Moreover, nearly 20 percent spent $250 or more of their own money on caregiving in the past month. The strains of caregiving may be alleviated by respite services (short-term temporary relief from duties), yet only 13.5 percent of caregivers report ever using any respite care.

The authors note that recent cuts to California’s In-Home Supportive Services program and the scheduled Dec 1. elimination of the Adult Day Health Care program will likely place even greater burdens on informal caregivers.

“Family members and friends supporting loved ones in need provide the bulk of personal assistance services and often absorb the high costs of caregiving, both financially and emotionally,” said Dr. Bruce Chernof, president and CEO of The SCAN Foundation, which provided funding for the analysis. “Programs that support family caregivers can help them create and sustain vulnerable elders in community settings, which promotes the values of dignity, choice and independence as loved ones grow older.”

The authors urge support for the Community Living Assistance and Supports (CLASS) program, a voluntary, consumer-funded long-term care insurance program proposed under health reform, which would provide a cash benefit that could be used to compensate informal caregivers and to purchase needed respite or mental health services.

Other provisions in the health reform law also offer a range of initiatives to provide in-home care to seniors and people with disabilities and reduce dependence on high-cost Medicaid nursing homes, according to the authors. Programs like the Community First Choice Option, which provides community-based attendant supports and services to disabled individuals requiring an institutional level of care, as well as proposed new Medicaid funding for Aging and Disability Resource Centers, could significantly lift the burden off of family and other informal caregivers, the researchers say.

Source: MedicalNewsToday.com

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WASHINGTON, D.C. — More than one in six Americans who work a full- or part-time job also report assisting with care for an elderly or disabled family member, relative, or friend.

Caregivers in the U.S. are diverse, with between 13% and 22% of American workers across major socioeconomic and demographic groups reporting that they fulfill a caregiver role.

These findings are from more than 200,000 surveys of employed Americans collected from January 2010 through June 2011 as part of the Gallup-Healthways Well-Being Index.

The 22% of middle-aged American workers who report being a caregiver is the highest of any group. The 13% of 18- to 29-year-olds who report the same is the lowest percentage across the various groups.

Blacks (21%) and Hispanics (20%) are also among the most likely to act as caregivers. Seventeen percent of white workers say they are caregivers.

Additionally, the lower income and less educated an American is, the more likely he or she is to be a caregiver. Twenty-one percent of Americans with an annual income of less than $36,000 report that they are caregivers compared with 15% of high-income ($90,000 or more per year) households. Similarly, 20% of Americans with a high school education or less fulfill a caregiver role versus 15% of college graduates and 16% of postgraduates.

The relatively lower percentages of high-income and highly-educated American caregivers may be a reflection of their ability to pay for professional care instead of having to fulfill the role themselves. Alternatively, the pattern may be due, at least in part, to those with higher incomes and higher levels of education tending to be younger.

Women are also slightly more likely than men to be caregivers — 20% versus 16%, respectively.

Caregiving even affects seniors, with 16% of those aged 65 or older reporting they help care for an elderly or disabled family member, relative, or friend.

Bottom Line

More than 1 in 10 American workers in all major demographic and socioeconomic groups report that they are a caregiver. Caregiving is most prevalent among those who are middle-aged, low-income, black, Hispanic, or less educated.

Previous Gallup research has also already shown that caregivers have worse emotional and physical health compared to non-caregivers.

Source: Gallup.com

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WASHINGTON, D.C. — Working American caregivers — those who work at least 15 hours per week and help care for an aging family member, relative, or friend — report that their caregiving obligations significantly affect their work life.

The majority of caregivers say that caregiving has at least some impact on their performance at work. Based on a five-point scale, where five is a great impact and one is no impact, 10% of caregivers choose five and 44% pick somewhere between two and four.

Additionally, 24% of caregivers say that providing care to an aging family member, relative, or friend keeps them from being able to work more.

Most caregivers also report missing entire workdays as a result of their caregiving responsibilities. Thirty-six percent report missing one to five days per year because of caregiving duties, while 30% say they missed six or more days in the past year.

Overall, caregivers reporting missing an average of 6.6 workdays per year. With approximately 17% of the American full-time workforce acting as caregivers, this amounts to a combined 126 million missed workdays each year. This absenteeism costs the U.S. economy an estimated $25.2 billion in lost productivity per year. Including caregivers who work part time in the equation would cause absenteeism costs to climb even higher.

These findings are from a special survey of Americans who self-identified as caregivers in Gallup-Healthways Well-Being Index surveys throughout 2010. Gallup recontacted those self-identified caregivers and interviewed 2,805 who were also employed at least 15 hours per week for a Pfizer-ReACT/Gallup poll specifically about caregiving. All respondents answered affirmatively to the question, “Do you currently help care for an elderly family member, relative, or friend, or not?”

Most Working Caregivers in Professional Roles

Nearly one-third of all working caregivers are in a professional occupation, with another 12% each in service and management roles. Less than 5% of caregivers work in other professions such as installation/repair, transportation, and construction.

Most caregivers (71%) indicate that their employer is aware of their caregiving status, but another 28% believe that their employer is unaware. Furthermore, an analysis of knowledge of workplace support programs shows that about one-quarter or less of working caregivers have access to support groups, ask-a-nurse-type services, financial/legal advisors, and assisted living counselors through their respective workplaces.

Source: Gallup.com

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WASHINGTON, D.C. — The large majority of employed American caregivers — people who work at least 15 hours per week and help care for an aging family member, relative, or friend — are looking after an elderly parent. Specifically, 72% say they provide care to a parent and separately 67% say the person is 75 years of age or older.

There is no one specific ailment that afflicts the majority of people being cared for in the United States. Rather, these people suffer from a wide array of diseases or conditions. However, the 15% of caregivers who report that the person they care for has Alzheimer’s disease or dementia is more than mention any other specific sickness.

These findings are from a special survey of Americans who self-identified as caregivers in Gallup-Healthways Well-Being Index surveys throughout 2010. Gallup recontacted those self-identified caregivers and interviewed 2,805 who were also employed at least 15 hours per week for a Pfizer-ReACT/Gallup poll specifically about caregiving.

In general, the findings from the survey reveal that caregiving has a significant impact on the life of the person providing care, including taking up a large portion of their life and a significant amount of time on a daily and monthly basis.

The majority of caregivers (55%) in the study said they have been providing care for three years or more. Another 31% reported giving care for between one year and less than three years. The remaining 15% had been providing care for a year or less. These data reveal that caregiving is generally a long-term commitment.

Errands and Day-to-Day Tasks Dominate Caregivers’ Work

Caregivers report spending a lot of time on different tasks related to looking after their aging family member, relative, or friend. Caregivers appear to be spending the most time on errands and general day-to-day tasks such as going shopping, doing laundry, and providing transportation. Caregivers spend an average of 13 days per month handling these types of tasks.

Caregivers spend far fewer days — six per month on average — performing personal tasks such as helping the person they are caring for eat, get dressed, and go to the bathroom. This is likely tied to the finding that the majority (64%) of caregivers say the person they care for does not live with them.

Caregivers are also spending considerable time on administrative-type tasks. They report spending an average of 13 hours per month doing things like researching care services or disease needs, coordinating physician visits, and managing financial matters.

Beyond the actual work and chores of caregiving — errands, personal items, and administrative tasks — caregivers are fulfilling a companionship role. On a typical day spent giving care, caregivers report devoting an average of five hours providing companionship or supervision.

Source: Gallup.com

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Desperate though caregivers may be for a temporary respite from their care
responsibilites, many care recipients are resistant to strangers coming into
their home to help. The help may be perceived as an invasion of privacy, a loss
of independence or a waste of money. Yet in-home assistance is often critical in
offering caregivers a break and time to relax and rejuvenate.

There are ways to make this transition easier. Here are some tips for making
your loved one feel more comfortable with in-home help:

1. Start gradually. Begin by
having the aide come only a couple of hours each week, then add hours as your
loved one builds a relationship with the helper. If you feel comfortable with
the attendant running errands or preparing meals that can be brought to the
house, you can start with those services, which can be done outside the
home.

2. Listen to your loved one’s fears and
reasons for not wanting in-home care. Express your understanding
of those feelings. If possible, get your loved one involved in choosing the
aide. He or she will feel more invested and comfortable with the decision.

3. “This is for me. I know you don’t need
help.” Expressing the need as yours, rather than the your loved
one’s, helps maintain her sense of dignity and independence. You can also add
that having someone stay at home allows you not to worry while you are gone.
Make it clear that you will be coming back.

4. “This is prescribed by the
doctor.” Doctors are often seen as authority figures and your
loved one may be more willing to accept help if she feels that she is required
to do so.

5. “I need someone to help clean.”
Even if this is not the real reason, often people will allow someone in to clean
when they “don’t need” care for themselves.

6. “This is a free service.” This
strategy may work if other family members are paying for the home care or if it
is, in fact, provided without charge. Your loved one may be more open to using
the service since she does not feel that she is spending money for it.

7. “This is my friend.” By
pretending that the attendant is a friend of yours you are relating the home
care worker to the family. This can help with establishing trust and rapport.
You can also say that your “friend” is the one who needs company and that by
having him or her over your loved one is helping him out.

8. “This is only temporary.” This
strategy depends on the condition of your loved one’s memory. If she often
forgets what you say then she may also forget that you said this. By presenting
the situation as short-term you will give some time for your loved one to form a
relationship or become comfortable with home care as part of her daily routine,
and give you a chance for a well-deserved break.

Source: Family Caregiver Alliance

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A study of Canadian home-care patients suggests doctors may be overprescribing antibiotics for patients receiving ongoing medical care at home. The study, published in the June issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, suggests that more should be done to monitor antibiotic use in home-care patients to avoid misuse that could decrease the efficacy of the drugs over time.

According to the study, led by researchers from McMaster University in Ontario, antibiotic prescriptions for home-care patients are quite common, with more than 6,800 patients receiving the drugs. Additionally, medical data on the patients reveal disturbing prescribing patterns, says Dr. Mark Loeb, one of the study’s authors.

For instance, patients under the age of 65 were substantially more likely to receive antibiotics. That finding suggests that “physicians may be overly cautious with younger patients,” Loeb said. In contrast, patients with longer life expectancies were less likely to receive antibiotics, despite the fact they would likely benefit more from the drugs compared to patients with poorer life expectancies.

“Taken together, our results reveal tremendous variability in how and why antibiotics are prescribed, and that overuse in the home-care population is likely,” Loeb said. “Younger and sicker patients seem to be at added risk for misuse and should be the focus of further study to assess the appropriateness of antibiotic use at home.”

Adding concern was the fact that the most common class of antibiotics prescribed in the study was fluoroquinolones, a class of drugs often associated with increased rates of resistance. Overuse of these drugs could weaken their efficacy, threatening their effectiveness against these and other emerging infections.

The researchers used data on more than 125,000 patients receiving home care for more than 60 days from 2006 to 2007. Medical data were collected by nurses through observation, client and family self-reports, and other medical records.

As the threat of drug resistant infections has increased in recent years, much work has been done to identify settings in which antibiotics may be overprescribed. However, before this study very little was known about antibiotics in the home care population, the researchers say.

“Our results illustrate the importance of continuing to monitor antibiotic use in home-care patients, and the need for more effective methods of diagnosis that allow for appropriate antibiotic use,” Loeb said. Antibiotic use studies are critical to understanding the basic science of how and why resistance is on the rise.

Notes:

Dominik Mertz, Erin Y. Tjam, Jeff Poss, John P. Hirdes, Bruce Arai, Jennie Johnstone, Micaela Jantzi, and Mark Loeb, “Prevalence and predictors of antibiotic use in community-based elderly in Ontario, Canada.” Infection Control and Hospital Epidemiology 32:6.

Source:
Tamara Moore
Society for Healthcare Epidemiology of America

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As their autonomy fades, tomorrow’s elderly will need to create non-traditional support networks or pay for the care they receive.

This is the conclusion of Jacques Légaré, professor at the Université de Montréal, who studies aging baby-boomers, a generation for whom children are relatively rare and stable couples almost an exception.

In a paper presented at the 2010 Congress of the Humanities and Social Sciences, held this week at Concordia University in Montreal, Mr. Légaré shows how the family circle available to the elderly will evolve from now until 2030.

It is usually the elderly person’s family circle that provides care. Mr. Légaré notes that about 70 per cent of the care provided for frail seniors comes from the informal network – essentially the spouse or the children. This is only possible because today’s elderly – baby-boomers’ parents – have more children to care for them and generally live in stable couples.

This situation will soon change. Divorce, common-law unions, blended families and relatively few children per couple are factors to consider. In addition to this, death rates have declined considerably, to the point where average life expectancy has grown considerably. Couples who have not split up will be living together longer.

“Tomorrow’s elderly – today’s boomers – had far fewer children. Who will take care of them?” the professor wonders. “They risk finding themselves in difficult circumstances and might have to turn to the public system or pay their way.”

According to Mr. Légaré, baby boomers not interested in paying or who can’t afford to pay will have to innovate and seek out non-traditional networks – friends, siblings and even cousins.

The research on boomers must adapt as well. Demographers, who are increasingly turning to micro-simulation to make projections, will have to factor in the recourse to these non-traditional networks. According to professor Légaré, new programs must be developed to model these extended families and new support systems.

If informal services change, the public system must also adapt. “Boomers have done nothing like the others,” Mr. Légaré points out. “They stand out from the other cohorts, and we believe they will do so again.”

Source:
Ryan Saxby Hill
Canadian Federation for the Humanities and Social Sciences

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An older individual who cares for a spouse with dementia may be at an increased risk of developing cognitive problems because of the lifestyle that was shared with the spouse and because of the stress of caring for a loved one who is ill. These findings, which are published today in the Journal of the American Geriatrics Society, indicate that efforts are needed to help caregivers maintain their cognitive and functional health and their ability to care for those who need them.

Research indicates that, compared with non-caregivers, caregivers often have trouble with cognition, which involves attention and memory. To examine the issue more thoroughly, investigators reviewed the medical literature for studies that looked at the cognitive health of older adults caring for a family member (primarily a spouse) with dementia. The review revealed that spouses who are caregivers may have a higher risk of cognitive impairment or dementia than spouses who are not caregivers. Their cognitive decline may be due to psychosocial factors such as depression, loneliness, social isolation, and sleep problems; behavioral factors such as exercise and diet; and physiological factors such as obesity, chronically elevated insulin and inflammation.

“Persons who are caring for a spouse with dementia may themselves be at risk for cognitive problems which, in turn, will not only negatively influence their quality of life, but may reduce their ability to provide the necessary care for their spouse,” said principal investigator Dr. Peter Vitaliano of the University of Washington School of Medicine. “Spouse caregivers are extremely important because most care-recipients prefer to be cared for in their homes, and, by remaining in their homes, health care costs are reduced greatly.”

The review argues for interventions that integrate strategies to reduce psychological distress in caregivers while promoting healthy behaviors, such as good diet and exercise. The authors note that community-level approaches may increase awareness and motivation. They point to Strength for Caring, an online resource for family caregivers that provides information, support, and ways to connect with other caregivers.

Source:
“Does Caring for a Spouse with Dementia Promote Cognitive Decline? A Hypothesis and Proposed Mechanisms.” Peter P. Vitaliano, Michael Murphy, Heather M. Young, Diana Echeverria and Soo Borson
Journal of the American Geriatrics Society, 2011; DOI: 10.1111/j.1532-5415.2011.03368.x

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