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Nursing care needs and services utilised by home-dwelling elderly with complex health problems: observational study
Gro Næss1, Marit Kirkevold2,3, Wenche Hammer4
1CHARM Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway. gro.nass@medisin.uio.no.
BMC Health Services Research
|September 14, 2017
Summary
Home-dwelling elderly patients have significant unmet nursing needs, particularly for chronic conditions and functional impairments. Flexible, proactive home care is crucial to preserve function and prevent hospitalizations.
Area of Science:
- Gerontology
- Public Health
- Nursing Science
Background:
- The global trend is shifting from institutional to home care for the elderly.
- Limited understanding exists regarding the specific nursing needs of home-dwelling elderly patients.
- This study addresses the gap in knowledge concerning nursing interventions for vulnerable elderly individuals receiving home care.
Purpose of the Study:
- To assess health and functional status in a representative sample of vulnerable home-dwelling elderly patients.
- To identify the specific nursing intervention needs of this population.
- To evaluate the extent to which these identified needs are currently being met.
Main Methods:
- An observational study included 83 home-dwelling patients aged 75+ in Oslo with multiple chronic conditions and recent hospitalizations.
- Functional assessments included the Trail Making Test A (TMT-A) for cognition, handgrip strength for sarcopenia, the "Timed Up-and-Go" test for mobility, and the Barthel Index for daily living independence.
- Nursing needs were defined by a consensus group based on diagnoses, medications, and functional impairments, and then assessed for fulfillment.
Main Results:
- The study included 83 frail elderly patients (mean age 87) with an average of 6 diagnoses and 9 daily medications.
- High prevalence of functional impairments: 75% had sarcopenia, 33% impaired mobility, and 83% cognitive processing deficits (TMT-A).
- Home nursing averaged 3.6 hours/week, with needs fulfillment >60% for skin/wound care and diabetes management, but <10% for most other identified needs.
Conclusions:
- A significantly frail population of elderly individuals is being cared for at home.
- Current home nursing resources appear insufficient to meet the complex needs of these patients.
- Recommendations include more flexible and proactive home nursing strategies to maintain function, reduce symptoms, and prevent hospital readmissions.
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