Long-term Care Long-term Care in old people in old people of 75 and more of 75 and more years old on Home years old on Home Care Service.Care Service.

Nuria Rodriguez AvilaMontserrat Puig LlobetUniversity of Barcelona

IndexIndex

DefinitionTheory Spanish contextMethodsResultsDiscussionConclusionReferences

DefinitionDefinition

The concept: Quality of life is relatively "new“. This concept has relations with:◦ Happiness.◦ Welfare.◦ Satisfaction of needs.

The World Health Organization (WHO) in 1994 say that the Quality of life is:

"Perception of the individual is in life position on the context of the culture and system of values. Also, it is relating to its objectives, expectations, standard and worries".

Definition (Life Quality Definition (Life Quality Models)Models)The life quality models try to determine

which are the multidimensional factors to explain the quality of life by:◦ Subjective indicators (by person).◦ Objective indicators (by

professionals). The reference models are : The World Health Organization Quality

of Life (WHOQOL-100). The Quality of Life Model Fernandez-

Ballesteros (1992).

For old people, the quality of life is marked by the interrelation with the person and environment, also in factors as:

1.Autonomy.

2.Health Status.

3.Family relations.

4.Economic Situation .

5.Social relations.

To analyze the quality of life is important the social role of old people with chronic illness (disease).

TheoryTheoryThe sociological theories on the social

aging have a strong relation to the social functions.

The Paradigm of functionalism (Talcott Pasrson) gives importance to process of socialization (the social role and the function of social institutions).

The social theory of the Dissociate by Cumming and Henry (1961), they try to explain why old people need others persons.

SpanishSpanish contextcontext According to the UN (2002) Spain is the

county with the largest number of old people.

The increase of the life expectancy is one of the factors to analyze in the quality of life.

The change in the family structure, together other social changes and insufficient resources make that the informal care system (family care) is not enough to care dependent old people.

In Spain, the formal care resources for old people with dependence (handicap) are classified in:

1. Home Care Service

2. Welfare centers and alternative systems.

3. Non-profit organizations and the social works.

SpanishSpanish contextcontextSince 2007 we have a new a Law of the

Dependence (handicap), It has been created to provide services and resources to old people with dependence and handicap.

Catalog of service are: Telecare Service. Home Care Service (formal and Informal

care). Nursing home Center, (Day or Night). Geriatric Institutions.

MethodsMethodsGeneral objective: was to determine which are the subjective and objective elements to identify a level in quality of life in old people with dependence.

Population of study: was the old people inside the ATDOM Home Care Service.

Universe: 75 and more years old.

Location: The Basic Area of health of Vilafranca of Penedès (Public Service).

Framework: was the sociological theories , paradigm of funcionalism ( Parson).

Methodology used on this study was:Qualitative (interviews face to face) : We interview a 10% of the total population of the database (ATDOM Progam,) and we tried to maintain the structure of aged and gender stratus.Quantitative: We used others surveys of Catalonia and Vilafranca del Penedes.

Fuente: www.ajvilafranca.es

Grafic 1 . Population in Vilafranca del Penedès (2005) by gender and aged.

Table 1 Population of ATDOM Table 1 Population of ATDOM ProgramProgramPoblación dependiente lista ATDOM

Valores absolutos Valores relativos %

Edad Hombres Mujeres Total Hombres Mujeres TOTAL

75-79 29 36 65 11,9 14,8 26,6

80-84 19 43 62 7,8 17,6 25,4

85-89 23 34 57 9,4 13,9 23,4

90-94 18 23 41 7,4 9,4 16,8

95 y más 5 14 19 2,0 5,7 7,8

75 y > años 94 150 244 38,5 61,5 100

Muestra de entrevistas a realizar

Valores absolutos Valores relativos %

Edad Hombres Mujeres Total Hombres Mujeres TOTAL

75-79 4 4 8 15,3 15,3 30,7

80-84 2 4 6 7,6 15,3 23,0

85-89 2 4 6 7.6 15,3 23,0

90-94 1 2 3 3,8 7,6 11,5

95 y más 1 2 3 3,8 7,6 11,5

75 y > años 10 16 26 38,46 61,53 100

Fuente: Área Básica de Salud de Vilafranca del Penedès: Servicio de Atención Domiciliaria (ATDOM)

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Table 2 Sample of ATDOM programTable 2 Sample of ATDOM program

Table 3Table 3: Variables Study: Variables Study

Subject Variables

Old person with dependence and 75 o more years old

Style of life Health Status and perception.Level of dependenceEating and DrinkingPhysical activitySocial relationship

Subjective Welfare:

Perception of quality of lifeSatisfaction of needs

Long-term care in aging Long-term care in aging with handicapwith handicap

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Interviews and instrumentsInterviews and instruments

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Data collection was performed from face to face interview in 2007. There have been a total of 59 interviews:- 26 old people with illness (handicap o dependency),- 22 family caregivers- 11 nurses in the ATDOM program.

The questionnaires includes:Type of questions: Closed Questions. Semi-closed questions. Open questions.

Validated test Zarit Test (overwork of caregivers). Katz Index (Independence in

Activities of Daily Living -ADL). The LawtonIndex (Instrumental

Activities of Daily Living -IADL). Mini-Review Nutritional Assessment . Instrument for Social Resources

(PAHO).

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Example of questionsExample of questions

ResultsResults

The women are representative in the ATDOM Program (61% are women).

The older people express their health status as regular. They have more that one illness (Comorbity) and they take a lot of medicines at the same time.

They are satisfied and feel well with their caregivers (formal and informal care).

However, they are not familiarized with the health resources available in the city.

The Old people needs:◦ Care in the daily living (hygiene)

(ADL- Kartz index).◦ Care in the instrumental activity

daily living (shopping) (IADL, Lawton Index) .

The style of life for dependent old people are: ◦ Diet poor in fruits and vegetables◦ Good level of protein.◦ Poor hydration,.◦ They are going out for walking a few

times.

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The older people perceive a good quality of life when:Best level of health and autonomy.More family relationship.More social relationship.More economic resources.

Quality of life:

“Me cuesta decirlo, a lo mejor tener más dinero (para arreglo, ropa) pero la salud, la salud es lo principal de todo” (E.03)

“Salud, dinero y amor” (E.05, E.19)

“Tener salud y autonomía” (E.09, E.10)

“Tener salud, poder caminar” (E.08)

“Tener salud y dinero” (E.12) “Tener salud y adaptarse” (E.20) “Tener salud y compañía” (E.21,

E.24) “Tener salud y ayuda” (E.23) “Tener 50 años menos, ser más

joven y poder trabajar (risas), me gustaría llevar un camión de basura. Que toda la familia tenga salud” (E.13).

Life Quality Model for Old PeopleLife Quality Model for Old People in ATDOM program in ATDOM program

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Calidad de Vida del mayordependiente

Calidad de los cuidados

Datos sociodemográficosSalud objetiva Dependencia

Situación económicaCuidados informales

Servicios sociosanitariosRelaciones familiares

Estilo de vida Entorno

Independencia y participación Satisfacción de necesidades

Valoración de los cuidados informalesDeterminar adaptación

Elementos Objetivos

Servicio ATDOM

Salud subjetivaSituación económicaCuidados informales

Servicios sociosanitariosRelaciones familiares

Estilo de vida Entorno

Bienestar subjetivo

Elementos Subjetivos

DiscussionDiscussionThe old women receive more informal care.

The perception of the health state for old person is regular , nevertheless, a high percentage of the majority has more than one chronic illness.

Observations:They do not eat enough fruit and vegetables that the WHO recommend daily.They eat less proportion of the rest population. The hydration of old people are quite precarious, they drink less than one daily liter of water. The physical activity is going out to walk inside and outside a few times. They receive visits from the relatives and friends. The factors to determinate a quality of life are: the adaptation of personal situation, to have resources, to have health, to have loved, to have autonomy, to be well attended by the relatives. The adaptability and social rol are important to maintain a good levels of satisfaction.

ConclusionsConclusions

The old people with dependence perceive a good quality of life with some limitations.

The social rol change with the new social context.

To know the quality of life level allows to detect needs and disabilities on time.

The need to promote activities for a healthy aging and to take care of family caregivers.

The functions of nursing professionals in ATDOM program are contributing to improve the quality of life for dependent old people and theirs family.

Others questionsOthers questions

We want to make a big sample of the ATDOM Program and study the outside dependent old people.

To do this study in other population with the same characteristics to make corporations.

ReferencesReferences Pérez A. El cuidador primario de familiares con

dependencia: Calidad de vida, apoyo social y salud mental. Tesis Doctoral. Salamanca: Universidad de Salamanca, 2006.

Fernández-Mayoralas G, Rojo F, Prieto M.E, León, B, Martínez P, Forjaz M.J, Frades B, García C. El significado de la salud en la calidad de vida de los mayores. Madrid: 2007.

Fernández-Ballesteros R, Zamarrón M.D, Maciá, A. Calidad de vida en la vejez en distintos contextos. Madrid: Ministerio de Trabajo y Asuntos sociales. IMSERSO, 1996.

Walker A. Calidad de vida de las personas mayores. Análisis comparativo europeo. Revista Española de Geriatría y Gerontología 2004; 39, 3: 8-17.

Gómez Vela M, Sabeh E. Calidad de vida. Evolución del concepto y su influencia en la investigación y la práctica. Instituto Universitario de Integración en la Comunidad. Facultad de Psicología. Universidad de Salamanca. 2006.

Rubio Herrera R. Modelos y teorías desde la perspectiva sociológica. Tratado de psicogerontología. Valencia: Editorial Promolibro, 1996.

Parsons T. El sistema Social. Madrid: Alianza, 1999. Bazo M.T, García B. Envejecimiento y Sociedad: Una

perspectiva internacional 2º ed. Madrid: Editorial Medica Panamericana, 2006.

Ministerio de Trabajo y Asuntos Sociales. Bases demográficas. Libro Blanco sobre la atención a las personas en situación de dependencia en España. Madrid: Secretaría de Estado de Servicios Sociales, Familias y discapacidad. IMSERSO, 2004.

ArticlesArticles

Puig LLobet, M., Lluch Canut, MT, Sabater Mateu, P., Rodríguez Ávila, N.”Calidad de vida y necesidades de formación de las cuidadoras formales de personas mayores dependientes institucionalizadas”. Enfermería global: Revista electrónica semestral de enfermería, Nº. 19, 2010. ISSN 1695-6141. Pág.1-6.

Puig Llobet, M., Rodríguez Ávila, N. “Valoración de enfermería en los cuidados domiciliarios a personas dependientes de más de 75 años”. Enfermería 21. Metas. Vol .julio/agosto (12/6). 2009. ISSN 138-7262 y el Depósito Legal M-43015-1997. Pág. 63-67.

Puig, M., Lluch, T., Rodríguez Ávila, N.“Valoración de enfermería: detección de la soledad y del aislamiento social en los ancianos de riesgo”. Gerokomos. 2009. Vol. 20-nº 1. ISSN 1134-928X. Pág. 9-14.

Rodríguez N. Manual de Sociología Gerontológica. Textos Docents 320. Departament de Sociologia i Anàlisi de les Organitzacions. Barcelona: Universitat de Barcelona, 2006.

Statistics for life Statistics for life expectation and healthexpectation and health

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.Principals indicators used:

◦ Life expectation◦ Human Development Index (HDI)

THANK YOU VERY MUCH MUCHAS GRACIAS MOLTES GRACIES

ContactContact

Dra. Nuria Rodríguez ÁvilaDept. Sociologia i A.O. Despatx 4119.Universitat de BarcelonaAvda. Diagonal 69008034 Barcelona, EspañaTel/Fax: +34 934021805E-mail: nrodriguez@ub.edu

Dra. Montserrat Puig LlobetDepartament Infermeria Salut Pública, Mental i

Maternoinfantil.C/ Feixa Llarga, s/n. Despatx 307Campus de Bellvitge.08907  Hospitalet de LlobregatTelèfon: 934024237 Fax: 934024297

E-mail: monpuigllob@ub.edu

Research topics:: Quality of life, Aging Nursing diagnostic, Public

Health..