Long-term Care
in old people
of 75 and more years
old on Home Care
Service.
Nuria Rodriguez Avila
Montserrat Puig Llobet
University of Barcelona
Index
Definition
Theory
Spanish context
Methods
Results
Discussion
Conclusion
References
Definition
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 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).
Theory
The 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.
Sociology of
Social Rol health: Illness rol
(Parsons, 1951)
Sociology of
Family: caregivers
rol
Funcionalism
Social Theory of
the Dissociate Social Theories of
(Cumming and aging
Henry, 1961) (Old person rol)
Spanish context
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.
Spanish context
Since 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.
Methods
General 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.
Grafic 1 . Population in Vilafranca del Penedès
(2005) by gender and aged.
Fuente: www.ajvilafranca.es
Table 1 Population of ATDOM Program
Población 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
Table 2 Sample of ATDOM program
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)
10
Table 3: Variables Study
Subject Variables
Old person with Style of life
dependence Health Status and perception.
and 75 o Level of dependence
more years old Eating and Drinking
Physical activity
Social relationship
Subjective Welfare:
Perception of quality of life
Satisfaction of needs
Long-term care in aging
with handicap
12
Interviews and instruments
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).
13
Example of questions
14
Results
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.
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.
17
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 People
in ATDOM program
Elementos Subjetivos Elementos Objetivos
Salud subjetiva Datos sociodemográficos
Situación económica Salud objetiva
Cuidados informales Dependencia
Servicios sociosanitarios Situación económica
Relaciones familiares Cuidados informales
Estilo de vida Servicios sociosanitarios
Entorno Relaciones familiares
Bienestar subjetivo Estilo de vida
Sa
tis Entorno
fa
cc
i ón
Servicio
Calidad de Vida del mayor
ATDOM
dependiente
Calidad de los cuidados
Independencia y participación
Satisfacción de necesidades
Valoración de los cuidados informales
Determinar adaptación
19
Discussion
The 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.
Conclusions
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 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.
References
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Articles
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.
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Statistics for life expectation
and health
Hans Rosling shows the best
stats you've ever seen
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Principals indicators used:
◦ Life expectation
◦ Human Development Index (HDI)
THANK YOU VERY MUCH
MUCHAS GRACIAS
MOLTES GRACIES
Contact
Dra. Nuria Rodríguez Ávila
Dept. Sociologia i A.O. Despatx 4119.
Universitat de Barcelona
Avda. Diagonal 690
08034 Barcelona, España
Tel/Fax: +34 934021805
E-mail: nrodriguez@ub.edu
Dra. Montserrat Puig Llobet
Departament Infermeria Salut Pública, Mental i Maternoinfantil.
C/ Feixa Llarga, s/n. Despatx 307
Campus de Bellvitge.
08907 Hospitalet de Llobregat
Telèfon: 934024237 Fax: 934024297
E-mail: monpuigllob@ub.edu
Research topics::
Quality of life, Aging Nursing diagnostic, Public Health..