No abstract available.
Hospices* ; Institutionalization*

PURPOSE: This study aims to explore general perception types about the life of institutionalized elderly and thus to provide the basic data for nursing intervention for them. METHOD: This study used a Q methodology. A Q sample was developed through a review of related literature and descriptions of ordinary people about the life of institutionalized elderly. Thirty-eight statements made up the finalized Q sample. RESULTS: The results revealed three different types of the general people's perception about the life of institutionalized elderly. Type 1 is an optimistic group which expects modernized institutions. This group focuses on social relationships enjoying a variety of cultural life. Type 2 is a positive group which pursues independence. They are open-minded about the use of the institution and are not ashamed of the life in the institution. Type 3 is a conservative group which disapproves institutionalization. The members of this group strongly disapprove the institution itself and have negative views on institutionalization. These three types share certain common features while having distinctive characteristics showing individual views and traits about the life of the institutionalized elderly. CONCLUSION: This study will provide us the basic data to understand institutionalized elderly and to develop nursing intervention for them.
Aged* ; Humans ; Institutionalization ; Nursing

BACKGROUND: The Philippines has, mandatory service policies to address the insufficiency and maldistribution of human resources particularly for health services. Despite being perceived as an appropriate intervention to bridge the aforementioned HRH gaps, the past and present implementations of such programs in the country have never been formally studied.

OBJECTIVE: This paper aimed to present the history of mandatory service programs in the Philippines, look at their natures, and see how their different implementations relate to each other.

METHODOLOGY: Using a qualitative document analysis method, administrative issuances and reports relevant to past and current implementations of mandatory service policies in the Philippines were obtained and reviewed.

RESULTS: Mandatory service programs have been implemented in the country by institutions from both the private and public sectors as early as 1968. The focus of such has been mostly for government positions and specialized professions including physicians and scientists. While extensive efforts have been made through the years, the policies demonstrated fragmentation and recurring gaps in implementation. Such gaps include the lack of enabling policy mechanisms, formal monitoring and evaluation, and program institutionalization.

CONCLUSION: The historical narrative of return service programs in the country is a potential source for the development of an overarching mandatory service policy framework for human resources in the Philippines, one that is specific to the context and setting of the country. By articulating policy issues identified, this paper provided a stepping-off point for future mandatory service program policy planning, implementation, evaluation, and institutionalization in the Philippines.

Voiding dysfunction is very common in Alzheimer's disease, especially urinary incontinence with reported frequencies of 11-90%. Urinary incontinence occurs secondarily from dementia, can result in medical morbidity, impaired self-esteem of the patents, caregiver's stress, early institutionalization of the patients, and considerable financial cost. Many studies have found that the frequency and severity of incontinence is positively correlated with the severity of dementia and the inability to walk or transfer. Research on the management of urinary incontinence in demented patients has focused almost exclusively on toileting programs and drug treatments for detrusor overactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in demented persons. Therefore we have to study about the etiology and treatment of Alzheimer's disease.
Alzheimer Disease ; Dementia* ; Humans ; Institutionalization ; Urinary Incontinence

The importance of palliative care for terminal cancer patients has been emphasized globally. Korea has formulated and implemented its policy for cancer control as it drew up a 10-year plan for cancer patient care. We examined Korea's National Cancer Act and the second 10-year plan for cancer patient care, which are legal grounds for palliative care projects for terminal cancer patients, to check the current status of Korea's efforts to establish a hospice and palliative care system. Institutionalization of hospice and palliative care has been developed within a framework of the national cancer project. Efforts such as expansion of hospice units, experts training and quality improvement should continue after the reimbursement of hospice and palliative care begins in 2013.
Hospices ; Humans ; Institutionalization ; Korea ; Palliative Care ; Patient Care ; Quality Improvement

OBJECTIVES: The purpose of this study was to examine the determinants of care burden of caregivers in patients with dementia. METHODS: 128 dementia patients and patients' caregivers participated in this study. Care burden using the BI ; cognition using the K-MMSE ; dementia severity using the CDR ; activities of daily living using the S-ADL and the S-IADL ; behaviour problems using NPI were measured. RESULTS: The results showed that care burden was related significantly with the K-MMSE, the CDR, the S-ADL, the SIADL and the NPI total score. Of the behavior problems, agitation/aggression, anxiety, disinhibition, irritability, and aberrant behavior correlated positively with care burden of caregivers. Regression analysis indicated that agitation/aggression, anxiety, the CDR contributed to care burden. CONCLUSION: Agitation/aggression, anxiety and dementia severity contributed to care burden of caregivers. The identified determinants of care burden and the stress of caregivers suggest areas of therapeutic intervention to reduce caregiver's burden so that the institutionalization can be delayed.
Activities of Daily Living ; Anxiety ; Caregivers* ; Cognition ; Dementia* ; Humans ; Institutionalization

Caring for people with dementia is associated with multiple devastating social, financial, physical, and psychological challenges. There is strong evidence that multicomponent tailored caregiver intervention is effective in improving caregiver well-being and delaying institutionalization. In US, the government is actively funding for developing caregiver program and to prove its efficacy through randomized controlled trials (RCTs) to translate into practice. Even with the introduction of Korean Long-term Care Plan, still, the most of the patients with dementia are being cared by the family members. The distress of caregiving is enormous, but structured therapeutic intervention program which efficacy is proven through RCT is very insufficient in Korea. The purpose of this article is to review the caregiver intervention programs of ongoing clinical trials comparing US and Korea, and to propose a tailored, therapeutic intervention program (I-CARE; A multicenter, randomized trial to assess efficacy of therapeutic intervention programs for decreasing caregiver burden in dementia caregiver) for hospital-care in Korea.
Caregivers* ; Dementia* ; Financial Management ; Humans ; Institutionalization ; Korea ; Long-Term Care

PURPOSE: The purpose of this study was to analyze the effects of respite care. The analysis was conducted by reviewing published intervention studies on the effects of formal respite care for caregivers of dementia patients, patients with dementia, and the prevented or delayed rate of institutionalization of the patients. METHOD: Two computerized databases (MEDLINE, CINAHL) were searched to find respite care-related articles published from the year of 1981 to 2000. A total of 49 published articles were identified. Of them, nine studies, which met for the inclusion criteria of this study, were included. RESULTS: Results revealed that there was little evidence of the effect of respite care on, not only caregivers' burden, stress, depression and well-being, but also the rate of institutionalization of the patients. It was noteworthy that dementia patients reported fewer problems in behavior, although cognitive functioning and activity of daily living abilities continued to decline. However, these findings should be carefully interpreted because of methodological problems, such as non-random sampling, non random group assignment, a small sample size, uncontrolled confounding variables, limited period of services, and no specific types of services. CONCLUSION: It is recommended to conduct intervention studies of respite care being conducted in Korea with the corrections of methodological problems suggested from this study.
Caregivers* ; Confounding Factors (Epidemiology) ; Dementia* ; Depression ; Humans ; Institutionalization ; Clinical Trial ; Korea ; Respite Care* ; Sample Size

OBJECTS: Many studies have demonstrated greater frequency of soft neurologic signs in patients with schizophrenia than in controls. However, factors associated with chronicity, institutionalization, individual differences and neuroleptic medication make it difficult to interpret these results. We report on our ongoing study of soft neurologic signs and their relationship to neuroleptics and institutionalization in schizophrenia. METHODS: Soft neurologic signs were examined with a standardized instrument, Neurological Evaluation Scale- Korean Version(NES-K) in 11 neuroleptic-naive patients with schizophrenia, 17 neuroleptic-treated patients and 14 chronically institutionalized patients. RESULTS: Scores of total items(p<0.005), sensory integration(p<0.05), sequencing of complex motor acts(p<0.05) and others(p<0.01) functional areas of NES-K were significantly different among three groups. There was no difference in the area of motor coordination. Posthoc analysis showed that scores of total items(p<0.005) and sensory integration areas(p<0.01) of NES-K were significantly higher in the institutionalized patients than those of neuroleptic-naive group. However scores of sequencing of complex motor act and others categories were not different in the institutionalized and neuroleptic-naive patients. CONCLUSION: These findings suggested that neuroleptic treatment or chronic institutionalization might partially affect soft neurologic signs, especially sensory integration area, in patients with schizophrenia. However, the soft neurologic signs of motor coordination area could be a biological trait marker of schizophrenia independent of confounding variables.
Antipsychotic Agents ; Confounding Factors (Epidemiology) ; Humans ; Individuality ; Institutionalization ; Neurologic Manifestations ; Schizophrenia

BPSD (behavioral and psychological symptoms of dementia) are common remediable cause of excess morbidity and lead to significant impairment in quality of life for both patients and their caregivers, as well as an increased risk of institutionalization. The most common treatment of BPSD is neuroleptic medication. Compared to other agents, conventional neuroleptics have been studied with relatively rigorous placebo-controlled trials. Efficacy is modest, but concerns regarding side effects, such as extrapyramidal symptoms, tardive dyskinesia, and emotional withdrawal, have often limited their uses. Treatment of BPSD with atypical antipsychotics such as risperidone or olanzapine is potentially advantageous in view of their tendency to cause considerably fewer side effects. But elderly demented patients may be particularly sensitive to untoward side effects of psychotropic drugs. The different atypical antipsychotics do have their own side effects and other limitations. Clinicians who prescribe antipsychotics for BPSD should start with a low initial dose, increasing this dose slowly until the lowest effective dose is reached. It is important to remember that although antipsychotics provide symptomatic relief, they do not cure underlying dementia. Clinicians should try to avoid prescribing multiple drugs with anticholinergic or sedative effects. Further study to determine more specific drug-responsive symptoms is needed to maximize benefits of atypical antipsychotics.
Aged ; Antipsychotic Agents* ; Caregivers ; Dementia* ; Humans ; Hypnotics and Sedatives ; Institutionalization ; Movement Disorders ; Psychotropic Drugs ; Quality of Life ; Risperidone