Abstract
Aims: To characterize the epidemiology of disability in, and the level of care available to, older community-dwellers in an Italian urban sample. Methods: In a 2-phase survey, persons aged 65+ years, randomly selected from the patients lists of 98 primary care physicians (PCP), were screened (phase I) by their PCP with a structured questionnaire to detect the presence of: 1) need of help in performing Basic and 2) Instrumental Activities of Daily Living (BADL, IADL); 3) poor vision or 4) hearing; 5) weight loss; 6) use of homecare services; 7) self-perceived inadequacy of income. Subjects reporting 2+ problems were further evaluated in face-to-face structured interviews (phase II). Results: Of 5445 participants, 597 (11%) screened positive in phase I and 416 were interviewed in phase II. Of these, 4, 29, 19 and 49% were disabled in 1–2 IADL, 3+ IADL, 1–2 BADL, and 3+ BADL. The extent of the support network increased with disability severity (p<0.01). The 274 participants with BADL disability received most of their help from close relatives (58.3±2.5%), followed by salaried assistants (20.5±2.1%), other relatives (19.5±1.9%), and public healthcare services (0.6±0.36%). Of the 397 care-givers interviewed, one-third were willing to institutionalize the older participants in case of further functional deterioration. This propensity was predicted only by a self-reported poor attitude towards caring. Conclusion: Many severely disabled older Italians receive care in their home by highly supportive family members. The level of assistance provided to them by public healthcare services is minimal.
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Population ageing 2002. United Nations Population Division Department of Economic and Social Affairs. 2006. Available at: http://www.un.org/esa/population/publications/ageing/Graph.pdf
Pesaresi G, Gori, C. Servizi domiciliari e residenziali per gli anziani non autosufficienti in Europa. 2006. Available at: http://www.centromaderna.com/file/pesaresi.PDF
CENSIS-La Repubblica. II quadro della vita degli anziani. 2006. Available at: http://www.censis.it/
Roti L, Bartali B, Cantini E, et al. Messa a punto e validazione di una breve intervista per lo screening della disabilità nella popolazione anziana. Il progetto DOMUS. G Gerontol 2003; 51: 35–41.
Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med 1990; 322: 1207–14.
Di Bari M, Marchionni N, Ferrucci L, et al. Heart failure in community-dwelling older persons: aims, design and adherence rate of the ICARe Dicomano project: an epidemiologic study. Insufficienza Cardiaca negli Anziani Residenti a Dicomano. J Am Geriatr Soc 1999; 47: 664–71.
Ferrucci L, Bandinelli S, Benvenuti E, et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 2000; 48: 1618–25.
Di Bari M, Silvestrini G, Chiarlone M, et al. Features of excessive alcohol drinking in older adults distinctively captured by behavioural and biological screening instruments: an epidemiological study in Italy. J Clin Epidemiol 2002; 55: 41–7.
Tamiya N, Yamaoka K, Yano E. Use of home health services covered by new public long-term care insurance in Japan: impact of the presence and kinship of family care-givers. Int J Qual Health Care 2002; 14: 295–303.
Jacobzone S. Coping with aging: international challenges. Health Aff (Millwood) 2000; 19: 213–25.
Carpenter I, Gambassi G, Topinkova E, et al. Community care in Europe. The Aged in Home Care project (AdHOC). Aging Clin Exp Res 2004; 16: 259–69.
Polverini, F, Principi, A, Balducci, et al. National background for Italy. Eurofamcare. 2004. Available at: http://www.uke.uni-ham-burg.de/extern/eurofamcare/documents/nabare_italy_rcl_a4.pdf
Beland F, Bergman H, Lebel P, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2006; 61: 367–73.
Chenier MC. Review and analysis of care-giver burden and nursing home placement. Geriatr Nurs 1997; 18: 121–6.
Lund M. Care-giver, take care. Geriatr Nurs 2005; 26: 152–3.
Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull 2003; 129: 946–72.
Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Care-giver Health Effects Study. JAMA 1999; 282: 2215–9.
McKinlay JB, Crawford SL, Tennstedt SL. The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients. J Aging Health 1995; 7: 497–528.
Cooper C, Katona C, Finne-Soveri H, et al. Indicators of elder abuse: a cross-national comparison of psychiatric morbidity and other determinants in the Ad-HOC study. Am J Geriatr Psychiatry 2006; 14: 489–97.
Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA 2006; 295: 2148–57.
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Di Bari, M., Pecchioli, A., Mazzaglia, G. et al. Care available to severely disabled older persons living at home in Florence, Italy. Aging Clin Exp Res 20, 31–39 (2008). https://doi.org/10.1007/BF03324745
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DOI: https://doi.org/10.1007/BF03324745