The financing of long-term care and the planning of care capacity are of increasing interest due to demographic changes and the ageing population in many countries. Since many care-intensive conditions begin to manifest at higher ages, a better understanding and assessment of the expected costs, required infrastructure, and number of qualified personnel are essential. To evaluate the overall burden of institutional care, we derive a model based on the duration of stay in dependence and the intensity of help provided to elderly individuals. This article aims to model both aspects using novel longitudinal data from nursing homes in the canton of Geneva in Switzerland. Our data contain comprehensive health and care information, including medical diagnoses, levels of dependence, and physical and psychological impairments on 21,758 individuals. We build an accelerated failure time model to study the influence of selected factors on the duration of care and a beta regression model to describe the intensity of care. We show that apart from age and gender, the duration of stay before death is mainly affected by the underlying diseases and the number of different diagnoses. Simultaneously, care intensity is driven by the individual level of dependence and specific limitations. Using both evaluations, we approximate the overall care severity for individual profiles. Our study sheds light on the relevant medical, physical, and psychological health indicators that need to be accounted for, not only by care providers but also by policy-makers and insurers.

Early institutional rearing is associated with increased risk for subsequent peer relationship difficulties, but the underlying mechanisms have not been identified. Friendship characteristics, social behaviors with peers, normed assessments of social problems, and social cue use were assessed in 142 children (mean age = 10.06, SD = 2.02; range 7–13 years), of whom 67 were previously institutionalized (PI), and 75 were raised by their biological families. Anxiety and attention-deficit/hyperactivity disorder (ADHD) symptoms, often elevated among PI children, were examined as potential mediators of PI status and baseline social functioning and longitudinal follow-ups (2 and 4 years later). Twenty-seven percent of PI children fell above the Child Behavior Checklist Social Problems cutoff. An examination of specific social behaviors with peers indicated that PI and comparison children did not differ in empathic concern or peer social approach, though parents were more likely to endorse aggression/overarousal as a reason that PI children might struggle with friendships. Comparison children outperformed PI children in computerized testing of social cue use learning. Finally, across these measures, social difficulties exhibited in the PI group were mediated by ADHD symptoms with predicted social problems assessed 4 years later. These findings show that, when PI children struggle with friendships, mechanisms involving attention and behavior regulation are likely contributors.

The aim of this study was to compare satisfaction with residence, wellbeing and physical health of continuing care retirement community (CCRC) residents with people who considered enrolling in the same CCRCs but elected not to move. A total of 101 participants were recruited from 13 CCRCs located in multiple cities in the United States of America. A phone interview was conducted with participants three months or less from enrolment and one year later. Compared with those who chose not to move, CCRC residents reported lower satisfaction at baseline, but higher satisfaction at one year. Wellbeing declined from baseline to follow-up for both groups, but was higher in CCRC residents both at baseline and at one year. CCRCs might consider giving new residents a longer cancellation period in order to allow sufficient time for the adjustment process. This, in turn, might both prevent an early departure and affect the decision of potential CCRC residents to move into the community.

This study’s objective was to identify the adversity profiles of children in different childcare placements, and to analyze their relationship with subsequent psychological adjustment. We studied a group of 230 children 4 to 10 years old indifferent childcare placements (international adoption, institutional care, non-kin foster care, and kinship care), as well as a control group. Information was collected from parent or caregiver interviews and the Strengths and Difficulties Questionnaire (SDQ). The results showed that children in the child welfare system had experienced significant adversity before their current placement, especially among institutional care cases and international adoptees. Meanwhile, children in kinship care had experienced less adversity (p < .001; size effects from d > .50 to d > .80). After a period of time in their respective placements, children’s psychological adjustment was generally positive, but children living in institutional care exhibited the most problems and difficulties, followed by non-kin foster care cases (p < .001; size effects from d > .50 to d > .80). Finally, we found that children’s early adversity levels (p < .05; r = .16), age of current placement (p < .01; r = .23), and duration of current placement (p < .05: r = –.19) were all tied to current psychological adjustment.

This paper draws on two data sources (Kelly's ethnographic study and a British Broadcasting Corporation television programme) to explore the practice of bodywork in the care of frail people with dementia in institutional settings. It explores the complexity of engaging in bodywork, particularly work that is distasteful to the care-worker, and shows how non-recognition of the selfhood of the person with dementia can result in practices that are demeaning and potentially abusive to those in receipt of such work. In contrast to a person-centred approach that urges practitioners to acknowledge people with dementia as unique individuals, with unique needs, wishes, abilities and desires, this paper argues for the use of Sabat's Selfs 1–3 construct to look for commonalities of selfhood, enabling care workers to recognise aspects of themselves in their patients as they carry out care, thereby facilitating care that empathically respects their patients' dignity and potential for vulnerability. Thus, it aims to advance theory and improve practice by arguing for the necessity of putting selfhood at the forefront of bodywork in order to facilitate respectful care that dignifies rather than objectifies the person.

Background: Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia.

Methods: This is a quasi-experimental study design involving 224 early dementia patients from both nursing home and community settings. Participants will be assessed for cognitive severity, QoL, needs, activities of daily living, depression and social isolation/connectedness by using the Mini-Mental State Examination (MMSE), Cognitive Impairment Scale – 4 items (CIS-4), EUROPE Health Interview Survey-Quality of Life (WHO8), Assessment of Quality of Life (AQoL8), Camberwell Assessment of Need for the Elderly – Short Version (CANE-S), Barthel Index (BI), Cornell Scale for Depression (CSDD), Geriatric Depression Scale – 15 items (GDS-15), and Friendship Scale (FS) respectively.

Conclusion: This study aims to provide a better understanding of care needs in early dementia. Given population aging, the study findings will provide evidence assisting decision-making for policies aimed at reducing the burden of caregiving and preserving the QoL of dementia patients.

In India, although notions of ageing and care are changing, there is a continued preference among families for home-based care of elderly relatives. The legislative policies and cultural practices that shape this preference will be examined in this paper with specific reference to aged-care facilities and the 2007 Maintenance and Welfare of Parents and Senior Citizens Act. Using qualitative data from a study on dementia care in urban India it will be shown how the Act and old-age homes are understood and experienced by Indian families and key service providers. In juxtaposing policy and practice it will be argued that while notions of care are being redefined by processes like migration and urbanisation, the preference for home care remains, indicating that existing services need to be re-oriented and expanded to support families in providing this care.

An increased demand for long-term care services coupled with the decreased availability of informal (family) carers in many industrialised countries has led to the employment of growing numbers of ‘migrant care workers’. Little is known about this heterogeneous group or of their experience of employment in long-term care. Providing an important insight into a hitherto little researched and poorly understood topic, this article presents the findings of a qualitative study in Ireland that sought greater understanding of migrant carers' experience of care work and of the intra-group differences among them. The findings suggest that some members of the long-term care workforce are more likely to confront obstacles and discrimination than others. The data indicate that the experiences of European, South Asian and African carers are significantly different and that relationships may exist between carers' region of origin and their experience of care work, employment mobility and long-term plans for remaining in the sector. The findings underscore the significance of acknowledging the unique barriers and obstacles faced by particular populations of care workers. A better understanding of the changing demographic profile and needs of both care recipients and their paid (migrant) care-givers is required to ensure that appropriate policy and practical interventions are developed to support both groups.

Background: No specialized geriatric psychiatry consultation services are available for elderly people in the institutional care system in Turkey. Our aim was to evaluate psychiatric consultations among the residents of three homes for the elderly in a country with a rapidly aging population, and to investigate possible problems regarding psychiatric consultations.

Methods: The residents of three homes for the elderly, which served partially as “care and rehabilitation centers” (equivalent to nursing homes), were chosen for the study. Data on the use of psychiatric services (mainly patient consultations with a visiting psychiatrist) were collected and analyzed.

Results: The percentage of patients in the three homes for the elderly who had psychiatric consultations between 2005 and 2007 was 31.8% (172/540). The main reasons for referral were forgetfulness (61%), depressive symptoms (37.7%), agitation and disruptive behavior (29.6%), and psychotic symptoms (27.9%). Of these patients, 46.5% were diagnosed with dementia, 20.9% with depression, 20.5% with behavioral and psychotic symptoms of dementia, and 18.6 % with primary psychotic disorders such as schizophrenia.

Conclusion: Homes for the elderly in Turkey are not adequate in terms of consultations for psychiatric problems. Integration of these institutions with hospitals and organizing routine consultation visits from the psychiatry units would enhance the mental health of the elderly. Supporting the staff, maintaining good cooperation between them, and organizing educational programs in the field of mental health of the elderly are also required.

This paper reports a systematic review of 28 evaluations of interventions that aimed to describe the benefits of the use of the life story for nursing-home residents with dementia, particularly with reference to their sense of identity. The 28 studies were published during 1990–2003. The review focuses on the methodology of the evaluations, and on how the studies contributed to our understanding of the value of using a resident's life story in care interactions. The studies were divided into three groups by the purpose of the intervention: to raise self-esteem and self-integration; to improve life quality; and to change behaviour. The features of the interventions that were associated with enhanced sense of identity were a thorough and encompassing treatment of the individual's life story, the translation of the life story into care interactions, and active encouragement of the residents' initiatives. Only one intervention had all of these features. The diverse aims and forms of the interventions were mirrored by the diverse methodologies of the evaluation studies. Recently the trend has been towards more rigorous designs that measure a few precisely-defined quantitative outcomes but at the cost of a narrower appreciation of the impacts. Given that there is still a great deal to learn about how best to deliver sensitive, individualised and effective support and care to people with dementia, it is argued that qualitative assessments have been too hastily discontinued.

A group of 4–7-year-old war orphans were examined for the first time while living in an institution (the Solomuna Orphanage) during a protracted war between Eritrea and Ethiopia. At that time, they were compared to a group of refugee children living in a nearby camp with one or both parents. The orphans exhibited significantly more behavioral symptoms than the refugee children, but performed the cognitive tests at a more advanced level. Five years later, the orphans were re-examined; and they were compared to unaccompanied 9–12-year-children living in one of two residential settings that differed qualitatively in their social climate, principles of child care, and patterns of staff–child interactions. Although the severity of their behavioral symptoms had diminished, the orphans still exhibited many symptoms of emotional distress. On the other hand, they performed the cognitive measures as well as, or better than, unaccompanied children who had been protected from the terrors of war. The cross-sectional comparisons indicated that a residential setting that respects the individuality of children and promotes their close personal ties with at least one staff member can ameliorate many of the more serious psychological sequelae of having lost both parents and being exposed to the physical dangers of the war. The implications for war orphans in other Third World countries are discussed.

Six per cent of child in a sample of 111 children who were adopted into U.K. families from Romania, and who were systematically assessed at the ages of 4 and 6 years, showed autistic-like patterns of behaviour. A further 6% showed milder (usually isolated) autistic features. Such autistic characteristics were not found in a similarly studied sample of 52 children adopted in the first 6 months of life within the U.K. The children from Romania with autistic patterns showed clinical features closely similar to “ordinary” autism at 4 years but they differed with respect to the improvement seen by age 6 years, to an equal sex ratio, and to a normal head circumference. The children from Romania with autistic features tended to differ from the other Romanian adoptees with respect to a greater degree of cognitive impairment and a longer duration of severe psychological privation.