Disability is more prevalent among the elderly. However, evidence on the factors associated with disability among them is limited. Therefore, this paper addresses the spatial and socio-demographic correlates of disability among individuals aged 60 and over in Indonesia. We employ data from the 2013 Indonesian National Socioeconomic Survey (SUSENAS). We defined disability as having any difficulties in doing daily activities using the ‘Low Threshold’ assumption. We fitted a multivariable logistic regression model to the dataset and evaluated statistical significance at the 95% level. The final regression model is statistically significant (P<0.001) with a sample of 23,709 individuals. The results show that 45.35% of the elderly reported being disabled. Moreover, higher age is associated with higher odds of being disabled (OR = 1.16; 95%; 95% CI = 1.10-1.23). An elderly living without a spouse is more likely to be disabled (OR = 1.54; 95% CI = 1.43-1.64). We also observed provincial differences in disabilities. Furthermore, elderly living in rural areas have higher odds of being disabled (OR = 1.18; 95% CI = 1.12-1.25) compared to their urban counterparts. Our results imply that the Indonesian elderly with certain characteristics are more vulnerable than others which requires long term care.

Background:

Heart failure is the number one cause of hospital readmissions among Veteran Affairs (VA) patients. We implemented a home-based RN/LPN team who provided short-term, intensive CHF case management in collaboration with a cardiologist with the goal of reducing 30-day readmissions, ER visits, and hospitalizations.

Methods:

This retrospective study evaluated ER visits, admissions, 30-day readmission rates, and total inpatient days for 108 CHF patients at the Indianapolis VA Medical Center enrolled in the home-based CHF program from May 2016-September 2017. Data was retrieved from national VA databases as well as the electronic medical record. We compared patients’ acute care utilization six months prior to the program, during the program, and at six months post-program discharge using chi squared test.

Results:

500 Veterans were admitted with HF at our hospital in 2016 with the 30-day readmission rate of 21% before our program start date. When comparing all 500 HF patients admitted at our VA with the 108 patients enrolled, the difference in 30-day readmissions was significant (p <.001), with only 7% of our patients having a 30-day readmission within the first 30 days of enrollment into the program. When comparing our study population itself six months pre-program versus during program, there was a large reduction in ER visits and admissions per patient during the program (0.537 vs. 0.361) and (1.63 vs. 0.296). When comparing 6 months pre-program vs. during program enrollment and 6 months post-program discharge, the number of total inpatient days per person was drastically reduced (9.31 vs. 1.33) (9.31 vs 2.73). Using the average cost of one day in the hospital, $3,400, the VA saved approximately $22,372 per patient during our study. The average cost for the CHF home care team yearly is $213, 004, whereas the approximate savings for this program per year is $4,832,352, giving a total annual cost savings of $4,619,348.

Conclusions:

Short-term, intensive home-based teams for high-risk Veterans with CHF can reduce ER visits, admissions, 30-day readmissions, and the number of inpatient days and be highly cost-effective. This home-based care model must also be noted for showing significant effect persisting after the formal program/intervention ended as there was a continued sizable reduction 6 months post-program discharge in total inpatient days.

Pressure injuries are areas of localised damage to skin and underlying tissue, usually over bony prominences. They are associated with pain, prolonged hospitalisation, poor quality of life, increased morbidity and risk of mortality.

An audit of pressure injury risk assessment forms on medical wards identified poor compliance with pressure injury prevention and increased prevalence of pressure injuries among patients, from 1.6% in 2011 to 20.4% in 2015. A study exploring nurses knowledge and practices on wound assessment identified more than half of the participants had limited knowledge, confirmed in an audit of nursing documentation of wound progress. Interventions to reduce risk of pressure injuries and improve management of pressure injuries require a comprehensive and multidisciplinary approach. The framework used to achieve this are outlined.

Multicomponent interventions involving development of care practices using a team approach include standardising pressure injury documentation and continuous education. The TaPIE (TAilored Pressure Injury Education) intervention for nurses and caregivers on reducing pressure injury is currently being undertaken. Nurse-led wound management utilising the TIME approach and monthly wound case conference improved ward-based management of pressure injuries. Community follow-up by home based nurses of complex wounds is facilitated by tele-assessment through electronic digital images shared with clinicians if there are uncertainties in management.​