Care available to severely disabled older persons living at home in Florence, Italy.
OBJECTIVE
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 home care services; 7) self-perceived inadequacy of income. Subjects reporting 2+ problems were further evaluated in face-to-face structured interviews (phase II).


RESULTS
Of 5,445 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.


CONCLUSIONS
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.
Di Bari
Mauro
M
Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy. dibari@unifi.it
Pecchioli
Alessandro
A
Mazzaglia
Giampiero
G
Marini
Monica
M
Maciocco
Gavino
G
Ferrucci
Luigi
L
Marchionni
Niccolò
N
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D016015:Logistic Models; D008297:Male