ObjectivesTo evaluate the effects of an advanced practice nurse (APN) in-home health consultation program (HCP) on quality of life, health indicators (falls, acute events), and healthcare utilization.DesignRandomized clinical trial.SettingOne urban area in the German-speaking part of Switzerland.ParticipantsFour hundred sixty-one community-dwelling individuals aged 80 and older (mean age 85, 72.7% female, all Caucasian) participated in the intervention (n = 231) and control (n = 230) groups.InterventionAfter a comprehensive geriatric assessment, participants were randomly assigned to the 9-month HCP with four in-home visits and three phone calls from APNs or to a control group with standard care with no intervention.MeasurementsThe primary outcome was quality of life at 3, 6, and 9 months. Secondary outcomes were incidence of falls, acute events due to health problems, and healthcare utilization measured for 3-month periods at 3, 6, and 9 months.ResultsThe intervention and control groups did not differ significantly on any dimension of the World Health Organization Quality of Life questionnaire but differed significantly over 9 months in self-reported acute events (116 vs 168, relative risk (RR) = 0.70, P = .001), falls (74 vs 101, RR = 0.71, P = .003), consequences of falls (63.1% vs 78.7%, chi-square = 7.39, P = .007), and hospitalizations (47 vs 68, RR = .70, P = .03).ConclusionThe in-home HCP provided by APNs and guided by the principles of health promotion, empowerment, partnership, and family-centeredness, can be effective in reducing adverse health outcomes such as falls, acute events, and hospitalizations.

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This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

Studies show that complaints about being forgetful are weakly correlated with standardized measures of memory impairment. Little attention has been paid to those complaints in a healthy elderly population. Therefore, this qualitative, grounded-theory study investigated the experiences and consequences of becoming forgetful. In-depth interviews with 32 participants were conducted and analyzed. The findings show that forgetfulness became part of daily life through 3 strategies, conceptualized as doing forgetfulness: (1) reducing complexity; (2) creating and maintaining routines; and (3) dealing with feelings of embarrassment and shame. The well-being of people experiencing forgetfulness depended on how successfully they performed the strategies of doing forgetfulness. Gaining insight into this process allows health care professionals to assess the phenomenon early and to individualize counseling and further diagnostic procedures.

BACKGROUND: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. OBJECTIVES: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. METHODS: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and investigated by the University of Zurich's Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990-2000 (n = 149) were compared with the data of the present study. RESULTS: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). CONCLUSIONS: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study.