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An introduction to the ways in which kids can help around the house.

Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting. ISRCTN Registry ISRCTN62237498.

Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase. In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers. The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost. Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

Dont throw away those breakfast grapefruit halvesadd a little salt and use them to clean your oven. Is space tight in the bathroom? Use hanging tiered fruit and vegetable baskets from the shower rod to stow shower toys and shampoo. Are your shoes looking a little dull and scuffed? Rub the pithy side of a banana skin over the scuffed leather. Instead of tossing that elastic band into a drawer, wrap it from shoulder to shoulder around a hanger to keep your clothes from slipping to the closet floor. Written with a special focus on simplifying, organizing and storing, Tidy Hacks includes dozens and dozens of inspired ideas for every area of your home (and more).

In this book, Nobel Prize-winning economist Edmund Phelps draws on a lifetime of thinking to make a sweeping new argument about what makes nations prosper--and why the sources of that prosperity are under threat today. Why did prosperity explode in some nations between the 1820s and 1960s, creating not just unprecedented material wealth but \"flourishing\"--meaningful work, self-expression, and personal growth for more people than ever before? Phelps makes the case that the wellspring of this flourishing was modern values such as the desire to create, explore, and meet challenges. These values fueled the grassroots dynamism that was necessary for widespread, indigenous innovation. Most innovation wasn't driven by a few isolated visionaries like Henry Ford; rather, it was driven by millions of people empowered to think of, develop, and market innumerable new products and processes, and improvements to existing ones. Mass flourishing--a combination of material well-being and the \"good life\" in a broader sense--was created by this mass innovation. Yet indigenous innovation and flourishing weakened decades ago. In America, evidence indicates that innovation and job satisfaction have decreased since the late 1960s, while postwar Europe has never recaptured its former dynamism. The reason, Phelps argues, is that the modern values underlying the modern economy are under threat by a resurgence of traditional, corporatist values that put the community and state over the individual. The ultimate fate of modern values is now the most pressing question for the West: will Western nations recommit themselves to modernity, grassroots dynamism, indigenous innovation, and widespread personal fulfillment, or will we go on with a narrowed innovation that limits flourishing to a few? A book of immense practical and intellectual importance,Mass Flourishingis essential reading for anyone who cares about the sources of prosperity and the future of the West.

Background In the UK older adults in care homes have exhibited poorer oral health than age-equivalent persons in the community. In response the National Institute for Health and Care Excellence issued guidance (NG48) on the maintenance and improvement of oral health in this group. Currently, there is little evidence on the cost-effectiveness of such interventions. The aim of this study was to examine the feasibility of evaluating an intervention framed around NICE guidance. Methods The study was undertaken in 22 care homes across 2 sites with eligibility criteria used to ensure access to residents for whom the oral health care intervention was relevant and who could consent to participation. The intervention followed the guidance issued by NICE in respect of care staff knowledge; oral health assessment and development of care plans, and provision of daily mouth care to residents. Quantitative and qualitative data were collected from residents and care home managers and interviews undertaken with a range of stakeholders. Quantitative data from residents comprised EQ5D5L at baseline, 6 and 12 months, qualitiative data was taken from interviews. Descriptive statistics and a discussion of themes raised in surveys and interviews was undertaken. The trial was registered with the UK’s Clinical Study Registry (ISRCTN10276613) on 17/04/2020. Results Of 119 residents recruited, 115 provided usable EQ5D5L data at baseline. The data had good face validity. Managers from 7 of 22 homes provided responses to the care home survey. All responding care homes routinely recorded information on care provided to residents and 5 of the 7 recorded information on the funding source for that care. Care assistant time was a key consideration among managers in terms of resource use. Residents overall quality of life was a key consideration among managers in terms of outcomes. Among key stakeholders, there was a universal appreciation of the need to improve the evidence base on the value for money of interventions framed around NG48. Conclusion The study supports the case for the conduct of an economic evaluation in a definitive trial to address a manifest gap in the evidence base on oral hygiene interventions in this context.

This practical book is the ultimate guide to reducing your environmental impact while saving you time and money. Inside are tips and home hacks on everything from eco cleaning, upcycling and making the most out of your weekly shop to small-space gardening and creative crafts, plus a selection of Nancy's delicious recipes. Clearly explained, accessible and beautifully illustrated with black and white line-drawings, 'Green Living Made Easy' is the perfect guide for anyone looking to pursue a more sustainable lifestyle but unsure where to start.

This study aims to evaluate the cost-effectiveness and cost-utility of the SElf-reliance, autonomy, Life quality, and Functionality-program (SELF) for nursing staff in nursing homes who provide long-term care to geriatric clients as compared to care as usual from a societal perspective. The economic evaluation ran parallel to a two-arm multicenter cluster-randomized trial, in which the nursing staff in the intervention group received the SELF-program, and nursing staff in the control group received no program and delivered care as usual. Outcomes and societal costs for clients who received care from nursing staff were measured using questionnaires at baseline, 3 months, and 6 months. The main measures included Activities of Daily Living, as measured with the GARS-4, utility scores as measured with the EQ-5D-5L, and costs related to the intervention, informal care and health service utilization. Cost-effectiveness and cost-utility analyses were conducted, calculating incremental cost-effectiveness ratios from societal and healthcare perspectives. Bootstrap analyses were performed, with results displayed on cost-effectiveness planes and acceptability curves. In total, 28 wards with a total of 241 clients were randomized (intervention, n = 115; control group, n = 126) From a societal perspective, care delivered in the intervention group led to lower costs than care as usual over the 6-month period, with incremental costs of -€584. In terms of the GARS-4 sum score, the SELF-program resulted in a favorable decrease of 0.81 points, and in terms of QALYs, it resulted in a favorable increase of 0.07. From a healthcare perspective, the incremental costs amounted to €556, with ratios of €410 per point reduction on the GARS-4 and €8,356 per QALY. The main analysis suggests that over 6 months from a societal perspective for both outcomes, the intervention is cost-effective as compared to care as usual. International Clinical Trials Registry Platform: NL9189; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9189.