Dissertations / Theses on the topic 'Long day care'
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1
Ballard, Rosslyn S. "Yoga and Long Day Care Services." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/400466.
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Yoga classes are an increasingly popular trend in early childhood education and care services. The purpose of this research is to examine how yoga classes are included in the programs of long day care centres, and how links are drawn between the components of yoga classes, and yogic strategies, and the curriculum framework Belonging, Being and Becoming: The Early Years Learning Framework for Australia, and mandated requirements that guide all service providers (and staff and educators in children’s services) to provide an environment that supports children’s growth across all developmental domains. Until recent years, yoga was not considered a suitable activity for environments such as schools and children’s services. In general, only adults attended yoga classes held in specified yoga venues. However, those who study the life skills that are advocated in yoga philosophy agree that yoga is a way of living that supports a healthy lifestyle. According to the National Quality Standard guide, the early childhood curriculum and daily programs should provide children with strategies that will lead to a healthy adulthood.
This research project explores the links between the content of the yoga classes in relation to the Early Years Learning Framework and the provision of programs that scaffold children’s levels of development. This research project examines the question: What happens when yoga is included in long day care programs?
Sub questions:
l How many long day care services in the Gold Coast offer yoga?
1 How does yoga fit with the legislated ECEC curriculum frameworks?
1 What matters to educators and parents about including yoga in the long day care programs?
Case study research methodology is used to examine how yoga is included in long day care services. Part One of the research project uses surveys to scope the early childhood education and care long-day care centres that include yoga classes in their service delivery. Part Two uses interviews to examine the perceptions of early childhood educators and yoga teachers about yoga in the early education and care programs.
On the surface, yoga classes are valued as part of the curriculum for services that include yoga in the weekly program. Early childhood services encapsulate a social culture of their own, that includes the beliefs and values of the staff and the families using the services.
This social culture needs to be considered when planning and implementing pedagogical strategies in the daily program. However, this project found that there is a paucity of research about the pedagogy of yoga in early childhood services. This project pinpoints the need to examine the use of extracurricular classes, including yoga, as part of the delivery of programs in early childhood services. Additionally, there is a need for research about how practising yoga can support early childhood development and provide strategies for continued health and well-being through a socio-cultural lens.
This research project concludes that there is no empirical evidence to confirm that yogic practices or extra-curricular yoga classes in early childhood increase the potential for health and well-being in adulthood. Recommendations for early education and care long-day care centres are three-fold. Firstly, it is necessary to collaborate with all stakeholders including children about the opportunities to participate in yoga classes. Secondly, we must examine the content activities of the yoga classes and practices and how they fit with the aspirations and expectations of parents and children. Finally, the third step is to assure a match between what the curriculum requires for children’s development and the content activities in the yoga classes. This has particular relevance to the professional knowledge of educators and yoga teachers. These recommendations are important considerations in the decision-making about the inclusion (or not) of yoga classes in the delivery of the curriculum of long day care services.Thesis (Masters)
Master of Medical Research (MMedRes)
School of Medical Science
Griffith Health
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Lunt, Catherine A. "Impact of day care services on older people with long term conditions." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3025902/.
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Background: Day care services support older people with multiple long term conditions (LTC) within the community to age in place. This salient topic is given little attention by researchers. Day care services models are complex and outcomes for service users unknown. In the UK, in response to wider policy reforms local authority models have been outsourced to a range of organisations, including Charitable and Voluntary services. This thesis aims to understand the models of day care provided in the community and the subsequent outcomes for users and their families. Methods: This is an exploratory study comparing outcomes for users across five different service types: firstly comparing day care provided by Paid staff services, Voluntary services and Blended services (provided by staff and volunteers) and secondly comparing services provided in urban and rural areas, with a particular focus on health inequalities. Mixed Methodology was used. Observations using focussed ethnography and semi structured qualitative interviews with staff and volunteers provided a greater understanding of the type of provision. Quantitative measures were used at 3 time points over 12 weeks of attendance with clients new to day care to assess outcomes using tools for health status and loneliness. Findings: Data was collected from nine day care centres across seven services. 94 clients and 16 carers attending day care were recruited. 36 semi structured interviews were undertaken with clients, carers, staff and volunteers at the services. At baseline there were no differences across services types in the numbers of long term conditions reported by service types but there were significant differences between rural and urban services (rural mean LTC 5.2, urban mean LTC 4.2, p0.04). A larger proportion of clients attending Blended and volunteer led services reported a reduction in loneliness. When adjusted for other baseline variables in logistic regression model, likelihood of reduction in loneliness was increased in Blended (OR=2.28) and Voluntary (OR=2.16) services compared to Paid staff service. People using Blended and Voluntary services reported better or same health outcomes across most EQ5D3L domains than Paid services. Observations and interview data suggests that the differences in outcomes at Blended and Voluntary services may be due to the delivery of activities promoting self-worth and facilitating links to the wider community. Conclusion: This thesis concludes that day care provides vital support for frail older people living at home and their volunteers can deliver effective support with favourable outcomes. It is suggested that activities that promote self-worth and provide links to the community may facilitate positive health outcomes and reduce loneliness. Preparation of such activities can be implemented with minimum resources, providing cost effective interventions for providers to deliver.
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Berish, Diane E. "INVESTIGATING THE EFFICACY OF SKILLED-NURSING FACILITIES’ TRANSITIONAL CARE PROGRAMS ON REDUCING 30-DAY HOSPITAL READMISSIONS." Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1531907403994485.
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El-Saadi, Debra Maree. "Managing infectious disease risks in long day care services: How well does this happen." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/192095/1/Debra_El-Saadi_Thesis.pdf.
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The transmission of infectious diseases in childcare centres regularly occur and can pose a risk to the health of young children. This research explored the issues that support or impede good infection prevention measures and found gaps in policy and training that, if addressed, could help reduce disease transmission risk. The findings from this research will help inform national conversations to ensure evidence-based infection prevention measures are part of standard practice in the early childhood education and care sector.
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McKinlay, Sharon. "Building a sustainable workforce in early childhood education and care: What keeps Australian early childhood teachers working in long day care?" Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/98507/4/Sharon_McKinlay_Thesis.pdf.
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The case study research of five early childhood teachers drew upon the theoretical framework of social constructivism to investigate what keeps early childhood teachers working in long day care. Examining the ecology of long day care in light of the national reform agenda for Early Childhood Education and Care, the research identified the individual and contextual factors that enabled and challenged the teachers’ work in long day care. The study contributes empirically-based insights and offers practical strategies to support the recruitment and retention of early childhood teachers in long day care.
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Caicedo, Carmen. "Children with Special Health Care Needs: Comparison of the Effects of Home Care Setting, Prescribed Pediatric Extended Care Setting, and Long-Term Care Setting on Child and Family Health Outcomes and Health Care Service Use." FIU Digital Commons, 2013. http://digitalcommons.fiu.edu/etd/844.
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Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL TM Generic Core Module for child health and functioning, PedsQL TM Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.
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Chen, Han-Yang. "Hospital Treatment Practices, 30-Day Hospital Readmissions, and Long-Term Prognosis in Patients Hospitalized with Acute Myocardial Infarction: A Dissertation." eScholarship@UMMS, 2015. http://escholarship.umassmed.edu/gsbs_diss/771.
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Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the U.S. Acute myocardial infarction (AMI), with or without ST-segment elevation, is a common presentation of coronary heart disease and affected more than 800,000 American adults in 2010. The overall goal of this dissertation was to examine decade-long trends in the extent of delay in the receipt of a primary percutaneous coronary intervention (PCI) among patients hospitalized with ST-segment elevation myocardial infarction (STEMI), 30-day hospital readmission rates in patients having survived an AMI, and multiple decade long trends in 1-year post-hospital all-cause mortality, as well as factors associated with these outcomes, among patients hospitalized with AMI.
Methods: Data from the Worcester Heart Attack Study, a population-based chronic disease surveillance project that has been carried out among adult residents of the Worcester, MA, metropolitan area, hospitalized with AMI on a biennial basis from 1975 through 2009 at all medical centers in central MA, were used for this dissertation.
Results: Between 1999 and 2009, among patients hospitalized with STEMI, the likelihood of receiving a primary PCI within 90 minutes after emergency department arrival increased dramatically from 1999/2001 (11.6%) to 2007/2009 (70.5%). Between 1999 and 2009, among hospital survivors of an AMI, the 30-day all-cause rehospitalization rates decreased from 1999/2001 (20.3%) to 2007/2009 (16.7%). The overall cause-specific 30-day rehospitalization rates due to CVD, non-CVD, and AMI were 10.1%, 7.1%, and 1.8%, respectively, during the years under study. Between 1975 and 2009, among hospital survivors for a first AMI, the 1-year post-discharge mortality rates remained relatively stable from 1975-1984 (12.9%) to 1986-1997 (12.5%), but increased during 1999-2009 (15.8%). We identified several demographic, clinical and in-hospital treatment factors associated with an increased risk of failing to receive a primary PCI within 90 minutes after emergency department arrival, 30-day readmissions, and 1-year post-discharge mortality.
Conclusions: Our findings can hopefully lead to the enhanced development of innovative, patient-centered, intervention strategies which can further improve the treatment and transitions of care, as well as short and long-term prognosis, of men and women hospitalized with AMI.
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Cranitch, Christina S. "Professional identity: Shaping attraction, retention, and training intentions in early childhood education and care." Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/112813/2/Christina_Cranitch_Thesis.pdf.
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Across Australian long day care centres, thousands of early childhood (EC) educators face enduring challenges adversely impacting their pay, conditions, and workplace retention. Despite such challenges, significant numbers of EC educators continue to work in their roles over the long-term. Data was collected from 18 study participants and viewed through a professional identity framework comprising the dimensions of continuity, belonging and attachment, status and esteem, and mastery. The analysis shed light on the reasons underlying EC educator decisions to continue working in long day care centres within the broader context of historical and current policy approaches.
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Briney, Glenna Denise. "Long term effects of day treatment programs for adults with severe and persistent mental illness: Effectiveness measured in rates of recidivism." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2731.
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The purpose of this study was to compare and measure the long term effectiveness of the rehabilitative day treatment program at San Bernardino County's Department of Mental Health. This current study was completed in 2005 and is a follow up study tracking the long term effectiveness of the program.
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Binstadt, Michele. "Growing and sustaining a professional early years workforce: The role of multidisciplinary networks in supporting professional practice." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/208270/1/Michele_Binstadt_Thesis.pdf.
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This thesis generated practical insights into how membership of a multidisciplinary network supported the professional practice of a small group of service leaders working in long day care in a Queensland community characterised by complexity. Nested within an Australian Research Council funded national Early Childhood Education and Care Workforce Study, this study contributes to the identification of effective strategies to grow and sustain a professional early years workforce.
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Bispo, Nuno de Noronha da Costa. "O impacto das doenças na vida cotidiana em pessoas idosas institucionalizadas." Pontifícia Universidade Católica de São Paulo, 2015. http://tede2.pucsp.br/handle/handle/2569.
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Previous issue date: 2015-08-24Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Despite the large number of healthy elderly people, old age is also followed by an overall decline in health conditions, especially among institutionalized elderly people. The general objective of this anthropological research is to verify the impact of diseases on the everyday life of institutionalized elderly people and their present and future consequences. The investigation took place at Asilo São Vicente de Paulo de Londrina, a nursing home with 37 residents. Data were collected through observations and interviews and analyzed through the description of the observations and the hermeneutic-dialectical method. Results showed loss of autonomy and personal control. Based on the participants comments, the study detected a perception of the sickening body, mobility loss, lack of freedom, physical dependence to carry out routine activities, occupation reduction and isolation, difficulty to sleep and hopelessness in regards to the future. In its final considerations, the study highlights the importance of the anthropological investigation in a Long-term Care institution for the elderly
Apesar de haver um grande número de pessoas idosas saudáveis, a velhice também é acompanhada pelo declínio geral das condições de saúde, especialmente entre idosos institucionalizados. Verificar o impacto das doenças na vida cotidiana em pessoas idosas institucionalizadas e seus desdobramentos no presente e no futuro foi o objetivo geral desta pesquisa antropológica. O campo de investigação desenvolveu-se no Asilo São Vicente de Paulo de Londrina, com 37 residentes. Na metodologia utilizou-se para a coleta de dados a observação e a entrevista, que foram analisados através da descrição da observação e pelo método hermenêutico-dialético. Nos resultados observou-se a perda da autonomia e do controle pessoal. Nas falas dos participantes, constatou-se a percepção do corpo que adoece, o acometimento da mobilidade, a perda da liberdade, a dependência física nas atividades do cotidiano, a diminuição da ocupação, o isolamento, a dificuldade para dormir e a esperança no futuro. Nas considerações finais, foi destacada a importância da investigação antropológica em uma Instituição de Longa Permanência para Idosos
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Gomes, Angélica Fabiana. "O trabalho de cuidado : uma análise das representações sociais de cuidadores de pessoas idosas em uma Instituição de Longa Permanência (ILPI)." Universidade Federal de São Carlos, 2017. https://repositorio.ufscar.br/handle/ufscar/9311.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Researching the work of the caregiver of elderly people in the Institution for the Long Stay of the Elderly (ILPI) is therefore a social phenomenon that must be clarified, since it depends on the individual condition of those who perform it. The scientific study of care work becomes increasingly relevant to improve the working conditions afforded by technological and scientific advances. It is noted that several countries are experiencing different aging populations in different ways. Some countries in Europe and Japan have gradually been aging, Brazil is among the countries that ages abruptly. Considering the specificities of the formal care work, emerging from this scenario, especially the long-term care in the context of ILPIs, this study had as objective to investigate the social representations about the work of care elaborated by formal caregivers of elderly people in a Institution of Long Stay for the Elderly (ILPI). This is a case study of a social and qualitative nature. Participants in the study were a group of 9 workers from an ILPI, who work in the care of institutionalized persons of both sexes, located in a municipality in the interior of the State of São Paulo. The data were analyzed starting from the assumptions of the Consensual Universes and Reified Universes and the concepts of Objectivation and Anchoring, as stated in the theory of social representations. Through the systematization of the narratives of the participants, discursive marks and thematic categories delimited, characterizing two distinct and complementary perspectives of social representations. Care work for participants reveals representations of "learning," "love," "art," "caring." Care work also represents "dimensions beyond techniques." Considering the nature and dynamics of a philanthropic, closed and "long-stay" institution, representations emerge of work marked by precarious conditions, lack of capacity to deal with the emotions of the elderly, and also of their own emotions, expressing a "Heavy work" that requires physical effort and recognition. It is verified that the knowledge about the care work is still limited, and it is necessary to develop internal actions of the institution, as well as the public policies of long-term follow-up of the working conditions of care.
Pesquisar o trabalho do cuidador de pessoas idosas em Instituição de Longa Permanência de Pessoas Idosas (ILPI) é, pois, um fenômeno social que deve ser esclarecido, pois, ele depende da condição individual dos que o executam. O estudo científico do trabalho de cuidado se torna cada vez mais relevante para melhorar as condições de trabalho propiciadas por avanços tecnológicos e científicos. Nota-se que diversos países estão atravessando, de formas diferentes o envelhecimento populacional. Alguns países na Europa e o Japão foram envelhecendo aos poucos, o Brasil está entre os países que envelhece bruscamente. Considerando-se a especificidades do trabalho de cuidado formal, emergentes deste cenário, em especial aos cuidados de longa duração no contexto das ILPIs, este estudo teve como objetivo investigar as representações sociais sobre o trabalho de cuidado elaborado por cuidadores formais de pessoas idosas em uma Instituição de Longa Permanência para Idosos (ILPI). Trata-se de um estudo de caso, de natureza social e qualitativa. Participaram do estudo um grupo de 9 trabalhadores de uma ILPI, atuantes no cuidado de pessoas institucionalizadas, de ambos os sexos, que está localizada em um município do interior do Estado de São Paulo. Os dados foram analisados partindo-se dos pressupostos dos Universos Consensuais e Universos Reificados e dos conceitos de Objetivação e Ancoragem, enunciados na teoria das representações sociais. Mediante a sistematização das narrativas dos participantes, marcas discursivas e categorias temáticas delimitadas, caracterizando duas perspectivas distintas e complementares das representações sociais. O trabalho de cuidado para os participantes revela representações de “aprendizado”, “amor”, “arte”, “carinho”. O trabalho de cuidado representa também “dimensões para além das técnicas”. Considerando a natureza e a dinâmica de uma instituição – filantrópica, fechada e de “longa permanência” emergem representações de um trabalho marcado por condições precárias, falta de capacitação em como lidar com as emoções das pessoas idosas e também das suas próprias emoções, expressando um “trabalho pesado” que requer um esforço físico e reconhecimento. Constata-se que o conhecimento sobre o trabalho de cuidado ainda é limitado, e é necessário o desenvolvimento de ações internas da instituição, bem como a de políticas públicas de acompanhamento a longo prazo, das condições de trabalho de cuidado.
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Santos, Cláudia Soares dos. "Prevalência e características das experiências espirituais no final da vida por meio de relatos de profissionais de saúde que atuam com pacientes fora de possibilidade curativa." Universidade Federal de Juiz de Fora (UFJF), 2016. https://repositorio.ufjf.br/jspui/handle/ufjf/3156.
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INTRODUÇÃO: Experiências espirituais no final da vida (ELEs) e fenômenos à beira do leito são comumente relatados de forma anedótica. Porém, ainda existem poucos estudos que tenham avaliado sistematicamente essas experiências. OBJETIVOS: Objetiva-se descrever e comparar as características e a prevalência das ELEs de acordo com relatos de profissionais de saúde em diferentes instituições (Unidade de cuidados paliativos, Instituições de Longa Permanência e Hospital oncológico) e avaliar a influência das crenças religiosas nesses relatos. MÉTODOS: Estudo multicêntrico, conduzido em Instituições de Longa Permanência (ILPI) em Juiz de Fora e no Hospital de Câncer de Barretos (Unidade oncológica-ONC e Cuidados Paliativos-PC), no Brasil. Foram avaliados dados sócio-demográficos, relatos de ELEs (pelo questionário de Fenwick), religiosidade (DUREL), espiritualidade (SRSS) e saúde mental (DASS 21). A análise foi feita através de ANOVA e qui-quadrado. RESULTADOS: 133 profissionais (46 ONC; 36 PC e 51 ILPI‟s) foram entrevistados, sendo que 70% tiveram relatos de ELEs nos últimos 5 anos. As principais ELEs relatadas foram “visões de parentes falecidos buscando o falecido” (n=82, 88,2%), “desejo súbito de reconciliamento” (n=79, 84,9%) e “parentes falecidos próximos ao leito proporcionando conforto” (n=75, 80,6%). A maioria dos profissionais (70-80%) acreditava que tais experiências tinham um cunho espiritual e não ocorriam por condições biológicas. Na comparação entre os grupos, PC tiveram mais relatos que os demais grupos e relataram maior abertura frente ao tema e maior interesse em um treinamento. As crenças individuais não interferiram de forma importante na percepção das ELEs. CONCLUSÃO: O estudo mostrou uma grande prevalência de ELEs relatadas por profissionais de saúde, associadas a opinião de que essas experiências seriam espirituais. Apesar de comum em todas as instituições, profissionais que atuam com cuidados paliativos referiram mais ELEs, maior abertura em sua instituição e maior desejo de treinamento. As crenças religiosas e espirituais tiveram pouca influência nos relatos de ELEs pelos profissionais, mostrando que não esse não foi um aspecto determinante para sua percepção.
INTRODUCTION: Spiritual end-of-life experiences (ELEs) and deathbed phenomena are often reported in an anecdotal fashion. Few studies however, have systematically assessed these experiences. OBJECTIVES: The objective of this study was to compare the characteristics and prevalence of ELEs as reported by health professionals at different institutions (palliative care, nursing homes and oncology hospital) and to assess the influence of religious beliefs on these reports. METHODS: A multi-center study was conducted at Nursing Homes (NH) in Juiz de Fora and at the Hospital de Câncer de Barretos (Oncology-ONC and Palliative Care-PC Unit) in Brazil. Sociodemographic data, ELE reports (Fenwick´s questionnaire), religiosity (DUREL), spirituality (SRSS) and mental health (DASS 21) were assessed. The analysis was performed using the ANOVA and Chi-square tests. RESULTS: A total of 133 health professionals (46 ONC, 36 PC and 51 NH) were interviewed, 70% of whom had ELEs reported to them in the past 5 years. The main ELEs reported were “visions of dead relatives collecting the dying person“ (n=82, 88.2%), “a desire to mend family rifts” (n=79, 84.9%) and “dead relatives near the bed who provide emotional comfort” (n=75, 80.6%). The majority of the health professionals (70-80%) believed these experiences had spiritual significance and were not due to biological conditions. Comparison among the groups revealed that the PC had more reports than the other groups and also greater openness on the issue and more interest in training. Individual religious beliefs had no relevant influence on the perception of ELEs. CONCLUSION: The study revealed a high prevalence of ELEs reported by health professionals, who believed these experiences were spiritual. Although prevalent in all of the institutions, greater ELEs, openness at their institution and desire for training were reported by palliative care professionals. Religious and spiritual beliefs had little influence on ELEs reported by the health professionals, indicating this was not a factor determining the perception of ELEs.
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Lin, Pin-Chun, and 林品君. "A Study of the Day-Care Center Price in Taiwan Ten-year Long-term Care Program." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/25989135699458091301.
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碩士國立中正大學
社會福利研究所
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Many countries were facing the social change of population aging. Taiwan was included, too. Government has improved and developed long-term care services to respond for increasing needs of care. Day-care service is one of services. Government made regulations of day-care, including service items, staffing, space, and facilities etc., however, there is no standards for pricing. As a result, the charging standards of day-care center were inconsistent. Therefore, the study focuses on the pricing of day-care center. There are three purposes of the research. First, analyze the charging standards and pricing models of day-care centers in Taiwan. Secondly, show finance and cost structure of day-care centers in Taiwan. Thirdly, find out the principle applies to pricing day-care centers in Taiwan. In this study, methods of data collection are in-depth interviews and secondary qualitative studies. We also combine quantitative and qualitative methods in order to enrich the content. To understand the imagination and views of day-care center price, researcher chose purposive sampling and had been invited ten executive officers and five local government authority staffs. Researcher used semi-structured interviews to focus on research framework to enrich flexibility and the content of the interview. The results of the study are as follows：First, the charging standards of day-care centers in Taiwan could be separated into three states. One is that whether the charging standards could distinguish different degrees of disability between models of single price and rating price; another is that different types of day-care center have different charging standards; according to the study, the single price in dementia day-care center is higher than others. The other is regional variation. We could find the price is getting lower from northern to southern in Taiwan. Secondly, as three states mentioned above, the effect of charging standards and degree of disability show the most significant deviation. Therefore, we analyzes the effects of models of single price and rating price for service providers, consumers, and governments. The results show that both of those two pricing models have strength and weakness for service providers and consumers. Thirdly, the causes of day-care center price could be divided into five categories：needs and willingness-to-pay, ability-to-pay, market price, cost, and policy. The study provides recommendations for the future day-care center development policy.
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Chou, Chia-Ni, and 周佳妮. "The structure and establishment of information and communications technology system in Long term care and day care." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/ujy35t.
Full text
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FU, YU-TING, and 傅鈺婷. "The Adult Day Care Service Quality and Satisfaction under The Implementation of The Long-Term Care Policy." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/674636.
Full textAbstract:
碩士國立臺北大學
公共行政暨政策學系
107
The purpose of this study is about the adult day care service quality and satisfaction under the implementation of the long-term care policy. Through literature review, we can propose the theoretical framework, assumptions and certified about it. The research’s purpose is to understand the service quality under the long-term care 2.0 policy. We hope to understand more about the adult day care policy’s implementation in Taiwan and supply some suggestion. Through this study, we can also understand the satisfaction about adult day care in Taiwan. We hope our government can improve the adult day care policy and makes the elder have better long-term care in our community. The research’s results reveal that users have the highest degree of satisfaction with the outcome dimension and the lowest degree of satisfaction with the structural dimension. 1. The service quality and satisfaction’s result shows very high score in structural dimension, process dimension and outcome dimension. 2. According to Pearson product moment correlation’s results, the structural dimension and outcome dimension are significant positive correlation. The process dimension and outcome dimension are significant positive correlation too. 3. According to Multiple regression analysis result, the structural dimension and process dimension have positive significant difference to outcome dimension.
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CHEN, YI-AN, and 陳怡安. "The Social care system of Long-term Care through Public-Private Partnerships-Such as Kaohsiung City OO district” day care center”." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/z5b54t.
Full textAbstract:
碩士國立高雄大學
政治法律學系碩士班
107
The development of this thesis is based on the “public-private partnership approach to the Kaohsiung City OO District Day Care Center for the development of a long-term care system community care system”. Increasing in the population of the elderly and domestic female labor participation rate, the implementation of Taiwan’s long-term care policy and system, and evolution the longer long-term care service resources have been, the more background of those who are in need will be cut. "Long-term care", requires long-term and high-intensity resources such as manpower, site and funding. The demand for such care services has also led to new tasks in the public sector. The most specific ones include "funding, venues and long-term public-private partnerships" to promote long-term care. Looking at the "Long-Term Care 2.0 Policy", municipalities (counties) of the municipalities directly under the Central Government are required to construct a "one-day care center" to enhance the service capacity and fitness level, however, in the case of other public and private partnerships, the day care center in social welfare category are emerging tasks. Is it possible to formulate specific laws and regulations, project managements through public and private consultation machines? The case study "Kaohsiung City OO District Day Care Center" be called, and uses to make recommendations on all of the "central or local government, non-government units, service users" with consider revising and special law in the day care center, and also trying to find a balance between innovation. Keywords: Long-term care, Public-Private Partnerships, The social care system, day care center, Case study.
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(9816341), Trudiann Marshall. "The role and work practices of the Educational Leader in long day care centres." Thesis, 2019. https://figshare.com/articles/thesis/The_role_and_work_practices_of_the_Educational_Leader_in_long_day_care_centres/13453160.
Full textAbstract:
There is evidence in the research literature that outlines the role of the Educational Leader (EL) is an important but developing role in the delivery of high-quality early childhood education and care. The National Quality Standard (NQS) stipulates a national criterion against which the quality of early childhood education and care services in Australia is benchmarked.
This research used a two-phased mixed method approach to explore the role and work practices of the EL in long day early childhood care centres. In Phase 1 of the research an on-line survey investigated the role of the EL and the work practices used. In Phase 2, interviews with ELs explored further in-depth insights into the role of, and work practices used by ELs.
The results from this research have identified four main EL responsibilities, namely to facilitate:
•professional practice;
•administrative practice;
•compliance with the requirements of the NQS (Quality Area 7); and
•mentoring of centre educators.
Within the four responsibilities, it was found that the EL uses a range of specific work practices. There are evident commonalities in the work practices used, but the extent of their use and the way in which the work practices are used varies from EL to EL.
The findings from this research can be used to strengthen the quality of conversations between ELs, other educators, centre Directors and management about professional practice in the early childhood setting.
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Huang, Chi-Chou, and 黃啟洲. "The New Market Field of Long-term Care Industry - Innovation and Integration Strategy among the Day Care Centers and Home Care Centers." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/468s7q.
Full textAbstract:
碩士國立臺灣大學
工業工程學研究所
102
Taiwan is soon to be a "super-aged society" in a couple of decades-more than 20% of population are senior people. In an aging society, family structures and family caring members will be changed when demographic characteristics change. The independent and comfortable living way for the elderly is an interesting research topic while developed countries have made "aging in place" as the main stream of long-term caring policy objectives, where aging in place is to assist an elderly staying at home for an independent and enjoyable life. In recent years, the governments are also actively promoting the "deinstitutionalization" of long-term care. The feature and capability of nursing centers can be seen in the community and home so that the elderly can live in their own familiar community or home. Including home care and day care, the community care is composed of two separate types of long-term care, collectively referred to as "community care services." Home Care is the most upstream of the long-term care for the most widely popular demand. While the Day Care is a transition from institutional care to home care. Both the demand and supply of community care are expected to be growing in the current aging society. However, we do not observe the growing trend in Taiwan due to the low-cost and substitution effects of foreign caregivers in Taiwan. This results in that community-based care service industry has been unable to successfully thrive as a private business. This study is to propose policy recommendations and innovative-designed operated ways to improve the current care patterns of elderly in a community. The proposed concepts can benefit the physical and mental health of elderly people; thereby delaying the aging process and diminishing the relative consumption of medical resources.
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Tregenza, Lisa. "A study of teaching behaviours in six selected long day care centres : an analysis of 12 educators interactions with children." 2008. http://arrow.unisa.edu.au:8081/1959.8/48305.
Full textAbstract:
This research reports on an observation study conducted in Adelaide, South Australia of how 12 educators working in six long day care centres spent their day when working in their care. Specifically the study sought to answer the following research questions: 1. How do educators spend their day in a long day care setting?-- 2. What is the quality of the interactions that occur between educators and children?-- 3. In what ways, if any, does an educator's qualifications and experience impact on the quality and frequency of interactions?
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CHING-SHENG, YIN, and 尹慶生. "The Planning Experience of the Day Care Model in Long Term Care 2.0-A Case Study of Ping’an Cooperative in Tainan Anding District." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/w637zx.
Full textAbstract:
碩士高苑科技大學
經營管理研究所
105
Abstract This study is based on the government's long-term care policy history. The changes of new long-term care 2.0 policy, which is a significant focus on community services and a pilot integration of various care models. The 3 primary roles of long term caring : such as medical hospitals, institutions, home caring association, the difference between the various roles to do analysis. Because Japan's aging population is the world's leading, its long-term care insurance has advanced in the world, It caring model can be referenced by Taiwan and China. Taiwan now becomes an aged society, After 7 years the proportion of the mainland china will be an aged society, Therefore, the government went through the experience of "long-term care 10 years" polices The new integration care model will try to introduce. Namely the current ABC three service structure and integration of the new service model. This paper, through in-depth interviews and literature analysis, among the Tainan peace of the cooperative as the core of the A-level units, and medical institutions as the role of B-level and find the grassroots 6 associations, respectively, to the public sector Building and space to take care of the elderly in the community, where the population and pathology issues need to do a survey, and through a semi-structured interview to conduct a qualitative study, which talks with government officials to identify policy objectives; and institutional management Staff interviews to identify various health promotion programs and services for human management issues; interviews with first-tier care givers of associations for the elderly to identify existing programs and can improve the direction in the future. Through interviews and literature analysis, we find the followings: 1. Architecture in line with ABC's three-tier service needs to strengthen the training of science and technology assistance. This will improve efficiency and manage healthy data. 2. Manpower solutions require more volunteer input and need to strengthen their abilities and expertise. 3. At all levels of service integration on the need for professional management personnel investment, education and training and professional work should be towards the young and innovative development.Through the relevant analysis, We reveal how to management and the new innovative services and industrial development opportunities in long term care 2.0. Finally, this article also provides several simples in Shanghai's day care Center. Look forward to the cross-strait Chinese day care exchange opportunities.
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Chen, Yu-Lin, and 陳昱霖. "Analysis of human resource gaps under Taiwan Long-Term Care2.0 — Lessons from a non-profit day care center." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/wyeb43.
Full textAbstract:
碩士國立中山大學
企業管理學系醫務管理碩士班
107
Background: The rapid development of an ageing society is already a problem faced by many advanced countries. According to the National Development Committee, Taiwan became the ageing society in 1993, and became the aged society in 2018. It is estimated that Taiwan will enter the super-aged society in 2026. As the function of family care has weakened, provision of long-term care by government has become an urgent task. Objectives: To identify the demand for workforce on adult day care and the supply of human resource engaged in Long-Term Care 2.0. Methods: This study adopts qualitative research methods by undertaking in-depth interviews with the operator and a senior social work supervisor at an adult day care center. The focus of interviews is on identifying shortage of health workers for home care services, respite care at home, small-scale and multiple-functions services, community development model(s), and adult day care under the Long-Term Care 2.0. Results: Research results indicate that human resources for adult day care and respite care at home are sufficient during week days, but not sufficient during weekends. Resident care attendants, social workers engaged in small-size multiple-functions services, and community care workers are in shortage. The research results may be instrumental to long-term care policy design, especially in the area of human resources planning.
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Shih-YaTseng and 曾詩雅. "The Evaluation of the Public-Private Partnerships Among Long-Term Care Management Centers and Elderly Day Care Centers: Cases Studies in Tainan and Kaohsiung." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/new35q.
Full textAbstract:
碩士國立成功大學
政治經濟研究所
106
Taiwan has become recognized as the “aged society” in 2018; the need for a long-term care system can be anticipated to increase in the future. Elderly day care services play an important role in long-term care service delivery systems and it requires public-private partnerships among long-term care management centers and elderly day care centers to provide care services to the people who need them the most. This thesis uses interview methods, including in-depth interviews and questionnaires, to collected opinions from public and private sectors about their public-private partnerships, and the research concludes are: (1) the evaluation of five dimensions of Public-Private Partnerships, (2) how the conditions affect the opinions of elderly day care center, and (3) the advices for future public-private partnerships among long-term care management centers and elderly day care centers.
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(13714027), Karen Zielke. "Professional practicum: Conceptions of an effective early childhood environment." Thesis, 2022. https://figshare.com/articles/thesis/Professional_practicum_Conceptions_of_an_effective_early_childhood_environment/20955964.
Full textAbstract:
Within the last decade, there have been significant changes to the field of early childhood care and education, both in the perceived role of early childhood programs and in the types of services that are available to young children and their families. For many service users and providers, the ideal or most effective environment for young children may vary considerably.
This study was conducted in order to attempt to reach a clearer understanding of the phenomenon of an effective early childhood environment. More specifically, this study centres around gathering service users' conceptions of what constitutes an effective early childhood environment for young children.
A phenomenographic approach was utilised, with several service users being interviewed during this study, in order to identify and characterise the different ways in which they conceptualise the phenomenon of an effective early childhood environment. This work provided a valuable learning experience in the use of phenomenoeraphic methodology.
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Berkemer, Esther. "Palliative Care bei Demenz: Das Verständnis von Palliative Care bei Demenz und die Bedeutung für das Pflegehandeln im Kontext der stationären Langzeitpflege." Doctoral thesis, 2017. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2017051815923.
Full textAbstract:
Hintergrund: Menschen mit Demenz zählen zu einer wichtigen, aber bislang vernachlässigten Zielgruppe in der palliativen Pflege und Betreuung. Viele dieser Personen haben palliative Versorgungserfordernisse, die in der stationären Langzeitpflege häufig weder wahrgenommen noch angemessen erfüllt werden. Das Versorgungskonzept Palliative Care gewinnt vor diesem Hintergrund zunehmend an Bedeutung für die Begleitung von Menschen mit Demenz. Es existieren normative Vorgaben und theoretische Überlegungen zur palliativen Versorgungspraxis, ohne dass näher konkretisiert wird, wie dies in der pflegerischen Alltagspraxis in Einrichtungen der stationären Al-tenhilfe umgesetzt werden soll. Hinzu kommt, dass die pflegerische Einschätzung zu palli-ativen Bedarfen anspruchsvoller wird, da die Demenzspezifik im fortgeschrittenen Stadium der Erkrankung verbale Kommunikationsräume verringert. Leibliche Kommunikation, Intuition, Erfahrungswissen und die Kontextualisierung im Sinne eines hermeneutischen Fallverstehens (Remmers, 2000) können bei Demenz als Zugang für die Bedürfniserfassung und das spezifische Situationsverstehen bedeutsamer sein als objektiv ermittelte Parameter. Unklar ist bislang, wie sich die hier dargestellten Dimensionen pflegerischer Handlungen in der Begleitung von demenzerkrankten Personen in stationären Pflegeeinrichtungen gestalten und wie Kontextfaktoren die palliative Pflegepraxis beeinflussen.
Ziele: Ziel der vorliegenden Studie ist es, einen Beitrag zu einem vertieften Verständnis von Merkmalen, Ausdrucksformen und Wirkungsweisen in der palliativpflegerischen Ver-sorgungspraxis von Menschen mit Demenz im Handlungsfeld der stationären Langzeit-pflege zu leisten.
Studiendesign und Methode:
Um die subjektiven Vorstellungen von Palliative Care bei Demenz, Kontextfaktoren und Ausdrucksformen alltäglicher pflegerischer Handlungen im Kontext von palliativen Erfor-dernissen bei Demenz zu erfassen und nachzuzeichnen, wurde ein offenes, qualitatives Verfahren gewählt. In Anlehnung an die Grounded-Theory-Methodology (vgl. Corbin & Strauss, 2008) wurden 22 leitfadengestützte Interviews mit professionellen Akteuren aus vier Pflegeheimen durchgeführt und Bedingungsfaktoren und Handlungsorientierungen im Hinblick auf Palliative Care bei Demenz identifiziert.
Ergebnisse:
Es existiert ein heterogenes Verständnis von Palliative Care bei Demenz und es zeigen sich widersprüchliche Ausdrucksformen pflegerischen Handelns in der palliativen Versorgungspraxis von Menschen mit Demenz in der Langzeitpflege. In der zentralen Kernkategorie „Sich zwischen Gewissheit und Ungewissheit arrangieren“ lassen sich die pflege-spezifischen komplexen Deutungsprozesse und Handlungsorientierungen zur Gestaltung einer palliativen Versorgungspraxis von Menschen mit Demenz abbilden. Die palliativ-pflegerischen Handlungsorientierungen werden von den angewendeten Strategien der Pflegenden maßgeblich beeinflusst. Aufbauend auf dem subjektiven Verständnis von Palliative Care bei Demenz gruppieren sich die Ergebnisse palliativpflegerischer Handlungen um das identifizierte Phänomen. Verschiedene intervenierende Bedingungen (u. a. Charakteristika von Pflegenden, Zuschreibungsprozesse als Sterbende, Arten der Bedürfnisermittlung in der Pflegebeziehung sowie spezifische Versorgungsformen) bilden im Kontext des beruflichen Pflegehandelns die Voraussetzungen und Hindernisse für Palliative Care bei Menschen mit Demenz. Deutlich wurde, dass proaktiv-steuernde Strategien wahrscheinlicher und frühzeitiger zu einem an palliativen Maßstäben orientierten Pflegehandeln führen. Umgekehrt führen passiv-reaktive Verhaltensweisen von Pflegenden tendenziell zu einem verzögerten oder ausbleibenden Übergang hin zu palliativen Versorgungskonzepten.
Diskussion und Schlussfolgerungen: Auf Grundlage der Diskussion der Ergebnisse wurden fundierte Handlungsempfehlungen und praxisbezogene Anforderungen an eine demenzspezifische Palliative Care in der stationären Langzeitpflege abgeleitet.
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Schultz, Lisa. "Fixation d’un but thérapeutique pour les patients supportés à long terme par un DAV aux soins intensifs : l’expérience des soignants." Thèse, 2010. http://hdl.handle.net/1866/4823.
Full textAbstract:
La situation d’un patient trop malade pour une transplantation et qui est maintenu à long terme aux soins intensifs (SI) avec l’aide d’un dispositif d'assistance ventriculaire (DAV) peut évoluer de multiples façons. Malheureusement, plusieurs soignants vivent un malaise lorsque ce patient survit avec des complications, sans possibilité de transplantation cardiaque ni de retour à domicile. Par conséquent, différents buts thérapeutiques sont poursuivis au sein de l’équipe soignante. L’étude avait pour objectifs de cerner les buts poursuivis par les professionnels de la santé œuvrant auprès de ce type de patient, de clarifier les facteurs influençant les buts poursuivis et de mieux connaître les difficultés éprouvées par l’équipe soignante dans l’élaboration d’un but commun. La phénoménologie a été utilisée comme méthodologie de définition de la problématique. L’échantillon comprenait 12 participants représentant les infirmières, médecins et perfusionnistes d'une unité de SI, travaillant auprès de ce type de patient. Chacun des participants a fait l’objet d’une entrevue individuelle, semi-dirigée et enregistrée sur appareil audio. Il leur a d’abord été présenté une vignette à partir de laquelle ont été posées un certain nombre de questions identiques pour tous. Dans leurs réponses à ces questions, les participants ont eu la possibilité de s’exprimer autant sur leur expérience que sur le contexte du phénomène. Une seconde rencontre a été nécessaire afin de valider ou de corriger l’interprétation de ce que chacun avait exprimé durant l’entrevue. L'analyse des données témoigne d’un manque d’harmonie quant au but à poursuivre à l’égard du patient en question. Environ la moitié des participants visent la transplantation, alors que les autres poursuivent d’autres buts comme la sortie des SI, la limitation des traitements ou les soins palliatifs. Les participants sont influencés majoritairement par les volontés du patient, l'absence de mécanisme formel de communication entre eux et les facteurs professionnels tels que : les valeurs, les pratiques et l’environnement, sans oublier les rapports de pouvoir. Un certain nombre de barrières empêchent l’équipe de déterminer un but commun. Pour vaincre ces obstacles et s’entendre sur les buts à poursuivre en équipe, le développement de la communication multidisciplinaire s’impose. Pour y arriver, deux prérequis doivent être développés : l’intention éthique et l’engagement.A non eligible transplant patient on long term ventricular assist device (VAD) support in intensive care unit (ICU), can evolve in multiple ways. Alot of health care professionnals live a malaise when the patient surves with complications without neither possibility of cardiaque transplantation nor return home. In consequence, defferent goals of care are pursued in the health care team. This is why, the researcher maintained all along the study, the objectives to understand the goals pursued by the health care professionnals working towards the particular patient, to clarify the factors influensing these pursued goals and to learn more on the health care team difficulties to elaborate a common goal. Phenomenology has been the method used to define the problem. Twelve participants working in ICU were included in the reasearch sample representing the nurses, physicians and perfusionists working towards the concerned patient. Each of the participants had collaborated to an individual, semi structured and audio recorded interview. First, the researcher presented a vignette with which she asked everyone a certain number of identical questions. The questions permitted the participants to express as much on there experience than on the context of the phenomenon. A second meeting has been necessary to validate or correct the interpretation of what has been expressed by each participant during the interview. The data analyisis testify a lack of continuity concerning the goal to pursue with the patient in question. Almost half of the participants aim for a transplantation when the rest of them pursue other goals like discharge of ICU, treatment limitation or paliative care. By a majority, the participants are influenced by the patient’s will, the absence of formal communication mecanism, profesionnal factors such as : values, practices and environment and power differential. Thus, health care profesionnals that would want to pursue a common team goal are facing a certain number of barriers. The resercher realises that to overcome these barriers, multidisciplinary communication has do be the driving force of team goal- setting. Although, to acheave this, two pre-requisits have to be developed: the ethical intention and the engagement.
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Gomes, Vanessa Sofia Caetano. "O planeamento das altas em unidades de cuidados continuados de longa duração e manutenção: um estudo de caso na unidade "Naturidade Rio Maior"." Master's thesis, 2013. http://hdl.handle.net/10437/5482.
Full textAbstract:
Orientação: Maria Irene B. Lopes de CarvalhoPerante o crescimento do envelhecimento das populações e das transformações funcionais provocados por este processo, inerente ao Ser Humano, o papel da Rede Nacional de Cuidados Continuados Integrados e das Unidades de Internamento torna-se cada vez mais importante. Seja na prestação de cuidados a pessoas em situação de dependência, ou na promoção do seu conforto, bem-estar e qualidade de vida. Atendendo às dinâmicas intrínsecas às Unidades da RNCCI e especificamente das Unidades de Longa Duração e Manutenção, com este estudo pretendeu-se conhecer a forma como são planeadas as altas das pessoas internadas nestas Unidades. E também como as equipas desenvolvem o seu trabalho em prol da manutenção da qualidade de vida dos utentes. O Planeamento de Alta é um processo que permite assegurar que após a alta, a pessoa recebe os cuidados adaptados às suas necessidades físicas e sociais e principalmente assegurar a qualidade de vida nos momentos após a alta. Assim a investigação decorreu sob um quadro teórico na área do envelhecimento, pois a maioria dos utentes internados na Unidade em estudo são idosos e sob a RNCCI, as ULDM´s e o processo de planeamento de alta, utilizando uma metodologia de investigação quantitativa e qualitativa. O estudo decorreu na ULDM – Naturidade Rio Maior, com recurso à técnica da entrevista na recolha de dados. A fonte de informação foram os profissionais da equipa da ULDM – Naturidade. Bem como a pesquisa documental dos processos individuais e das intervenções/diligências do Serviço Social para cada utente. O regulamento interno também serviu como base de estudo. Os resultados da investigação representam o modo como a equipa desta Unidade trabalha para realizar o planeamento da alta, para a sua efetivação e para a promoção/manutenção da qualidade de vida dos utentes, após a alta. Ou seja, quando o utente passar de uma instituição para outra ou para a comunidade.
Due to the population ageing and its consequences, the role of the Continued Care National Network (RNCCI) and its Hospitalization Units (ULDM) are more and more crucial in the society. Not only in assisting dependent people, but also promoting their comfort and life quality. According to the RNCCI dynamics and more specifically to the Long Term and Maintenance Units, with this study we aim to reflect on how people are discharged from these units. As well as how teams develop their work in order to maintain the patient life quality. The discharge’s scheming is a process that allows guaranteeing the patient keeps getting the physical and social assistance needed, after leaving the units. Therefore, this analysis is based on a theoretical context related to the population ageing – the majority of the patients are elder people – and also on the RNCCI and the ULDM associated with its discharge plan, using a quantitative and qualitative method. The current investigation took place in the ULDM – Naturidade Rio Maior, using the interviews as a key technic for the data gathering. The main source of the information was the staff, along with the individual files and the Social Service procedures for each patient. Moreover, the internal regulation played an important role. The outcome of the inquiries represents the way how this Unit’s team work in order to establish the discharge plan, its consummation and to the maintenance of the patients’ life quality after being discharge from the institution. After being transferred for another unit or integrated in the community.
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Gonçalves, Paula Maria Broeiro. "Multimorbilidade em idosos dependentes ao cuidado das equipas domiciliárias da Rede Nacional de Cuidados Continuados Integrados na Região de Lisboa e Vale do Tejo." Doctoral thesis, 2018. http://hdl.handle.net/10362/49842.
Full textAbstract:
RESUMO - Multimorbilidade em idosos dependentes ao cuidado das equipas domiciliárias da
Rede Nacional de Cuidados Continuados Integrados na Região de Lisboa e Vale do
Tejo
Introdução: A longevidade fez emergir a multimorbilidade, a fragilidade e a dependência.
Os objectivos foram caracterizar estes conceitos em idosos a receber cuidados
domiciliários e verificar que associação existe entre eles.
Métodos: Estudo transversal em idosos assistidos pelas equipas de cuidados continuados,
na região de Lisboa e Vale do Tejo. Após cálculo da dimensão (228, erro 5%, 92% de
prevalência da multimorbilidade e 2 efeito de desenho) a amostragem foi feita por clusters.
A análise fez-se pelo modelo linear generalizado – GEE, com recurso à ferramenta IBM
SPSS–v24.0.
Resultados: Dos 230 idosos, distribuídos por 23 equipas, 54% eram mulheres e a média
de idades foi de 83,6 anos. A dependência grave a total ocorreu em 65,2%. A média de
condições por pessoa foi de 9,5 e do índice de Charlson de 8,5, ambos superiores no sexo
masculino. O ponto de corte de seis ou mais condições esteve associado a gravidade da
multimorbilidade.
Verificou-se associação estatisticamente significativa entre os diagnósticos, doença
cerebrovascular e DPOC e o sexo masculino e a osteoporose e o sexo feminino. À
fragilidade estiveram associadas condições como osteoartrose, doença cerebrovascular e
demência. As actividades com maior dependência foram a mobilidade e utilização de
escadas. Os determinantes de incapacidade mais frequentes foram doença
cerebrovascular, a demência e a fractura do fémur, sendo que os dois primeiros tiveram
associação estisticamente significativa a dependência. A obesidade e a hipertensão,
revelaram ter efeito protector (OR < 1) relativamente à dependência.
Discussão: A multimorbilidade definida como a coexistência de duas condições médicas é
questionável nos idosos. O ponto de corte seis ou mais condições médicas pode ser uma
medida que integra duas dimensões de multimorbilidade (magnitude e gravidade). O
processo de adoecer e depender parece ter trajectórias distintas entre sexos. O modelo
GEE permitiu identificar agregados de doenças com significado clínico. Nos idosos a
acumulação de défices pode ser mais relevante que a multimorbilidade.ABSTRACT - Multimorbidity in disabled elderly patients assisted by home-care teams of the National Network of Continued Integrated Care in the Lisbon and Tagus Valley Region Introduction: Longevity has given rise to concepts such as multimorbidity, frailty and disability. The objectives of the study were to characterise these concepts in a population of elderly patients receiving home-care, and to verify what association exists between them. Methods: A cross-sectional study in elderly patients assisted by the continuous care teams in the Lisbon and Tagus Valley region. After sample size calculation (228 patients, 5% error, assuming 92% multimorbidity prevalence, design effect of 2), sampling was done by clusters. Statistical analysis was performed through the generalised linear model - GEE, using the IBM SPSS-v24.0 tool. Results: From the 230 elderly patients, distributed among 23 teams, 54% were women, and the mean age was 83.6 years. Severe dependence to total occurred in 65.2%. The mean medical conditions per person was 9.5 and the Charlson index was 8.5, both higher in males. The cut-off six or more medical conditions was associated with the severity of multimorbidity. There was a statistically significant association between the diagnoses cerebrovascular disease and COPD and the male sex, and osteoporosis with the female gender. Frailty has been associated with conditions such as osteoarthrosis, cerebrovascular disease and dementia. The activities with greater dependence were mobility and stairs use. Disability was associated with cerebrovascular disease, dementia and fémur fracture. The two first conditions had statistically significant association with physical dependence. Obesity and hypertension conditions showed a protective effect (OR <1 ) to dependence. Discussion: Multimorbidity defined as the coexistence of two medical conditions is questionable in the elderly. The six or more medical conditions cut-off may be a measure that integrates two multimorbidity dimensions (magnitude and severity). The process of becoming ill and disabled seems to have different trajectories between the sexes. The GEE model allowed to identify diseases aggregates with clinical significance. In the elderly, deficits accumulation may be more relevant than multimorbidity.