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1
Kingsley, Elizabeth J. S. "Articulating and ameliorating elder abuse in Australia." Thesis, Curtin University, 2002. http://hdl.handle.net/20.500.11937/1753.
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The abuse of older people is a largely unrecognised and under acknowledged social problem in Australia. My major objective in undertaking the work, which is represented by the original published articles that comprise the thesis, was to make a scholarly and practical contribution toward the minimisation of 'elder abuse. This objective was achieved with the development and implementation of a series of studies that articulated and ameliorated elder abuse in Australia.The thesis provides an erudite synthesis of these studies, which fall into four themes that illustrate the nature and scope of my theoretical and professional work in elder abuse. Much of the work was guided by a conceptual framework of ways of knowing in nursing, and was underpinned by the principles and practice of community development and participatory community-based action processes.The outcomes of these studies include work with three stakeholder groups: professionals who deal with elder abuse, older people who are victims or potential victims of abuse, and those who perpetrate abuse on an older person. The work, illustrated in the four themes, includesthe articulation of elder abuse issues with West Australian aged care workersthe development of elder abuse protocols, policy guidelines and ethical principles, to guide professional practice in abuse prevention and interventionthe design and implementation of participative community programs to empower older people, and their carers, to resist being abused or abusing and to assist perpetrators stop their abusethe amelioration of abuse of nursing home residents by staff.The thesis situates my conceptual and clinical effort within the wider corpus of Australian knowledge and practice on elder abuse and contributes to addressing the social problem of elder abuse within the context of Australian aged care.
2
Loh, Poh Kooi. "Innovations in health for older people in Western Australia." University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0051.
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Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.
3
Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning /." Title page, abstract and table of contents only, 2003. http://web4.library.adelaide.edu.au/theses/09PH/09phf5971.pdf.
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Kingsley, Elizabeth J. S. "Articulating and ameliorating elder abuse in Australia." Curtin University of Technology, School of Nursing, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=13966.
Full textAbstract:
The abuse of older people is a largely unrecognised and under acknowledged social problem in Australia. My major objective in undertaking the work, which is represented by the original published articles that comprise the thesis, was to make a scholarly and practical contribution toward the minimisation of 'elder abuse. This objective was achieved with the development and implementation of a series of studies that articulated and ameliorated elder abuse in Australia.The thesis provides an erudite synthesis of these studies, which fall into four themes that illustrate the nature and scope of my theoretical and professional work in elder abuse. Much of the work was guided by a conceptual framework of ways of knowing in nursing, and was underpinned by the principles and practice of community development and participatory community-based action processes.The outcomes of these studies include work with three stakeholder groups: professionals who deal with elder abuse, older people who are victims or potential victims of abuse, and those who perpetrate abuse on an older person. The work, illustrated in the four themes, includesthe articulation of elder abuse issues with West Australian aged care workersthe development of elder abuse protocols, policy guidelines and ethical principles, to guide professional practice in abuse prevention and interventionthe design and implementation of participative community programs to empower older people, and their carers, to resist being abused or abusing and to assist perpetrators stop their abusethe amelioration of abuse of nursing home residents by staff.The thesis situates my conceptual and clinical effort within the wider corpus of Australian knowledge and practice on elder abuse and contributes to addressing the social problem of elder abuse within the context of Australian aged care.
5
Chalmers, Jane. "The oral health of older adults with dementia." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phc438.pdf.
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Bibliography: leaves 347-361. Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened.
6
Marquis, Ruth. "The meaning of quality in living service environments: An analysis of the experiences of people with disabilities, elderly people and service workers." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/976.
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The purpose of the study was to examine the experiences of both people with disabilities and elderly people and to identify their perceptions of quality as it relates to living in a service or being supported by a service to live in the community. The study was naturalistic in design and used a phenomenological approach and inductive analysis. It involved immersion in living services for a two year period, in-depth interviews with people living and working in services and participant observation. Fifty service users between the ages of twenty-one and ninety-six, and twenty-six service workers between the ages of twenty-six and fifty-four were informants in the study. The study comprised of three phases, the first phase involved repeated in-depth interviews with service users in two disability and two aged care living services to examine the experiences of people living in services and their perceptions of quality. As a result of the consistency with which relationships with key staff members emerged in the context of quality experiences, selected service workers who were named by service users were also interviewed. The findings in this phase indicated that relationships experienced by service users in their encounters with service workers were more significant in service users' evaluation of quality than tangible acts of physical and environmental care. Relational experiences of people living in services were variable. Some informants experienced consistent validation and socio-emotional support, whilst others experienced role distancing and negative communication experiences. Service workers who were interviewed as a result of being identified by service users in the context of quality, attached importance to the relational domain in the acts and behaviours of providing a service. They also attached personal meaning to their roles as service workers and shared the view that their role as service worker was underpinned by an ethos of communality. The second phase of the study involved accessing another five disability and five aged care services to collect further data to support or refute the findings from phase one. As a result a large data bank was established to confirm the consistency with which relational experiences in living services were linked to perceptions of quality by both service users and service providers. Acts and behaviours which were consistently present in the context of quality were also identified and the need for emotional support in the living context was further confirmed. The third phase of the study involved an in-depth analysis and identification of commonly experienced categories of relationships between service users and workers. Relationships were categorised into ethical and technical living service experiences and exemplars used to illustrate findings. Data analysis indicated that service experiences lie on a continuum, with mutually supportive relationships between service users and workers at one end, and physical and psychological abuse at the other. Experiences were variable in singular service contexts. This highlighted the individual nature of service relationships between service users and workers and the need to articulate human service as relationship. It also highlighted the inadequacies of using standard measures to evaluate quality in living services.
7
Campbell, Kathleen J. "People over 85 years say I'd rather go under a train than go into a nursing home." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2008. https://ro.ecu.edu.au/theses/202.
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This study uses a qualitative in-depth research design to explore the attitudes that community living people over 85 years of age (n=lO) hold towards relocating to an aged care facility. Aged care facilities are supported accommodation options for the elderly that were previously known as nursing homes or hostels (Commonwealth Department of Health and Family Services, 1997). This type of accommodation currently houses 31 % of the total population of people over 85 years of age (Australian Bureau of Statistics, 2004-2005). Attitudes towards new environments are associated with relocation adjustment, and a review of the literature reveals negative perceptions by younger elderly people towards aged care facilities. Demographic trends indicate a rapid increase in the number of very-old people who are in the high-risk group for admission to aged care facilities; however there is a paucity of research regarding their attitudes towards such relocation. There are many implications for aged care service providers as a result of these demographic trends, but particularly in relation to accommodation options for the elderly. This research examines the attitudes that the very-old hold about going into residential care. It also explores the emotions underpinning that attitude. The main areas that emerged included concerns over media representation, perceived lack of control and fear of a loss of independence. There were very negative attitudes toward the loss of the home itself followed by concerns over loss of personal possessions. The very-old have such rich histories embedded in their home and possessions that these things become a part of their identity and culture (Moore, 2000) rather that a separate entity, and therefore the loss of these possessions could ultimately lead to the loss of self. The results have proven to be generally negative toward relocation to an aged care facility and combined with an assumption by the participants that there is no opportunity for future planning once in care, some expressed they would choose death rather than relocation. The implications of allowing these negative attitudes to continue without interventions based on further research and community consultation, will only add to the relocation stress syndrome already being experienced by many of very senior members of society (Capezuti, Boltz, & Renz, 2004).
8
Ruler, Amanda Jane. "Culture of nursing homes : an ethnomethodological study /." Title page, contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09PH/09phr935.pdf.
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Stehlik, Daniela Anna. "Making the invisible visable : an analysis of the Home and Community Care Program : a socialist-feminist perspective." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1991. https://ro.ecu.edu.au/theses/1118.
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As the population of Australia ages, social policy and human service practice in the field of aged care is increasingly important and relevant. The Home and community Care (H.A.C.C.) Program was established in 1985 by the Labor Government as a response to a demand for more community services for the frail aged and was designed to reduce the incidence of institutionalisation by increasing home care services. In this way the Home and Community Care Program is seen as linchpin in the Federal Government's initiative to create an efficient and cost-effective aged care policy to contend with the future growth of Australia's ageing population. This thesis argues that there are several assumptions intrinsic to the H.AC.C. Program that are potentially jeopardising and undermining its usefulness. These assumptions are based on familial ideology and nostalgic conceptualizations of 'the community’ and 'the family'. In addition, these assumptions also involve stereotypic attitudes to women as primary carers and nurturers that ignore, to a great degree, the needs of women themselves. These assumptions, combined with an increasingly neo-conservative view about a reduction in the role of the State and a corresponding increase in family responsibility in welfare, have major implications for Australian women. This socialist-feminist analysis argues that women who are providing care for aged spouses or relatives are doing essential, hard and stressful work, work which is unpaid and often unacknowledged, and that the Australian welfare system is now structured around the invisible labour of such women. Consequentially, the assumption that a social policy program such as H.A.C.C. makes, that is, that there will always be women who care, requires further analysis. This research has revealed that such assumptions have implications for the future development of social policy for the aged in Australia and on the future roles of women in this country. Particular questions which this thesis addresses include, firstly, who actually provides care? Empirical research indicates that the majority of care is provided by one individual, usually the spouse, daughter or daughter-in law. Secondly, what are the assumptions underlying the development and implementation of Home and Community Care social policy in relation to the social construction of caring? Such assumptions are found to include, that the H.A.C.C. Program is premised upon an erroneous concept of the 'community' and consequentially 'community care' and that traditional 'family' and familial values are a precondition to H.A.C.C. service delivery. A socialist-feminist critique offers a deeper analysis of such assumptions by disclosing that the Home and Community Care policies assume that service delivery can be best undertaken by extending the traditional domestic role of women, thus utilising them as an unpaid, or poorly paid, labour force. This analysis also discloses the explicit rejection of the informal service system as having any real economic significance but rather being viewed as ‘complementary’ to the formal service system. Finally, there are future implications of such assumptions for women as primary carers, services users or paid staff within the H.A.C.C. Program which require urgent cognisance in order to develop a future aged care policy in Australia that avoids exploitation of women.
10
Trigg, Lisa. "Improving the quality of residential care for older people : a study of government approaches in England and Australia." Thesis, London School of Economics and Political Science (University of London), 2018. http://etheses.lse.ac.uk/3772/.
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Improving the quality of residential care for older people is a priority for many governments, but the relationship between government actions and high-quality provision is unclear. This qualitative research study uses the cases of England and Australia to examine and compare regulatory regimes for raising provider quality. It examines how understandings of quality in each country are linked to differences in the respective regulatory regimes; how and why these regimes have developed; how information on quality is used by each government to influence quality improvement; and how regulatory regimes influence providers to deliver quality. The study develops a new typology of three provider quality orientations (organisation-focused, consumer-directed, relationship-centred) to examine differences between the two regulatory regimes. The research draws on interviews conducted between January 2015 and April 2017 with 79 individuals from different stakeholder groups in England and Australia, and interviews with 24 individuals from five provider organisations in each country. These interviews highlighted greater differences between the two regimes than previous research suggests. For example, while each system includes a government role for inspecting or reviewing provider quality, there are differences around how quality is formally defined, the role and transparency of quality information, and how some provider quality behaviour is influenced by different policy interventions. Two important findings emerge from the study for policymakers and researchers. First, the importance of considering the broader historical and institutional context of the care sector overall, not simply the regulatory environment, as shown by the more welfare-oriented approach in England when compared to Australia’s highly consumerist approach. Second, the importance of considering the overall ‘regulatory space’ when designing policy interventions for quality. Policymakers should consider the effects and interaction of multiple policy interventions, the impact of funding mechanisms and the activity of multiple stakeholders, and not restrict attention to those policy interventions explicitly developed for quality improvement goals.
11
McNamara, Laurence James. "Just health care for aged Australians : a Roman Catholic perspective /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phm1682.pdf.
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Howrie, Paul. "How general practitioners and aged care workers perceive incidences of elder abuse." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2000. https://ro.ecu.edu.au/theses/1351.
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As the Australian population is expanding and ageing, there is an associated need for a focus to be placed on the Individual rights of elderly people, and for the general populus to be made more aware of areas related to our older generation. Elder abuse, as an area of concern, developed as an offshoot of investigations into child abuse and general domestic violence, and initially surfaced in the 1970s and 80s. Some sections of the medical profession were made specifically aware of the problem initially in 1975, through a letter that was sent to the British Medical Journal. However, throughout some of the literature, GPs have been criticised about their level of awareness of the issue of elder abuse, and for their lack of involvement in this area. The purpose of this study was to explore how General Practitioners and Aged Care workers perceive incidences of elder abuse. Due to the limited amount of research which has been undertaken on elder abuse within Australia, the study looked at exploring the issue rather than trying to measure its cause, or trying to identify the extent of the problem. The study investigated the perceptions of general practitioners (GPs) toward the area of elder abuse, and looked further to explore how general practitioners were perceived by aged care workers. The approach used for data collection consisted of circulating 100 mailed out questionnaires to general practitioners within metropolitan Perth, and follow up face-to-face interviews with some of the respondents to this questionnaire. Additionally, face-to-face interviews were also held with key informants who worked in the aged care industry, to ascertain their perceptions of elder abuse. The mailed questionnaires were analysed by adding the frequencies of responses given to each question. The data from the face-to-face doctor interviews and the key informant interviews were transcribed verbatim from the tape recordings and then assessed by looking for consistent regularities from each response made, therefore using a cross-case analysis. From this analysis, patterns emerged in the data, from which themes were developed. The recommendations from the data suggest that a clear and concise definition of elder abuse needs to be developed, to assist in clearly Identifying the prevalence of the problem. The data further recommended the need for an awareness campaign on the area of elder abuse to be undertaken. This should focus on raising the awareness of the possible characteristics of individuals who are vulnerable to being abused, as well as the characteristics of likely perpetrators of abuse. This study also recommended that a coordinated approach to dealing with the area of elder abuse should be developed, which should include the development of specific roles that should be undertaken by professional and non-professionals. Training of people across the Human Services field in the area of elder abuse, and in particular, GPs, social workers and paraprofessionals who work with elderly people, was identified as a recommendation of the study. Areas of training should include: awareness of the problem's existence; providing people with the required skills to detect cases of abuse; providing insight to referral agencies who may be able to assist; having a clear and exhaustive list of interventions to use to assist with addressing the problem; and having knowledge of the characteristics that abused individuals, and perpetrators are likely to have. This study also Identified that more research is required to ascertain if the amount of time which GPs spend with elderly people, is sufficient for them to identify cases of elder abuse, and if the allocated time from Medicare is adequate for GPs to Identify elder abuse.
13
Hill, Heather, and heatherhill@hotkey net au. "TALKING THE TALK BUT NOT WALKING THE WALK: BARRIERS TO PERSON CENTRED CARE IN DEMENTIA." La Trobe University. School of Public Health, 2004. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20041215.100826.
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While the concept of person-centred care in dementia has been around for 15 years or more and has attracted much interest and enthusiasm, aged care facilities continue to have difficulty in actually implementing and maintaining person-centred practices. In this study I explore the experience of one aged care facility in order to identify the barriers to changing care practice. The research took place in an ethno-specific (Jewish) aged care facility, Star of David, which was in the process of setting up a program for its residents with dementia based on person-centred principles. The methodology used in the research study was ethnographic, involving participant observation and interview, with a particular focus on a limited number of participants: four residents and their families, four senior staff, four personal care attendants and the executive director. Interviews were also conducted with staff members from three other aged care facilities. The findings showed that Star of David was unable to bring about substantial change in its care practices, while the external interviews and the literature suggest that other facilities have similar difficulties. I identify three major types of barrier: procedural barriers within the institution itself; (government) policy; and barriers relating to hegemonic values and beliefs which underpin established health care practice. These three types of barrier interact with and reinforce one another. I conclude that if we are to change care practice in institutions, we must address all of these barriers at the same time. Finally, I suggest that person-centred care itself, which continues to place emphasis on professional service provision, may only be the beginning of necessary change. In order to be truly person-centred, we need to move towards a more community based or public health approach which recognizes the need of all persons to be treated both as significant individuals and accepted as part of a community.
14
Buckley, Patricia Louise, and pbuckley@swin edu au. "'A sense of place' : the role of the building in the organisation culture of nursing homes." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20060317.114711.
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This study attempted to identifj and explore the role the building plays in the
organisation culture of nursing homes. To do this a research plan was formulated in
which the central plank was a case-study of a seventy-five bed high care nursing home.
As part of the case-study, interviews were conducted at the nursing home with ten
members of staff, two residents and a daughter of a resident. The study was also
informed by interviews with two architects, who specialise in the design of nursing
homes and aged care facilities. A theoretical model entitled the 'Conceptual
Framework' was developed prior to the case-study. It was tested by applying it to
findings related to the physical context and the organisation culture of the case-study
venue. The hypothesis that the building does influence the culture of the nursing home
environment was explored by studying the manner in which the building influenced the
lives of those who work in the nursing home and those who live there. This challenge
was met with the use of theoretical contributions from organisation theory and psychodynamics,
which together provided a vehicle for analysis of the culture and the
building's role in it.
15
Summers, Michael. "Great expectations : a policy case study of four case management programs in one organisation /." Connect to thesis, 2007. http://repository.unimelb.edu.au/10187/2182.
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Four different case management programs delivered by UnitingCare Community Options (UCCO) in the eastern suburbs of Melbourne were examined against the expectations of case management as a policy solution to a range of perceived policy problems at the micro-, meso- and macro-levels. The micro-level expectations were related to client and family experiences of the service system and outcomes. At the meso-level expectations were focused on perceived service delivery problems such as poor matching of services to the needs of ‘complex’ clients including a lack of integration, flexibility and responsiveness to clients’ needs and preferences. Perceived macro-level policy problems were concerned with a variety of issues including increasing rates of institutionalisation, increasing costs to governments, lack of economic efficiency and the desire to create market or quasi-market conditions in the community care service delivery sector. (For complete abstract open document)
16
Barrett, Thomas. "Elder Abuse : Agencies' Experiences and Seniors' Relationships." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/234.
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This study examines elder abuse in an Australian context and comprises two parts: agencies' experiences with elder abuse; and seniors and their relationships. The first part sought baseline data on elder abuse as recorded by a range of agencies in New South Wales (NSW) and Western Australia (WA). A mailed questionnaire was sent to a random sample of 400 agencies per State, seeking information for the 1994 calendar year regarding abused elders 65 years of age or older, and resulted in an overall return rate of 57.62%. Data was analysed using SPSS for Windows.
The second part of the study was qualitative, exploratory and phenomenological in nature. The objectives were: to increase the knowledge and understanding of elder abuse within an Australian context by examining the experiences and feelings of care givers and care recipients in the transition from independence to dependence for one partner; to identify factors contributing to the abuse of elderly persons in private accommodation; to determine the relevance of a disability-related dependency to the likely occurrence of elder abuse; and to explore the applicability of a range of theories, in particular social exchange theory and the situational model, to caring situations.
A purposive, nonrandom sample of nine cases was drawn totalling 12 persons who were interviewed using a semi-structured questionnaire. Four general research questions examined the characteristics of the participants prior to the onset of caring; explored the impact of the change from the pre-caring stage to the caring stage on the respondents; assessed caring demands on the care giver; and sought to determine the impact of continuous care provision on the care giver/care recipient relationship. Seven ancillary research questions addressed more specific aspects of the care giver/care recipient relationship. Qualitative data analysis utilised NUD.IST.
The major findings from part 1 of the study revealed 92 (44%) agencies in NSW and 66 (26.2%) in WA had seen cases of elder abuse in 1994. In both States, female elder abuse victims as care recipients, were represented three times more often over a greater range of victims per agency than male counterparts. Psychological, physical, material/financial and sexual forms of abuse, plus neglect, were represented in both States' findings. Psychological abuse was most frequent in NSW, and in WA, neglect. Sexual abuse was reported with least frequency in both States. In each State, victims were represented in a ratio of approximately 1:6 (care giver to care recipients). For care givers, the most common forms of abuse received were physical, psychological and material/financial.
No reliable Australian data exists on the incidence and prevalence of elder abuse. These research findings indicated its presence and found similarities with findings in the USA, Canada and the UK for perpetrators and abuse types. Perpetrators of elder abuse included: spouses; sons; sons-in-law; de facto partners; daughters; and daughters-in-law. Spouses were cited most often as perpetrators in both States followed by sons and daughters in NSW and daughters-in-law and sons in WA.
Direct agency services for victims were found wanting. Where available, they provided information; counselling; mediation; and referral.
Mandatory reporting of elder abuse was supported in both NSW ( 4 7 .1 % ) and WA (44.8%). One-third of the agencies in both States were undecided on the issue and the remainder were opposed. However, many agencies ignored the question, leaving the results inconclusive.
The major findings from part 2 of the study revealed eight of nine care givers interviewed to have been in long-term marriages and of having satisfying relationships prior to the onset of the partner's disability. Trauma, loss and grief experiences prior to their partner's disability, for some, exacerbated the demands of caring in later years.
The onset of the disability-related dependency whether sudden, or gradual, determined how the care giver coped initially. Regardless of the type of disability, common feelings expressed by care givers included: social isolation; change or loss in communication; a sense of coping alone; lack of external supports; feeling trapped; a loss of intimacy with the partner; stress, both structural and situational; having health problems related to carer stress; physical and mental exhaustion; anger; disappointment; frustration; general loss and grief; resentment; sadness; anxiety; and the monotony of the caring role. Environmental factors were rarely mentioned as being stressful. There appeared to be a connection between care giver stress and elder abuse in eight of the nine cases studied, notably psychological abuse. Physical abuse was indirect, and only one possible instance of neglect was noted. Sexual and material/financial abuse were not represented in the sample of case studies.
Theories associated with elder abuse explored in the study included: stress theory; crisis theory; learned violence; issues of dependency; mental impairment; loss and grief; societal ageism and sexism. The findings lend only partial support to the situational model as a possible explanation for elder abuse. This study identified as situational factors: physical dependency; poor health; impaired mental status; difficult personalities in the care recipients; and corresponding care giver health problems. Only one structural factor was identified, namely social isolation. The concepts associated with social exchange theory - including power advantage/disadvantage, positive sentiments, rewards and punishments, instrumental services and personal resources - were evident across the nine cases. However, without the application of additional variables, it could not be concluded that social exchange theory, on its own, adequately explained elder abuse. No one theory emerged as offering a satisfactory explanation for the causes of elder abuse, suggesting that its complex and diverse nature defies a single causal theory.
17
Rahman, Naila. "Conflict, stress and coping in caring for the elderly at home : proposal for intervention." Phd thesis, 1994. http://hdl.handle.net/1885/127877.
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This thesis explores the experiences of caregivers caring for an elderly
relative at home using qualitative and quantitative methodologies of data
collection. Emphasis is particularly placed on conflict. In-depth interviews were
conducted to explore the caring experiences of 30 female caregivers, while
quantitative methods were employed on 151 caregivers both males and
females to identify the predictors of interpersonal conflict and also to test the
proposed conceptual model . To get detailed information of the caring situation
two new measures were developed : one was a new instrument to quantify
interpersonal conflict; the other was the ' Vignette' methodology, which tapped
information about the caregivers' sensitivity to conflict and coping with conflict.
All caregivers reported experiencing conflict 'in their relationship with the
elderly person. Caregiving burden , coping strategy, the caregiver's attitude
towards caring, the dependency of the elderly person in activities of daily
living, predicted most of the conflict. The quantitative data also indicated a
two-way interaction between coping strategies and conflict. Conflict was found
to divide the caregivers into two groups: adopting adaptive coping and
maladaptive coping. Maladaptive coping discriminated between those
experiencing high conflict and those experiencing low conflict. Ineffective
coping thus led to conflict while high confl ict led to ineffective coping. The
study concluded with some interventions proposed to reduce the conflict in
elder-caregiver relationships.
18
Crisp, Dimity Ann. "Transitions in later life : the impact of residential relocation on well-being." Phd thesis, 2012. http://hdl.handle.net/1885/150914.
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In the face of normative age-related declines in health and mobility, increasing numbers of older adults are considering self-care accommodation within the context of a retirement community as a mechanism to maintain independence. Whilst the benefits of down-sizing in older age are well established, relocation to a retirement community offers the additional provision of a) facilities to cater for current and anticipated future healthcare needs; b) general household maintenance and/or cleaning services; c) the security of an enclosed complex that increases older adults' sense of physical safety; and d) a close and supportive community network that reduces social isolation. The present study employed a prospective longitudinal design to examine the adaptation of 83 older Australians (aged 57 to 90 years) to independent living units within a retirement village over a 12 month period. A number of health, subjective well-being, and social network outcomes are examined. Comparisons are made with a sample of community-dwelling older adults of the same age. A promising indicator of the decision to relocate as a positive life change, results indicate that 12-months post-relocation, those who relocated to the village rated the environment as more positive than their pre-move residence. A reduction in perceived loneliness and an increase in neighbour social networks were then found to be the most significant benefits to relocation. Characteristics of those older adults likely to adapt best to living in a retirement village were dependent largely on the outcome in question. Contextual factors associated with the move, physical health, personality characteristics, and perceived control each contributed to adjustment.This investigation of the impact of relocationtoa retirement village on the social networks and well-being of older adults provides an important contribution to our understanding of the needs and experiences of our ageing community. Both government policy and aged care providers should benefit from monitoring and continued improvement of housing options for older adults. Through indentifying the needs and experiences of our older population, along with the factors characterizing successful transition, we can strive to ensure that relocation performed either out of preference or necessity is a positive experience and a step toward continued healthy ageing.
19
Fleming, Brian James. "The social gradient in health : trends in C20th ideas, Australian Health Policy 1970-1998, and a health equity policy evaluation of Australian aged care planning / Brian James Fleming." Thesis, 2003. http://hdl.handle.net/2440/22062.
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Denson, Linley Alice. "Values and long-term care decision-making for frail elderly people." 2006. http://hdl.handle.net/2440/37794.
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This project explored the values considered by elderly people, their younger relatives, and health professionals in decisions about residential long - term care, aiming to contribute to the literature on prospectively held values. The mixed methods design utilised a medical record review of 60 frail elderly hospital patients, a stratified survey of 3,015 adults in the South Australian community, and interviews with 36 stakeholders ( 10 elderly people, 10 younger relatives, and 18 health professionals ). The medical record review confirmed that the hospital patients and their outcomes resembled those described internationally. It was used to develop a hypothetical vignette, used in the later studies. Survey responses suggested that when considering a hypothetical long - term care decision, community members put the elderly person ' s physical health and safety first. Situational variables ( the elderly person ' s autonomy, environmental adaptation, and caregiver burden ) appeared secondary, albeit less so with increasing age of the respondent. Thematic analysis of the interviews demonstrated that elderly stakeholders considering a hypothetical decision were more likely to mention autonomy values, and less likely to mention safety values, than were relatives or health professionals. However, elderly stakeholders were also more likely to suggest restrictive solutions, such as residential placement and proxy decision - making. This finding raised methodological issues concerning ' third person ' vignettes, in that respondents might be responding as proxy decision - makers, rather than as if the hypothetical decision applied to themselves. The project confirmed that, in this context, prospectively held values resembled the retrospectively described values identified by McCullough, Wilson, Teasdale, Kolpakchi and Shelly ( 1993 ). Hence, the retrospective literature could be applied. The project supported the importance and complexity of psychosocial predisposing factors when applying the Andersen Behavioral Model ( Andersen, 1995 ) to long - term care decisions. Additionally, the Ecological Theory of Aging ( Nahemow, 2000 ) and the MacArthur Model of Successful Aging ( Andrews, Clark, & Luszcz, 2002 ) were found to be relevant to long - term care decisions for individuals and populations. It was concluded that both clinically, and at a policy level, discussions of long - term care could be more effective if they focussed on maintenance of elderly people ' s autonomy and control, rather than on their physical health and safety.Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006.
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Chan, Natalie. "Disability, informal and formal support, and psychological health in later life : a cross-sectional and longitudinal examination." Phd thesis, 2010. http://hdl.handle.net/1885/150372.
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This thesis examines the relationships between disability, informal and formal instrumental support, and psychological health in later life. Specifically, it addresses three questions cross-sectionally and longitudinally: (a) what factors are associated with the type of support received (no support, informal support only, formal support only or both informal and formal support), with a focus on the determinants of formal support in isolation? (b) does the type of support received (informal and/or formal support) differentially buffer the harmful association between disability and psychological health? and (c) do the stress-buffering effects of enacted support strengthen in later life with advancing age? To address these three research questions, data are drawn from the Australian Longitudinal Study of Ageing. The sample comprises 1961 community{u00AC}dwelling individuals aged 65 years or over at Wave 1; 1518 at Wave 3 and 666 at Wave 6. Results from the first research question show that only a small proportion of older adults rely solely on formal support in isolation over time. Further, results indicate that increases in functional limitations over time are associated with higher odds of transitioning from receiving formal support only to receiving both informal and formal support, compared with remaining a formal-only recipient. Overall, the results suggest that assistance received from formal sources only may not be sufficient to meet extensive health needs. Findings are both consistent with the theory of complementarity and suggest that it may need to be refined to encompass the proposition that informal support may be drawn upon to supplement existing formal support as physical health needs increase. In relation to the second research question, results show that receiving (a) informal support only and (b) both informal and formal support are associated with weaker relationships between functional limitations and depressive symptoms and life satisfaction relative to the receipt of no support. There is also a trend that suggests receiving formal support only provides a buffering effect against disability for life satisfaction but not depressive symptoms. However, a closer examination of the results reveal that this moderating effect is driven by an adverse association between receipt of formal support in isolation and life satisfaction for individuals with minimal functional limitations, rather than a protective effect. These findings highlight the importance of informal instrumental support in later life and suggest that the receipt of formal support in isolation may not be sufficient to meet an individual's physical health needs. Results from these analyses also show that receiving instrumental support for individuals with no or minimal functional limitations are generally associated with poorer psychological health. This unexpected finding emphasises the complex interrelationships between disability, instrumental support and psychological health and cautions us against assuming that support is always beneficial. In regards to the third research question, longitudinal results lend support to the stress-buffer age-variation hypothesis, which posits that the protective influence of enacted support strengthens with advancing age in later life. This finding highlights the importance of social relationships in later life and has important implications for service provision. Specifically, the results are consistent with socioemotional selectivity theory and suggest that informal aspects of the provider-receiver relationship such as continuity of care may be particularly beneficial for older adults.
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Crawford, Gregory Brian. "Depression in palliative care patients in Australia identification and assessment /." 2007. http://catalogue.flinders.edu.au/local/adt/public/adt-SFU20090127.133003/index.html.
Full textAbstract:
Thesis (MD (Doctor of Medicine))--Flinders University, School of Medicine, Dept. of Palliative and Supportive Care.Typescript bound. Includes bibliographical references: (leaves 147-177) Also available online.
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Geoghegan, John, University of Western Sydney, College of Health and Science, and School of Nursing. "What do RNs working in hospital aged care units identify as the positive and negative aspects of aged care nursing?" 2006. http://handle.uws.edu.au:8081/1959.7/19352.
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This study reports the positive and negative aspects identified by registered nurses (RNs) working with older people in public hospital aged care units and was conducted in 4 public hospitals in Sydney, Australia. Qualitative data using questionnaires and telephone interviews was collected from 26 female and 4 male RNs of which 46% (n 14) had worked in an aged care unit for 10 years or more. The participants identified positive perceptions within three major themes: a genuine liking of older people; the stories older people tell and the complexity of the older patient’s illnesses. Positive responses were a focus as it was identified that this was a gap in the literature which required addressing at the time. These findings are significant and have implications for nursing practice for several reasons: Data was collected exclusively from RNs and focused on their positive perceptions about aged care nursing in public hospitals. Participants reported a genuine liking for older people. Patients’ telling their stories was reported by 60% (n 18) of participants as being interesting in their work and meaningful to the patient and should be considered more as a therapeutic process during hospitalisation to assist support and enhance patient outcomes and therapy. The participants reported that aged care nursing is complex, rewarding and requires mature nurses, with current nursing knowledge and skilled in the art of caring for older people. These findings can be used to improve recruitment and retention of RNs within aged care nursing.Master of Health Science (M.Sc.(Hons) Health)
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Kilstoff, Kathleen, University of Western Sydney, College of Health and Science, and School of Nursing. "The nursing management of acutely ill older adults in hospital." 2006. http://handle.uws.edu.au:8081/1959.7/16573.
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The health care requirements of older people admitted to acute hospitals and their need for nursing care have been identified in current literature as problematic. Hospital organisations which are medically oriented and more focused on implementing programs directed by economics, efficiency and effectiveness may be unsupportive of nursing practices based on a professional value system. There is a need, therefore, to examine how health care structures that tend to promote cost containment and a technical imperative, impact on the professional capability of nurses to provide the standard of care required by acutely ill older hospitalised patients. The collected data, analysed thematically, indicates that the nurses were knowledgeable and potentially competent in providing the standard of technical and functional care required by older adults in hospital. However, although nurses articulated that they wanted to provide the quality of care needed by acutely ill older patients, they nevertheless admitted they were optionalising this care because of constraints in the health care system.While the nurses’ constructions revealed they believed technical tasks took up most of their time during shifts, it is evident during the observations that this was not the case. Through the use of Giddens’s (1984) Structuration Theory, a very different picture began to unfold about the incongruence about was said, and what was actually done. The significance of this study is that the incongruence found between the nurses’ knowledge and their actions has been revealed.Doctor of Philosophy (PhD)
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Phillips, Jane, University of Western Sydney, College of Health and Science, and School of Nursing. "Navigating a palliative approach in residential aged care using a population based focus." 2008. http://handle.uws.edu.au:8081/1959.7/33324.
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Changes in demographic patterns and the burden of chronic illness have challenged palliative care clinicians to engage populations other than those with malignant disease. This new paradigm has promoted the development of a population based approach to service delivery which aims to extend the reach of palliative care to hard to reach populations, including older people in residential aged care. In Australia, the high levels of disability and death experienced by older people in this care setting has resulted in policy promoting the delivery of a palliative approach to care. Achieving health care reform in this complex health care environment has traditionally been difficult to realise due to a range of workforce, training, funding, variable organizational philosophies and legal factors. The “Residential - Palliative Approach Competency” (R-PAC) Project aimed to collaboratively develop, implement and evaluate a sustainable model of care to facilitate the delivery of a palliative approach to care for older people admitted to residential aged care facilities, in regional Australian. Action research, with a focus on improving care and involving participants, was used to promote the delivery of a palliative approach in residential aged care facilities. The R-PAC Project was designed to follow the action research sequence of reflection, assessment, planning, action and observation. Nested within the action research method are eight distinct but interrelated studies in a mixed method design. Study A, a focused needs assessment undertaken as part of the preliminary investigations, confirms that older people in aged care have unmet palliative care needs. The three studies conducted during Phase One provide a greater understanding of delivering palliative care in the residential aged care setting. Study B, a chart audit identified the strengths and gaps in end-of-life care provision in the local aged care setting. While, Study C identified that aged care nurses and care assistants are committed and compassionate about delivering palliative care but desired greater palliative care competencies. The palliative care attitudes, values and learning needs of aged care providers were explored in greater depth in Study D. The data from these investigations guided the development and implementation of a multifaceted intervention during Phase Two. Following the implementation of the multi-faceted intervention and during Phase Three another series of investigations was undertaken to measure the impact of the collaborative intervention. Focus groups were used to determine the perceptions of aged care providers toward the multi-faceted intervention (Study E) and to seek the views of general practitioners (Study F). These data revealed that aged care nurses and general practitioners wanted to establish a more collaborative approach to care planning and delivery. The survey (Study G) and chart audits (Study H) were repeated in Phase Four in order to measure the impact of the action. The findings of the survey of aged care nurses and care assistants shown an increase in palliative care competencies, while the chart audit demonstrated positive trends in improving end-of-life care. Although, some aspects of care, particularly advance care planning and routine use of pain assessment tools required ongoing attention. This data propel the R-PAC Project into Phase Five and the development of a model of care to promote the delivery of a palliative approach, which was informed by the research findings. The R-PAC Project use of the action research method has facilitated a cascade of engagement and participation of all residential aged care facilities in this regional community and enabled practice innovation. The project has seen the sharing of valuable insights into usual practice and collaboratively engaging aged care nurses, care assistants and general practitioners in developing practical solutions to end-of-life care. This process has allowed for the acknowledgement and validation of the role of aged care providers, fostered personal empowerment and identified the importance of collaboration. This research has provided greater insight into the palliative care needs of people in residential aged care and collaboratively developed an intervention to improve the outcomes of older people. Study findings have also identified important issues requiring ongoing evaluation, particularly multidisciplinary team meetings and care planning.Doctor of philosophy (PhD)
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Chalmers, Jane. "The oral health of older adults with dementia / Jane Chalmers." Thesis, 2001. http://hdl.handle.net/2440/21695.
Full textAbstract:
Bibliography: leaves 347-361.403 leaves ; 30 cm.
Presents results of 2 longitudinal studies investigating the oral health of older adults with dementia, using questionnaires and clinical inspections at baseline and one year. Groups studied were nursing home residents and those living in the community, with moderate to severe dementia or no dementia diagnosis. Caries experience was related to dementias severity and not to specific dementia diagnoses. Coronal and root caries experience was higher in dementia participants with moderate-severe dementia, the socio-economically disadvantaged, more functionally dependent, taking neuroleptic medications with high anticholinergic adverse effects, with eating and swallowing problems, were not attending the dentist, who needed assistance and were behaviourally difficult during oral hygiene care and whose carers were burdened.
Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 2001
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Tinney, Dorothy Jean. "Still me: being old and in care: the role of social and communicative interactions in maintaining sense of self and well-being in residents in aged care." 2006. http://repository.unimelb.edu.au/10187/3646.
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This ethnographic nursing home study explores the meaning which residents make of being old and in care. Its primary focus is on the role of social and communicative interactions in maintaining residents’ sense of self. Throughout the thesis I argue that the self is socially constructed, narratively communicated and is continuous throughout the life span. This narrative, relational self is diminished in old age by bereavement and the loss of social networks, and threatened by the loneliness and isolation of the institutional environment. Nonetheless, despite the stripping of relational layers entailed in the loss of the people with whom the younger self was constructed, there is a continuing core of self which, while bending, does not break. I argue that the nursing home can be a site of recovery for this vulnerable, diminished self, offering support and the opportunity to take on new roles and form new relationships, and through these relationships, new layers of self.Staff are key players in the healing process, and staff-resident relationships important new sources of meaning for the relational self. The ageing, marginalised self is strengthened through empathetic communication which recognises the individual person and the importance of that individual’s life, acknowledges residents’ adult status, and enhances self-esteem by enhancing personal control. For residents, telling their stories and remembering their past lives provides a means of making sense of where and who they are in the present, and of envisaging a future. Consequently, it is vital that residents have opportunities to speak and be heard, and to be recognised and spoken to. These opportunities are sometimes adequately provided by families, friends, church and other visitors and volunteers, but frequently they are not. Staff then become the main source of resident support.
The capacity of individual staff to meet residents’ communication needs is dependent on many factors including the legislative framework and funding of the aged care system, the philosophy of the individual provider organisation (translated into work routines, staffing practices, and the training, mentoring and support available to staff) and the individual personalities and communication skills of staff themselves. Continuity of staffing is a vital factor, with “Know your resident” identified by staff in this study as the most important element in understanding and recognising the needs of residents withcognitive and communicative impairment, and in building relationships which support residents and enhance their autonomy.
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McNamara, Laurence James. "Just health care for aged Australians : a Roman Catholic perspective / Laurence James McNamara." Thesis, 1997. http://hdl.handle.net/2440/19142.
Full textAbstract:
Bibliography: p. 493-562.iv, 562 p. ; 30 cm.
Provides a philosophical and theological analysis of health care for aged persons, exploring the ways in which Roman Catholic moral theory might contribute to the development of just health care for aged Australians.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1998?
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Ruler, Amanda Jane. "Culture of nursing homes : an ethnomethodological study / Amanda Jane Ruler." Thesis, 2000. http://hdl.handle.net/2440/19726.
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Bibliography: leaves 309-334.Examines the culture of two nursing homes using an ethnographic method which is underpinned by ethnomethodology as a philosophical approach. The study shows how older and disabled people are seen to deviate from social norms and how society responds to their situation. Future directions for aged care are suggested, and include evidence based practice, primary nursing and the evolution of a nurse practitioner focussed model of care, with adequate support for nurses.
Thesis (Ph.D.) -- University of Adelaide, Dept. of Clinical Nursing, 2000
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Wilson, Leah Ruth. "Resident and resident-related committees and meetings in South Australian aged care hostels / Leah Ruth Wilson." 2003. http://hdl.handle.net/2440/21959.
Full textAbstract:
"February 20, 2003"Includes bibliographical references (leaves 586-603)
xvii, 603 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Investigates the level of resident participation in decision-making in aged care hostels in South Australia.
Thesis (Ph.D.)--University of Adelaide, Dept. of Psychology, 2003
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Smart, Sharon. "Towards the health promoting retirement village : a case study." Thesis, 2003. https://vuir.vu.edu.au/15306/.
Full textAbstract:
The aged care industry along with the public health movement has undergone profound change, yet aged care is a growing concern with an ageing population. Within the Australian context, there remains the need for further research and education especially with regard to the retirement village setting that offers a variety of services including a continuum of care from independent living through to aged care facility living (hostel and nursing home). Through an exploration of the health promoting settings approach that has been applied to schools, hospitals, workplaces and so on, it can be demonstrated that a retirement village can also move beyond institutional care to one that is a health promoting retirement village.