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Dissertations / Theses on the topic 'Older people Diseases Prevention'

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Published: 4 June 2021
Last updated: 29 January 2023

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1

Chiu, Man-yin, and 趙敏延. "Clinical guideline for preventing aspiration pneumonia among oral-fed older adults in hospitals." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46581510.

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2

MacIntosh, Caroline Gabrielle. "Investigation of the 'anorexia of ageing'." Title page, contents and summary only, 2000. http://web4.library.adelaide.edu.au/theses/09PH/09phm15187.pdf.

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Includes bibliographical references (leaves 349-421) Addresses some of the mechanisms which may potentially contribute to the physiological anorexia of ageing, as suggested by previous animal and human studies.
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3

Lau, Ming-ming Christine, and 劉明明. "The impact of SARS on elderly people in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31972950.

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4

Conroy, Simon. "Preventing falls in older people." Thesis, University of Nottingham, 2009. http://eprints.nottingham.ac.uk/11058/.

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Falls are a major cause of injury fear of falling and death affecting 24% of older people annually. Falls have a major impact on hospital services, are an important cause of carer strain and admission to long term care. Multifactorial interventions delivered to fallers are effective in reducing falls rates by 25%. However, no UK studies have evaluated the role of screening older people living in the community and offering those at high risk a falls prevention programme. This work describes two studies – the evaluation of a postal falls risk screening tool, and a randomised controlled trial assessing the benefits of offering a falls prevention programme to those identified as being at high risk. 335 older people were recruited into the screening study, using a modified version of the Falls Risk Assessment Tool. The sensitivity was 79%, specificity 58%, positive predictive value 50% and the negative predictive value 83%. In the RCT, 364 community-dwelling older people at high risk of falls were randomised into a pragmatic, multicentre trial evaluating falls prevention programmes. 181 were allocated to the control group and 183 to the intervention. The primary outcome was the rate of falls; the adjusted IRR was 0.73 (0.51-1.03), p=0.071. There were no significant differences between the groups in terms of the proportion of fallers, recurrent fallers, medically verified falls, injurious falls, time to first fall or time to second fall. Nor were there significant differences in terms of institutionalisation, mortality, basic or extended activities of daily living, or fear of falling. Further work on testing falls prevention interventions for acceptability is required, followed by a further adequately powered RCT to determine the clinical effectiveness of a systematic screening programme and intervention. At present, there is insufficient evidence for health care commissioners to recommend screening and intervention for falls.
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5

Ruf, Mary Kay. "Continuing education for nurse's aides." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2634.

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The purpose of this project was to develop an instructional manual on in-service education for Certified Nurses' Aides. It provides examples of classes for staff developers to use when teaching continuing education classes. Topics covered include caring for the elderly, Alzheimer's disease, infection control, adult cardiopulmonary resuscitation, and end of life care.
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6

Tan, Haiping. "Prevention and arrest of root surface caries in Chinese elders living in residential homes." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B37196297.

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7

Balló, Peña Elisabet. "Validesa del Sistema d’Informació pel Desenvolupament de la Investigació a Atenció Primària en l'estudi de malalties vasculars i estudi de l'efectivitat de les estatines en la reducció de mortalitat i malalties vasculars en la població major de 74 anys." Doctoral thesis, Universitat de Girona, 2020. http://hdl.handle.net/10803/670063.

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Electronic Health Record are legal documents where all the bio-psycho-social information of care received by the healthcare system is recorded throughout their lives. The first causes of death in Spain are cardiovascular diseases. The main risk factors associated with these diseases are hypertension, diabetes mellitus, dyslipidemia, smoking and obesity, .These pathologies are more prevalent in elderly population (> 74 years). The results obtained demonstrate that EHR is a good quality tool to be used in research, and that statins used as primary prevention in people over 74 are useful, as they reduce the appearance of cardiovascular disease and all-cause mortality, but only in those patients with type 2 diabetes mellitus and between 75 and 85 years of age. Statin use in people over the age of 74 does not show an apparent increase in adverse effects
La Història Clínica Electrònica és el document legal on es registra tota la informació bio-psico-social dels pacients atesos al sistema sanitari. La primera causa de mort a Espanya són les malalties cardiovasculars; els factors de risc associat són: hipertensió, diabetis mellitus, dislipèmia, tabaquisme, obesitat. Patologies amb elevada prevalença en població >74 anys. Una població on no existeixen estudis en prevenció primària amb presència d’un o més factors de risc per evitar la morbimortalitat de malalties cardiovasculars. Els resultats obtinguts són: la Història clínica electrònica és una eina de qualitat per ser utilitzada en recerca. Les estatines utilitzades en prevenció primària en majors de 74 anys són útils per la reducció d’aparició de malalties cardiovasculars i la mortalitat per totes les causes en pacients diabètics tipus 2 d’entre 75 i 85 anys. I que l’ús de les estatines en majors de 74 anys no presenta un augment aparent d’efectes adversos
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8

L'Italien, Matthew R. "Longitudinal Nutrition Risk Assessment of the Elderly." Fogler Library, University of Maine, 2004. http://www.library.umaine.edu/theses/pdf/LItalienMR2004.pdf.

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9

陸凱縈 and Hoi-ying Victoria Luk. "How does population aging affect disease control among old age from a public health perspective." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42997495.

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10

Chan, Kwai-foon May. "Translating the evidence of fall prevention into practice for Hong Kong residential care homes with a multifactorial approach." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720226.

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11

Huang, Tzu-ting. "Fall-prevention in Taiwanese elderly adults /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.

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12

陳葵歡 and Kwai-foon May Chan. "Translating the evidence of fall prevention into practice for Hong Kong residential care homes with a multifactorial approach." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720226.

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13

Choy, Choi-lin. "The impact of family relations on caregiving effectiveness peceived by the adult-child as primary caregiver to the elderly suffering from chronic obstructive airway diseases (COAD) /." Hong Kong : University of Hong Kong, 1994. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13991152.

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14

Lao, Xiangqian. "Inflammation, metabolic syndrome and vascular diseases in older Chinese the Guangzhou biobank cohort study /." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40687685.

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15

Law, Man-wai, and 羅敏慧. "Evidence-based guidelines of fall prevention programme for hospitalized older patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193074.

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Background: Falls are one of the most common and serious problems facing the elderly and are known to be associated with significant mortality, morbidity, decreased functioning and premature institutionalization. In Hong Kong, the prevalence of falls among community-dwelling older adults is 19.3%. Moreover, the incidence of falls among older people in institutions is almost three times the fall rates for the community-dwelling elderly. Institutional falls are regarded as common adverse events in hospitalized older patients. Significant mortality, morbidity and healthcare costs associated with institutional falls led institutions to recognize falls as a high-priority safety risk for hospitalized patients. This demonstrated the significance of providing the health care providers with an evidenced-based practice guideline of an effective multifactorial fall prevention programme in order to prevent in-patient falls. Objectives: The objectives of the study are to systematically review and present the best evidence for the effectiveness of multifactorial fall prevention interventions in reducing falls in hospitals, to translate the reviewed evidence and to develop evidence-based practice guidelines for the multifactorial fall prevention programme as well as to develop a plan for implementing and evaluating the multifactorial fall prevention programme. Methods: The relevant literature was searched by several electronic databases. The related literature was then retrieved, reviewed and synthesized. The quality assessment of the studies was performed according to the methodological checklist for controlled trials designed by the Scottish intercollegiate Guideline Network (SIGN). Evidenced-based practice guidelines for the multifactorial fall prevention programme were then synthesized according to the findings of the reviewed literature, while the implementation potential being assessed in terms of transferability, feasibility and the cost-benefit ratio. Results: Five studies were identified according to the inclusion and exclusion criteria set. “Evidence-based guidelines of fall prevention programme for hospitalized older patients” were formulated based on the review of the selected studies. Fourteen recommendations of the evidence-based guidelines are formulated and graded according to the grading system of Scottish Intercollegiate Guidelines Network (SIGN). The evidence-based recommendations can offer nurses and other health care professionals the standards and strategies required for implementing multifactorial fall risk assessment and multifactorial fall prevention interventions, including environmental modifications, knowledge, medication reviews and exercise. A communication plan for various parties in hospitals including a pilot test for determining the feasibility of the innovation and an evaluation plan to determine the effectiveness of the fall prevention programme were subsequently developed. Conclusion: This study reviewed evidence for the effectiveness of the multifactorial fall prevention programme in reducing the incidence of falls, translated the reviewed evidence and developed evidence-based guidelines for a multifactorial fall prevention programme, which can provide the health care practitioners with an evidence-based approach in fall risk assessment and management so as to prevent in-patient falls.
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Nursing Studies
Master
Master of Nursing
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16

Djukanovic, Ingrid. "Depression in late life-prevalence and preventive intervention." Doctoral thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-60554.

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Background Depression in older people often goes undetected but has severe consequences on physical health, functioning and quality of life. As the aging population is growing, mental ill-health already is and will continue to be an important public health problem. There is a need for adequate strategies to meet this challenge. Aims (1) To investigate the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex in a random Swedish sample in the age group 65-80 years, and to investigate to what extent those scoring ≥ 8 in the depression dimension of the Hospital Anxiety and Depression Scale (HAD) had visited health care professionals and/ or used antidepressive medication. (2) To evaluate the effect of group discussions, in which structured reminiscence and a Problem Based Method (PBM) were used, on depressive symptoms, Quality of Life (QoL) and Self-Rated Health (SRH) among older people. (3) To describe the individual´s experiences of the year before and the time after retirement. (4) To evaluate the factorial structure of the HAD in a general older population 65-80 years and to examine the possible presence of differential item functioning (DIF) related to sex. Result More men than women reported depressive symptoms, few were offered psychological treatment and a quarter used antidepressant medication. Depressive symptoms were associated with loneliness and this association decreased with increasing age.   Participation in group discussions resulted in a decrease in depressive symptoms and an increase in QoL and SRH. Both expectations and fears were experienced the year before and the time after retirement. The psychometric evaluation of the HAD showed a two-factorial structure and invariance regarding sex. Conclusion The result highlights the importance of detecting depressive symptoms and loneliness in older people and offer adequate treatment. Transition into retirement should receive more attention both from a health care and organizational perspective. Group discussions with structured reminiscence and PBM as a nursing intervention, seem to be a promising method to prevent depressive symptoms in older people, but further research is needed. The HAD can be recommended to assess anxiety and depression among a general population 65-80 years old.
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17

Tan, Haiping, and 譚海平. "Prevention and arrest of root surface caries in Chinese elders living in residential homes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B37196297.

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18

Wong, Wai-lung, and 黃偉龍. "Fall efficacy and reinvestment in older adults." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31257483.

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19

Lam, Yuk-king. "The effects of one session cognitive behavioral therapy for elderly patients with cardiopulmonary diseases /." View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B30469727.

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20

Sin, Yuen-kwong, and 冼遠光. "A study of an effective compression of morbidity strategy for Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206986.

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The ageing population has been increasing the healthcare expenditure of Hong Kong and will continue to increase the financial burden. James Fries proposed a phenomenon of compression of morbidity in the early 1980s that the onset of morbidity of elderly can be delayed to a later year and the duration of disability can be compressed. If it works, it could be a solution to ease the burden caused by the ageing population. Scholars around the world have carried out research for the evaluation of the existence of the compression of morbidity and its effects. Inconsistent inter-countries and intra-country results on the effect of compression of morbidity from the studies were reviewed. It was found that compression of morbidity is not necessarily associated with longer life expectancy. Effective policies have to be implemented to work against the causes of morbidity in order to realise the benefits of compression of morbidity. It has to be an integrated policy from healthcare promotion, providing accessible physical exercise facilities, improving air quality through legislation and appropriate public health policy for people of Hong Kong.
published_or_final_version
Public Health
Master
Master of Public Health
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21

Lao, Xiangqian, and 勞向前. "Inflammation, metabolic syndrome and vascular diseases in older Chinese: the Guangzhou biobank cohortstudy." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40687685.

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22

Thomson, William Murray. "Medications, dry mouth and dental caries among older people : a longitudinal study /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09PH/09pht4858.pdf.

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23

Tomlinson, Karen A. "Safety practices of older adults in residential environments." Thesis, Virginia Tech, 1990. http://hdl.handle.net/10919/42230.

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The major objectives of this study were to identify critical safety hazards, safety precautions practiced by older adults, and the factors that would assist older adults in preventing accidents in their residential environment and to examine the relationship between these safety practices and selected demographic characteristics of older adults. A personal interview schedule was developed and administered to a random sample of 50 members of the Virginia Cooperative Extension Homemaker's Council, over age 70, in Giles, Montgomery, and Pulaski Counties and the city of Radford. Means, frequencies, and correlations were used to examine the data. The findings revealed that older adults evaluate their home as moderately or extremely safe and they perceive that it is not likely to somewhat likely that hazards exist in their home that could cause an accident. Older adults currently practice an average of 15 out of a possible 20 safety precautions in their home. They are most likely to seek assistance in preventing accidents in their home from family members in the form of routine cleaning. If given the money and assistance to make improvements in the safety of their home, older adults would be interested in installing a secure grab bar in the bathtub or shower, painting or taping the edge of steps in order to see them better, attaching handrails on the stairway, and installing a telephone close to the bed. No significant relationship was found between the older adult's safety hazard perception score, safety precaution score, or factors that would assist older adults in preventing accidents in their residential environment and their health status, accident history, income, or mastery level.
Master of Science
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24

Choy, Choi-lin, and 蔡彩蓮. "The impact of family relations on caregiving effectiveness peceived bythe adult-child as primary caregiver to the elderly suffering fromchronic obstructive airway diseases (COAD)." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1994. http://hub.hku.hk/bib/B31249711.

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25

Xu, Lin, and 徐琳. "Subclinical atherosclerosis, cardiovascular risk factors and metabolicsyndrome in older Chinese people." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4451430X.

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26

Thiyagarajan, Jotheeswaran Amuthavalli. "Identification, prevention, and management of dependence among frail older people in low resourced primary health care setting." Thesis, King's College London (University of London), 2013. http://kclpure.kcl.ac.uk/portal/en/theses/identification-prevention-and-management-of-dependence-among-frail-older-people-in-low-resourced-primary-health-care-setting(ab45d253-0919-4e60-b2e4-cd6ad9a4eeb0).html.

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Background: Numbers of dependent older people will increase in low and middleincome countries (LMIC) with population ageing. Healthcare services do not meet their needs, and little attention has been given to developing age-appropriate services. Research described in this thesis is formative to development of World Health Organization WHO-COPE clinical intervention guidelines for prevention/management of dependence among older people in LMIC. >Method: Predictive validity of frailty indicators was tested by analysing 10/66 Dementia Research Group population-based cohort study data from Latin America, China, and India. Field research was conducted in Goa to train Community Health Workers (CHWs) for case-identification and assessment of frail/dependent older people. Case-identification and impairment classifications were compared with local clinician judgment. Clinical intervention guidelines were developed using WHO methodology (scoping questions/systematic reviews/expert consensus). Qualitative interviews in Goa with CHWs, doctors, and dependent older people and their carers assessed implementation issues for WHO-COPE guidelines. Results: Frailty indicators (weight loss, inactivity, exhaustion, slow gait speed, undernutrition, cognitive and sensory impairments) are consistent predictors of dependence and mortality. Goan CHWs accurately identified older people with multimorbidity, impairments, polymedication, disability and dependence. Agreement with clinicians for specific impairments was moderate, but the COPE assessment positive predictive value was high. It identified those with more pronounced disability. Systematic reviews found moderate quality evidence (from developed countries) for effectiveness of interventions for frail/dependent older people; e.g. exercise, nutritional supplementation/dietary advice, and prompted voiding for incontinence. Consensus guidelines are drafted for most intervention domains. Frail/dependent older people receive little attention in Goan primary healthcare. Home-based assessment and management was endorsed by healthcare professionals, but role definitions, referral options, limited knowledge and skills constituted important obstacles. Discussion: WHO-COPE assessment and multi-component intervention may address the needs of frail/dependent older people. However, feasibility, acceptability, fidelity, and effectiveness should be evaluated when administered by CHWs in the community.
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Zhao, Yanan. "The effect of a tailor-made exercise program on improving balance among older adults at risk of falling." HKBU Institutional Repository, 2015. https://repository.hkbu.edu.hk/etd_oa/223.

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Context: There is a paucity of information on well-designed exercise programs for the Primary Falls Prevention. Objective: This study aimed to evaluate a tailor-made exercise program for improving balance and balance-related fitness among older adults without history of falls but who were at risk of falling. Design, Setting, and Participants: A single-blind and randomized controlled trial for 61 older adults (age = 70 ± 3 years, males = 25%) with no history of falls but who were at risk of falling enrolled at the local senior center. Intervention: Participants were randomly allocated into three groups. An intervention group receiving a tailor-made Exercise for Balance Improvement Program (ExBP; n = 20), an active control group receiving the 8-form Yang-style Tai Chi (TC; n = 20), and a no-treatment concurrent control group (CON; n = 21). The ExBP was developed based on demographic and clinical characteristics of old adults as well as on the most reported deficits in balance and balance-related systems. The movements chosen in ExBP were those used in previous studies for older adults. The movements were integrated with considerations of movement specificity, movement complexity and organization, movement safety, feasibility and gracefulness, as well as the transfer of exercise learning. Modifications of these movements were made following experts and end-users’ evaluations. Training dosage was set at “90 minutes per session x 3 sessions per week x 16 weeks with an 8-week follow-up. Outcome Measurements: The primary outcome was a composite measure of balance capacities, including Fall Risk Test (FRT), Postural Stability Test (PST), Limits of Stability Test (LOS), and a modified Clinical Test of Sensory Organization and Balance (m-CTSIB). The secondary outcomes referred to those balance-related fitness including 30s Chair Stand Test (CS), Chair Sit-and-Reach Test (SR), 8ft Up and Go Test (UG), 2min Step Test (Step), Choice Stepping Response Time (CSRT), as well as Fear of Falling (FF). All the testing parameters were collected one week before the intervention (pre-test), at the end of 12th week (mid-test), at the end of 16th week (post-test), and at the end of 24th week (follow-up test). Analysis of variance with pre-test data as covariance and repeated measures analysis of variance were conducted to examine Group effect and Time effect, respectively. Results: All testing parameters in the ExBP group demonstrated an improvement trend from pre-test to post-test, especially in FRT, m-CTSIB, CS, SR, UG, and FF (p < .05). In comparison with the CON group at post-test, there were significant improvements in the ExBP group in FRT, m-CTSIB with compromised somatosensation, m-CTSIB with compromised vision and somatosensation, CS, UG, Step, and FES (p < .05), while the improvements at mid-test were only shown in UG and FF. There were no significant differences on any of the testing parameters between post-test and follow-up test. In addition, continuous improvements were shown in FRT, PST, m-CTSIB, SR, UG, CSRT, and FF during the follow-up period. In comparison with the TC group at mid-test, ExBP showed significantly more improvements in FRT, UG, Step and FF. Although without statistically significant group difference at post-test except in Step, improvements in FRT, PST in anterior-and-posterior direction, m-CTSIB with compromised somatosensation, m-CTSIB with compromised vision and somatosensation, SR, UG, Step, and CSRT were more pronounced in the ExBP group. The losses of training effect from post-test to follow-up test in ExBP was lower than the Tai Chi especially in FRT, m-CTSIB with compromised vision and somatosensation, Step, and CSRT. Conclusion: The ExBP can be applied as an effective exercise program for improving balance and balance-related fitness among older adults at risk of falling. In comparison with Tai Chi, training effects from ExBP occurred earlier and lasted longer.
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Chan, Hei Nga. "Analysis of biomarkers of age-related diseases by total internal reflection fluorescence microscopy." HKBU Institutional Repository, 2018. https://repository.hkbu.edu.hk/etd_oa/527.

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Total internal reflection fluorescence microscopy (TIRFM) has been widely applied for the study of biomolecules because of their ability to quantify biomolecules in a sample pretreatment and enrichment free manner, when compared with those costly, sample consuming and labor intensive conventional detection assay. Here, we have applied the TIRFM imaging system for the direct quantification and analysis of the biomarkers for the age-related diseases. Three research works on the quantification and study of biomarkers with the aid of TIRFM were herein described.
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Fahlgren, Maria, and Elisabeth Persson. "Sjuksköterskans omvårdnadsåtgärder för att förebygga och minska risken för fallskador på särskild boende : En litteraturstudie." Thesis, University of Skövde, School of Life Sciences, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-2750.

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Bakgrund: Fall är vanligt och kan leda till höftfrakturer och ett tidigare behov av särskiltboende. Ett hälsofrämjande och sjukdomsförebyggande perspektiv ska vara en självklar deli all vård och behandling. Syfte: Syftet med studien var att beskriva hur sjuksköterskor kanförebygga och minska risken för fallskador hos äldre på särskilt boende. Metod: Arbetetvar en litteraturstudie på tidigare forskningsmaterial. Resultat: Den viktigaste åtgärden äratt få fram vilka äldre som tillhör riskgruppen. Detta innebär att det är viktigt attuppmärksamma äldre med kognitiva försämringar, tidigare fall, urininkontinens,nedstämdhet, lågt BMI och äldre med behov av hjälp i sin ADL. Andra åtgärder är blandannat att ha regelbundna läkemedelsgenomgångar, att skapa förutsättningar för äldrepersoner att bära höftskydd, att informera och handleda omvårdnadspersonalen, attinformera de äldre och deras anhöriga om risker och åtgärder. Slutsats: Ytterligareforskning behövs vad det gäller sjuksköterskans omvårdnadsåtgärder för att förebygga ochminska fallskador på särskilt boende för att nå ett tillförlitligt resultat inom dettaämnesområde. Förbättrade bedömningar och åtgärder, mer stöd och förståelse från cheferskulle kunna ge tydligare rutiner, minskade kostnader för samhället och inte minst minskadet lidande som det kan innebära för äldre med fallskador.


Background: Falls are common and can lead to hip fractures and earlier need ofinstitutionalization. A health promoting and preventive perspective is an important concernin public health. Aim: The aim of the study was to examine how the nurse can prevent andreduce the risk of fall injures at older people living in residential care. Method: This workwas a literature study on earlier research materials. Results: The most important measureis to identify older people with risk factors for falls. This means that it is important toattentive older people with cognitive impairment, history of falls, urinary incontinence,depressed mood, low BMI and older persons with needs of help in daily physical activities.Other measures are for example to have regular medicine reviews, to create conditions forthe older to carry hip protections, to inform and teach the care employers, to inform theolder and his relative about risks and measures. Conclusion: Further research is neededregarding nurses care measures to prevent and decrease fall injuries in residential care inorder to reach a good result within the subject. Improved assessment and measures, moresupport and understanding of the managers would give more clear routines, the costs forsociety would decrease and most important it would decrease the suffering that fall injuriescauses elderly residents.

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30

Lui, Wai-ming Priscilla, and 雷慧明. "Effect of exercise on fall prevention of community-dwelling elderly." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B50222867.

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Objective: To evaluate the effectiveness of exercises on fall prevention among community-dwelling elderly. Design: Systematic review of randomized controlled trials. Method: The literature search of articles was conducted through the electronic databases of PubMed, Medline and EMBASE and manual search, and was confined to articles in English language with full text and publications from 2002 to 2012. Randomized controlled trials with exercise as the only intervention which aimed at reducing falls in older people aged 60 or above in community i.e. community-dwelling elderly were included. The primary outcomes were number of fallers, fall rate, time to the first and subsequent falls. Data Extraction: A total of 145 articles were retrieved through the electronic data bases (137 articles) and manual search (8 articles) of which 10 were selected after applying the inclusion criteria. According to the checklist developed by National Institute for Health and Clinical Excellence (NICE) for randomized controlled trials, the overall methodological quality of the 10 studies was rated as good as they had fulfilled 79%-93% of the assessment criteria in the NICE checklist. Results: The studies involved a sample size of 3,138 at the median age of 69 to 83. All the subjects were ambulatory and able to mobilize independently. The duration of exercise interventions ranged from 1.5 months to 12 months at a total of 11-156 hours. Eight studies showed that exercises were effective in fall prevention whereas two studies found no evidence of such effectiveness. The effect of exercises on fall prevention was multifactorial including the duration, frequency and continuity of the exercise programs, the health status of the target population and the individuals’ adherence to the exercise programs. Shorter exercise programs and make-up class arrangement resulted in higher adherence rate. Tailor-made (based on the functional capabilities of the subjects) and progressive (gradual increase of the intensity and challenge of the exercises during the intervention period) nature of the exercise programs also enhanced their effectiveness on the elderly. For the studies in which exercise did not have any positive effect on fall prevention, the subjects were generally older (median age at 81) and frailer (with 3-7 frail attributes). Conclusions: This review suggests exercise may be an effective intervention for fall prevention among community-dwelling elderly. Different types of exercise including strengthening, balance, endurance and weight-bearing exercises as well as Tai Chi may prevent falls. The elderly’s age and health status must be taken into consideration when designing exercise intervention programs for the elderly. Further researches are recommended to determine the optimal type, intensity, frequency and duration of exercises in fall prevention. Observations from the studies provide insights for future researches, such as the fall prevention effect of group and home exercises, tailor-made and progressive exercise programs. In Hong Kong, no randomized controlled trial studies have been conducted to examine different intervention programs on fall prevention. To achieve generalizabilty of the studies in the review, further local researches, particularly well designed and powered randomized controlled trials have to be conducted to assess the effect of different kinds of exercise interventions on fall prevention among the community-dwelling elderly.
published_or_final_version
Public Health
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Master of Public Health
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31

Nyman, Samuel Robert. "Evaluation of a website designed to encourage older people to undertake balance training for the prevention of falls." Thesis, University of Southampton, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485437.

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Falls are common and represent a major cause of severe injury and death among older people. Effective interventions to prevent falls have been developed, in particular 'balance training' - activities that enhance balance, coordination, and lower-leg muscle strength. However, older people's uptake offalls prevention interventions can be low, and so older people require advice to help motivate them to undertake balance training. Tailoring, the method ofmaking advice personally relevant to individuals, has been successfully used with other health behaviours to make advice more persuasive. The Internet lends itself to tailoring health advice, as it can reach a wide audience and present personally relevant advice to users through interactive websites. This thesis evaluated the use oftailoring in falls prevention. A website was created that presented tailored advice intended to encourage older adults to undertake balance training. Theory and research guided the selection of factors chosen to tailor the advice and to evaluate its efficacy. From interviews with older people and health and social care providers, views towards the website suggested that the website was usable and acceptable. In a randomised controlled evaluation comparing the tailored advice with a generic equivalent, questionnaire scores indicated that after receiving the tailored advice, older people reported that the advice was more personally relevant, and reported greater confidence and intention to undertake balance training. Completing an action plan also increased· older people's confidence to undertake balance training. Based on the feedback from participants derived from the two qualitative studies and the limitations identified from the quantitative study, a revised version ofthe website was created and re-tested. In a partial replication study, the tailored advice was reported by older people as more personally relevant and good for them to do, and creating an action plan increased their confidence to undertake balance training, although the effects of the intervention on intentions were weaker than in the first study, and did not quite reach significance. Nevertheless, the effect oftailoring on personal relevance and intention, and the effect of an action plan on confidence were significant' in a meta-analysis ofthe two quantitative studies. Whilst not conclusive, this research suggests that a website providing tailored advice to encourage older people to undertake balance training may be usable and acceptable, and lead to greater intention and confidence to undertake balance training.
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Bouwens, C. S. H. "Analysis of hereditary haemochromatosis and clinical correlations in the elderly." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51584.

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Thesis (MSc)--Stellenbosch University, 2000.
ENGLISH ABSTRACT: Hereditary haemochromatosis (HH) is an autosomal recessive iron storage disease where the accumulation of iron in parenchymal organs may lead to diabetes, heart failure, liver cirrhosis, arthropathy, weakness and a variety of other ailments if preventive measures are not taken. HH is often not considered as a cause of these conditions, particularly not in the elderly where the background frequencies of type II diabetes, osteoarthritis and heart failure are generally high. Heterozygosity for C282Y, the HFE-mutation causing HH in approximately 80% of affected individuals worldwide, has been linked to a raised incidence of malignancies of the colon and rectum, stomach and the haematological system. One of the highest carrier-frequencies (116) in the world for this mutation has been reported in the South-African Afrikaner population, resulting in C282Y-homozygosity in approximately 1 in every 115 people in this group. A sample of 197 elderly Afrikaner volunteers was recruited for genotype/phenotype association studies. Their clinical presentation was denoted, biochemical iron-status determined and HFE genotyping performed. Either an increase or decrease in survival, or both, were proposed, depending on possible gender effects. HH has been positively associated with various cancer types, but may also protect against iron-deficiency anaemia which is by far the most frequent cause of anaemia in the older person. This study has led to the following findings: 1. The carrier frequency of mutation C282Y was found to be 1/8 in the elderly population (similar in males and females), which is slightly lower than the 1/6 reported in younger adults from the same population. Only one C282Y homozygote and two C282YIH63D compound heterozygotes were detected, all of them female. 2. The prevalence of diabetes, heart disease, arthropathy or a combination of these conditions did not differ significantly in C282Y heterozygotes and the mutationnegative group. 3. Among 24 C282Y heterozygotes only one individual with rectal carcmoma was detected compared with two cases with rectal- and seven with colonic malignancies in 153 mutation-negative individuals. The single female C282Y homozygote identified suffered from both rectal and colon carcinoma and died approximately 6 months ago as a consequence of her colon malignancy. 4. Serum ferritin appears to be a highly unreliable parameter of iron status, particularly in the elderly where a variety of factors that may influence the levels are often present in elderly individuals. This may be due to ageing alone or as a result of multiple comorbidities. 5. Serum ferritin levels were lower than expected in elderly subjects with mutation C282Y and compound heterozygotes with both C282Y and H63D, which may be related to a variable penetrance of the HFE gene mutations. It is possible that variation in other genes exist that confer protection against iron-loading by gene-gene interaction. The probability that environmental factors (e.g. a low iron diet) are more important in this respect cannot be excluded, although this is considered less likely in the light of the fact that the same trend was observed in all mutation-positive elderly individuals. It is therefore highly likely that C282Y -positive subjects with significant iron loading have died before reaching their seventies, particularly since none of the males included in this study were homozygous or compound heterozygous for the mutations analysed. In conclusion, possession of a mutant HFE gene does not appear to confer a survival advantage in old age, neither does it seem that mutation carriers with significant ironloading are overlooked by the medical fraternity. Further investigations are warranted to shed more light on the contributions of gene-gene and gene-environment interaction in the clinical manifestation of Hll, and how these processes can be manipulated to prevent the symptoms of this largely underdiagnosed disease.
AFRIKAANSE OPSOMMING: Oorerflike hemochromatose (OH) is 'n outosomaal resessiewe yster-oorladingssiekte waar akkumulasie van yster in parenkimale organe kan lei tot suikersiekte, hartversaking, lewer sirrose, artropatie, moegheid en 'n verskeidenheid van ander probleme indien voorkomende maatreëls nie getref word nie. OH word gewoonlik nie oorweeg as moontlike oorsaak vir hierdie toestande nie, veral nie in ouer mense nie waar die agtergrond-frekwensie van tipe II diabetes, osteoartritis en hartversaking in elk geval hoog is. Heterosigositeit vir die HFE mutasie C282Y, wat OH veroorsaak in ongeveer 80% van geaffekteerde gevalle wêreldwyd, is geassosieer met 'n verhoogde voorkoms van kanker van die kolon, rektum, maag en ook die hematologiese sisteem. Van die hoogste draer frekwensies ter wêreld vir hierdie mutasie (1/6) is gevind in die Afrikaner populasie van Suid-Afrika, wat daarop dui dat 1 uit elke 115 mense in die groep homosigoties vir die C282Y mutasie kan wees. Eenhonderd sewe-en-negentig bejaarde Afrikaner vrywilligers het aan die studie deelgeneem wat daarop gemik was om genotipe/fenotipe korrelasies uit te voer. Die kliniese beeld van elke individu is gedokumenteer, die yster status biochemies bepaal en HFE genotipering uitgevoer. Die a priori veronderstelling was dat oorlewing sou toeneem of afneem, of beide, afhangende van die geslag van die individu. Daar is voorheen 'n verband gevind tussen OH en die ontwikkeling van bogenoemde maligniteite, maar aan die ander kant kan dit moontlik ook beskerm teen anemie as gevolg van yster gebrek, wat juis die mees algemene oorsaak van anemie in die ouer persoon is. Hierdie studie het tot die volgende bevindings gelei: 1. Die draer frekwensie van mutasie C282Y was 1/8 in die bejaardes (dieselfde in mans en vrouens), wat effens laer is as die 1/6 wat gerappoteer is in jonger volwassenes. Slegs een C282Y homosigoot en twee C282YIH63D saamgestelde heterosigote is opgespoor, en al drie was vroulik. 2. Die voorkoms van suikersiekte, hartsiekte, gewrigspyne of 'n kombinasie van hierdie aandoenings het nie betekenisvol verskil tussen die C282Y heterosigote en die mutasienegatiewe groep nie. 3. Daar was slegs een persoon met rektum karsinoom in die groep van 24 bejaarde C282Y heterosigote, terwyl daar twee gevalle met rektum kanker en sewe gevalle met kolon kanker gevind is onder die 153 mutasie-negatiewe individue. Die enkele vroulike C282Y homosigoot wat opgespoor is het beide rektum- en kolonkanker gehad en is ongeveer 6 maande vóór voltooing van die tesis oorlede aan haar kolon karsinoom. 4. Dit wil voorkom asof serum ferritien veral in bejaardes 'n hoogs onbetroubare maatstaf is vir yster status, aangesien dit deur 'n verskeidenheid faktore beïnvloed word wat dikwels in bejaardes aanwesig is as gevolg van veroudering of veelvuldige komorbiditeite. 5. Die serum ferritien vlakke was laer as verwag in sowel die bejaarde C282Y-homosigoot as in die twee saamgestelde heterosigote met mutasies C282Y en H63D, wat moonlik die gevolg is van die wisselende graad van penetrasie van HFE mutasies. Dit is moontlik dat variasie in ander gene beskerming bied teen yster-oorlading deur middel van geen-geen interaksie. Die moontlikheid dat omgewingsfaktore (soos 'n lae-yster dieet) 'n belangrike rol speel in hierdie verband kan nie uitgesluit word nie, hoewel dit minder waarskynlik lyk te wees in die lig van die feit dat dieselfde neiging waargeneem is in alle mutasie-positiewe bejaardes. Die kans is dus redelik groot dat individue met die C282Y mutasie en betekenisvolle yster oorlading oorlede is voordat hulle die sewentiger jare kon bereik, veral omdat geeneen van die mans wat ingesluit is in die studie homosigoot of 'n saamgestelde heterosigoot was vir die mutasies wat geanaliseer is nie. Opsommend wil dit voorkom asof die teenwoordigheid van 'n mutante HFE geen nie 'n beter oorlewingskans bied op ouer leeftyd nie, en dit blyk ook dat mutasie draers met betekenisvolle ysteroorlading nie deur dokters misgekyk word nie. Verdere navorsing is nodig om meer lig te werp op die bydrae van geen-geen- en geen-omgewing interaksie in die kliniese manifestasie van OH, en ook hoe hierdie prosesse gemanipuleer kan word om die simptome van hierdie onder -gediagnoseerde siekte te voorkom.
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33

Miller, Eva Mary. "Communicating with elderly mental health clients about medication concordance." CSUSB ScholarWorks, 2007. https://scholarworks.lib.csusb.edu/etd-project/3195.

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34

Mitzel, Gina Marie. "The Impact of Genetics, Socioeconomic Status, and Lifestyle Factors on Visual Health in an Adult Population." Thesis, University of North Texas, 2010. https://digital.library.unt.edu/ark:/67531/metadc33187/.

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The purpose of this dissertation was to understand how genetics, socioeconomic status (SES), and lifestyle factors influence the development of age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy in an adult population in Dallas County. Two hundred fifty-three older adults participated in this study as the sample. Crosstabulation and binary logistic regression were utilized to analyze the data. Results indicated a disparity among participants' test scores, visual health status, and perceptions of their visual impairment and highlighted the fact that many seniors are not educated about age-related retinal disorders. Furthermore, variables reaching statistical significance were consistent with the literature included race/ethnicity, age, having a family history of both AMD and diabetes, frequency of eye exams, and level of education. The results not consistent with the literature as affecting visual health included health insurance, access to health care, body weight, and smoking status. Recommendations for future study included applied research focusing on determining risk factors, raising awareness, educating, and providing early detection of these diseases among low to middle income Caucasian, African American, and Hispanic older adults.
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35

Ronald, Lisa Helena. "General practitioners' attitudes to suicide prevention in older people and barriers to assessing risk : a public health psychology approach." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/25132.

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Background: Suicide is an important public health problem. Older people constitute the highest rate of completed suicides worldwide, with depression as the leading risk factor within this population. However older people's mental health has long been a neglected area both in terms of public policy and service provision. Research suggests that despite the fact older people visit their primary care practitioner more frequently than their younger counterparts, depressive symptoms and suicidal ideations are often not identified. Furthermore, even when psychological distress is recognised, older people are less likely to be treated or referred on to appropriate mental health services, despite the availability of efficacious treatments. Research suggests that "ageist" attitudes within society adversely affect the health-seeking behaviours of older people as well as health-care practitioners' clinical practice. Such attitudes require particular consideration when attempting to reduce suicide rates in older populations. Aim: The present research looks to enhance understanding of potential barriers to recognising and treating late-life depression and suicidal ideation by exploring GPs' attitudes and self-reported clinical practice in this area. Method: The study adopted a within-subject, questionnaire based design. 399 General Practitioners within a single health board area completed a self-administered questionnaire exploring attitudes towards suicide prevention in older people and selfreported clinical practice in terms of risk assessment with older adult populations. Results: Participants' attitudes towards suicide prevention in older people, on the whole, were marginally negative. Furthermore, there was a positive correlation between participants' attitudes and their self-reported clinical practice in terms of conducting a suicide risk assessment with this population - more negative attitudes were associated with less proactive clinical practice. There was also a relationship between age of participant and attitude where older GPs were more pessimistic regarding suicide prevention in older people. Previous training in suicide risk assessment did not appear to impact on attitudes towards suicide prevention, but did result in more pro-active clinical practice. Discussion: The present study provides a useful insight into GPs attitudes towards suicide prevention in older people and how such attitudes may impact on clinical practice. The findings have significant clinical implications in terms of multi-level approaches to reducing suicide rates within older populations. At an individual level it is important to enhance primary care practitioners' knowledge and skills regarding late-life depression and suicidality, while simultaneously highlighting factors associated with healthy ageing. At a wider strategic level it is necessary to develop sustainable mental health services for an ageing population while reducing age related discrimination and the stigma of mental illness through appropriate public policy and legislation. The potential role of clinical psychology at each of these levels was demonstrated. The strengths and limitations of the present study are also discussed along with suggestions for further research.
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36

Van, Lent Diane. "The relationship of spirituality, self-transcendence, and social support to morale in chronically ill elderly." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/276820.

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The relationship of spirituality, self-transcendence, and social support to morale in chronically ill elderly was the focus of this research study. The research was based upon a developmental framework of aging. Individuals answered questionnaires regarding their perspectives on the above variables to determine how significantly the variables related to feelings of morale. Findings revealed that self-transcendence and social support were significantly correlated with morale in this population. No significant relationship between spirituality and morale was found. Self-transcendence and social support together accounted for 45% of the variance in predicting morale in the chronically ill elderly. Findings also revealed existing relationships between spirituality and gender, education level and social support, and length of illness and social support.
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37

Pearson, Melanie A. "Cardiovascular adaptability influences cortical neuronal activation in very old adults /." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p3137735.

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38

Kwong, Chi-ho, and 鄺智豪. "Common eye diseases and their impacts on elderly in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46938369.

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39

Frizzel, Gregory R. "Training deacons to counsel senior adults of Georgian Hills Baptist Church who are experiencing crime victimization." Theological Research Exchange Network (TREN), 1991. http://www.tren.com.

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40

Kullberg, Kerstin. "Food in older men with somatic diseases : Eating habits and approaches to food-related activities." Licentiate thesis, Uppsala University, Department of Public Health and Caring Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-106429.

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The overall aim was to improve the knowledge and understanding of eating habits of older men with somatic diseases, and the men's perceptions about managing food-related habits, such as grocery shopping and cooking. A total of 67 men between 64 and 89 years of age were visited in their homes on two occasions with 1-2 weeks in between. The participants were diagnosed with one of the three diseases Parkinson’s disease, rheumatoid arthritis, or stroke. A food survey, with repeated 24-h recall, was used to assess food intake and meal patterns. Interviews with 18 participants were conducted with open-ended questions. The interviews were further analysed with a thematic framework approach.The findings showed that eating events were distributed over a 24-h period.Further, co-living men had a significantly larger number of eating events over the day (p=0.001). No differences in daily energy intake were observed between co-living and single-living men. Co-living men’s hot eating events were compared with those of single-living men more often cooked from fresh ingredients (p=0.001), including a greater mix of vegetables/roots (p=0.003).Thematic analysis revealed three different approaches to food-related activities(FRA), namely ‘Cooking as a pleasure’, describing joy in cooking; ‘Cooking as a need’, indicating no habits or skills in cooking; and ‘Food is served’, that is, being served meals by a partner. The men's approaches to FRA were affected in particular by gender-related roles, but also by changed life circumstances, activity limitations, personal interests, and a wish to maintain continuity and independence. Further adaptive strategies were used among the men in attempts to maintain continuity and independence in FRA. In conclusion, single-living older men, especially those with activity limitations, were identified as being a vulnerable group from a nutritional perspective. Further, health care efforts in promoting FRA should preferably be individualised with respect to the older man’s approach to these activities.

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41

Hargett, Thompson Candace L. "Social Support, Depression, and Cardiovascular Disease in Married, Middle-Aged/Older Adults." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4611/.

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This study examined the relationship between physical health, social support, and depression in a married, middle-aged/older adult sample in which at least one partner has heart disease. The data was obtained from a national longitudinal study the Health and Retirement Survey (HRS) and is composed of selected respondents and their spouses. The HRS Wave 1 data that was used for these analyses was collected in 1992 and 1993. This study tested a stress buffer model predicting the relationship between physical health, social support, and depression. For study inclusion, participants must have been diagnosed with cardiovascular disease and received treatment in the last year. A heart disease construct was developed by calculating the level of disease by the number of conditions and medical treatments received within the last year. A second health category for other chronic health conditions included diabetes, arthritis, cancer, and chronic pain. These constructs were combined into a total disease construct, which provided a broad measure of health problems typical of an older adult population. Social support was determined by respondents' satisfaction with friends, neighbors, family, their marriage, and enjoyable time spent with their spouse. Social support was subdivided into two constructs separating spousal support from social support sources outside the marriage. The Center for Epidemiological Studies Depression short-form (CES-D) calculated depression scores. Findings support a stress-buffering model among older married adults with chronic diseases. Hierarchical multiple regressions found the following main effects predicted Depression: Total Disease (Beta=. 03, p<. 000), Exercise (Beta=-.11, p<. 000), Smoking (Beta=. 04, p<. 001), General Support (Beta=-.21, p<. 000), Spousal Support (Beta=-.19, p<. 000). The Total Diseases by Spousal Support interaction was a significant predictor of Depression for men and women (Beta= -.04, p<. 000) and Total Disease by Spousal Support was also a significant predictor for men and women (Beta=-.03, plt;. 000). For men with Heart Disease, Total Disease by Spousal Support was a stronger predictor (Beta=-.03) than it was for women with Heart Disease (Beta=-.10). These results may partially explain gender differences in heart disease patients and suggests several psychological interventions that could be beneficial.
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42

Montgomery, Alan A. "Physical activity and perceived benefits and barriers in adults aged 55-74." Thesis, University of St Andrews, 1997. http://hdl.handle.net/10023/2663.

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In order to increase the number of older adults physically active enough to obtain the health benefits of exercise, inactive individuals must firstly be identified, and attention must then be focused on determinants of exercise amenable to change. This study set out to develop self-complete questionnaires for assessing activity status, and perceived benefits of, and barriers to, physical activity. Of 1456 questionnaires sent out to a random sample of adults aged 55-74 a usable return rate of 37.6% (n=548) was achieved. A principal components analysis of the benefits of physical activity revealed five factors (physical performance, social, weight control, enjoyment, and psychological), and of the barriers to physical activity, also five factors (opportunities, physical exertion, time, limiting health, and support). Alpha internal consistency coefficients for the 10 factors ranged from 0.64 to 0.92, and test-retest reliability coefficients from 0.56 to 0.87. A series of one-way ANOVAs revealed that, with the exception of the benefit weight control, there was a significant gradation in factor scores between active and inactive subjects as classified by 4-, 9-, and 5- point activity classification methods. Validity of the activity classifications was assessed in a subsample of 86 subjects against measures of strength, flexibility, aerobic fitness and objectively measured physical activity. Active and inactive subjects classified using the 4- and 9-point questionnaires differed significantly in 1-mile walk time and energy expenditure estimated by a Caltrac accelerometer. The 5-point questionnaire did not appear able to differentiate active and inactive subjects. Test-retest reliability of the questionnaires ranged from 0.62 to 0.73. The questionnaire developed from this work for measuring perceived benefits and barriers of older adults can be used in either practical or research settings. Further work is required to determine the accuracy of the physical activity questionnaires in identifying low-active individuals in the population.
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Law, Wai-jun, and 羅偉真. "A validation study of the geriatric suicide ideation scale (GSIS) of Hong Kong for Chinese older adults." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B43895268.

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44

Craig, Yvonne Joan. "Mediation and empowering older people to resolve interpersonal conflicts leading to elder abuse and contribute to its prevention : an exploratory study." Thesis, London Metropolitan University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312929.

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45

Ho, Tip-yin, and 何蝶燕. "Community-acquired pneumonia in elderly requiring hospitalization." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971787.

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46

Thomson, Victoria. "Common mental health problems in later life : considering new approaches to meet the challenges of an ageing population." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/25763.

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Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.
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47

Biraguma, Juvenal. "Health policy brief: Towards prevention of risk factors for non-communicable diseases among people living with HIV infection in Rwanda." University of the Western Cape, 2017. http://hdl.handle.net/11394/6173.

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Philosophiae Doctor - PhD (Physiotherapy)
People living with the HIV infection (PLWHI) can now live longer due to the availability and effective use of combination antiretroviral therapy (cART). Eastern and Southern Africa remains the region affected by HIV. Rwanda is one the Eastern Africa that has achieved high rates of antiretroviral therapy (ART) coverage, accounting 164,262 (78%) of all PLWHI in 2016. However, both HIV infection and continued use of life-long cART medications have been associated with a constellation of non-communicable diseases (NCDs). Additionally, HIVinfected (HIV+) persons are at increased risk of NCDs, especially cardiometabolic diseases (CMD), compared to HIV-uninfected (HIV-) counterparts. People living with HIV infection are at an increased risk for NCDs due to their HIV status and their resultant reduced immunity, the use of some cART, and contextual and sociodemographic factors. Fortunately, lifestyle factors including regular physical activity participation, diet modification, and smoking cessation could play a major role in preventing CMD, and in improving life expectancy for HIV+ individuals. However, these interventions are not always integrated in routine African clinical settings, particularly in Rwanda. Currently, health-related benefits of people living with HIV infection on established ART, has shifted from survival to a health-related quality of life outcome (HRQOL).
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48

Robinson, Lisa. "Self-management and adherence with exercise-based falls prevention programmes for older people with long-term conditions : a framework for physiotherapy practice." Thesis, Northumbria University, 2012. http://nrl.northumbria.ac.uk/8448/.

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Introduction: This study aimed to work with older people attending a regional falls and syncope service, older people with the falls-associated chronic liver disease primary biliary cirrhosis, relatives and local physiotherapy practitioners to develop a framework for physiotherapy practice to promote self-management and adherence with an exercise based falls prevention programme for older people with a long-term condition. Methods: Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants), relatives (1 group, total 4 participants) and local physiotherapists (4 groups, total 18 participants). Participants were asked to propose strategies to promote self-management and adherence with an exercise-based falls prevention programme. These strategies were tested and refined in an experimental case-series for 10 older people with primary biliary cirrhosis. Findings: The older people participating in the focus group research expressed a long-term commitment to exercise-based falls prevention programmes. They valued approaches that promoted self-efficacy and self-management. The physiotherapists indicated that the older people they came into contact with were poorly motivated to participate in an exercise-based falls prevention programme. They demonstrated a limited awareness of strategies to promote self-efficacy and self-management. Visual analysis of the experimental case-series data revealed unstable baselines and fluctuations throughout the treatment and follow up phases in keeping with variations in disease-specific quality of life measures, suggesting that long-term conditions interact with measures that predict and monitor falls-risk and self-efficacy. The exercise-based falls prevention programmes had perceived benefit for older people with primary biliary cirrhosis. However, this was not evident in the measures selected, many of which demonstrated a ceiling effect in the population group under investigation. The self-management strategies had low levels of perceived acceptability. Participants indicated that they lacked the necessary skills to monitor their progress with an exercise-based falls prevention programme on completion of the experimental case-series. Conclusion: This study demonstrated that self-management does not sit comfortably within the philosophy of routine clinical practice. The framework for physiotherapy practice developed during the course of the current study has the potential to empower physiotherapists and older people with long-term conditions identified as being at increased risk of falling to work in partnership to challenge existing approaches to clinical service delivery.
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Wang, Xin, and 王昕. "Physical activity and cardiovascular disease mortality, morbidity and all-cause mortality in Chinese elderly people." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41508257.

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50

Myers, Helen. "Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1494.

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Falls are a significant problem in acute care, hospital settings, and can have serious consequences, especially for older patients. Fall prevention has therefore been recognised as an important area for research and intervention. In order to target interventions and use resources effectively, a major strategy of many fall prevention programmes has been the development and/or use of risk assessment tools to identify patients who are at high risk of falling. Although many tools have been developed, few have been rigorously tested, and there is currently no evidence to support the clinical utility of fall risk assessment tools. There is a need to conduct further research to establish the efficacy of fall risk assessment tools for inpatient populations. Additionally, nurses clinical judgement in assessing fall risk may aid the development of fall risk assessment protocols and further research is needed to build on limited knowledge in this area. A prospective cohort study was used to evaluate two fall risk assessment tools and nurses' clinical judgement in predicting patient falls. Each patient was assessed for fall risk by the clinical judgement of the nurse caring for the patient and by the researcher using a data collection form containing the two fall risk assessment tools. The study wards comprised two aged care and rehabilitation wards, within a 570 bed acute care tertiary teaching hospital facility in Western Australia. Test-retest reliability of the two fall risk assessment tools and nurses' clinical judgement was established over a twenty four hour period. The ability of the fall risk assessment tools, and nurses' clinical judgements to discriminate between patients with a high probability of falling and , patients with a low probability of falling; was determined by calculating the sensitivity, specificity, positive predictive value and negative-predictive value for each method. The reference criterion used for these calculations was whether or not the patient fell within the hospitalisation period in which they were admitted to the study. In addition, the accuracy of each method was determined by calculating the number of times the risk assessment tool or clinical judgement classified the patient into the correct, fall risk category, expressed as a percentage. The same reference criterion was used for this calculation. Both the fall risk assessment tools and nurses' clinical judgement had good test-retest reliability. When assessing validity, all three methods of determining fall risk showed good sensitivity, ranging from 88% to 91 %,but poor specificity, ranging from 25% to 26%. This meant that the risk assessment methods classified too many patients who did not fall as at high risk for falling. All methods also had limited accuracy, ranging from 35% to 36%, and overall exhibited an inability to adequately discriminate between patient populations at risk of falling and those not at risk of falling. Consequently, neither nurses' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in the clinical setting. In addition, results indicated that there was a large difference between the accuracy of first year enrolled and registered nurses in assessing patient fall risk. First year enrolled nurses accurately predicted fall risk 44.4% of the time while first year registered nurses achieved an accuracy level of only 8.6%. These results are potentially biased, as measuring differences in accuracy between types of nurses was not a main focus of this study and in many cases the same nurse gave multiple judgements about patients' fall risk. The results however, provide an indication that further study is warranted using a specifically methodology to explore this issue. There are a number of specific recommendations arising from the results of this study. It is recommended that further studies be undertaken to assess the reliability and validity of current fall risk assessment tools in inpatient populations. If no valid and reliable fall risk assessment tool can be identified, research should be undertaken to develop such a tool. It is also recommended that studies be conducted to assess changes in fall risk profiles over time to determine if the sensitivity and specificity of instruments changes depending on the timing of the risk assessment. Differentiating between stable and transient risk factors should be an integral component of these types of studies. Further research is also required to determine if there are differences in fall risk factors between different specialties or if a generic risk assessment tool can be used for all inpatient populations. Additionally, further investigation into the clinical judgement of registered and enrolled nurses in .their first year of clinical practice should be undertaken and results reported to appropriate educational institutions. Changes in accuracy of clinical judgement in the first five years of clinical practice should also be measured.
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