Thèses sur le sujet « Older people – Protection »

The thesis makes the case for special protection of older people in international human rights law. This begins with an approach to human rights combining concepts of Human Dignity and Vulnerability. An interdependent relationship is identified, promoting grounds for both to underpin human rights. From this, a vulnerability framework is devised directing findings of research into the “vulnerability position” of older people, and examination of existing international rights. The overarching theme is the fulfilment of interests of older people in human rights. Such interests are examined using principles of Interest Theory. Research method into threats to dignity and related vulnerabilities comprises Theories of Ageing and lived experiences. The findings assist in identification of older people as a vulnerable group, predominantly by reference to academic literature, standards defined by the European Court of Human Rights, and the vulnerabilities framework. The central hypothesis is the potential inadequacy of the existing international framework of human rights to protect the inherent dignity and vulnerable position of older people. Existing international human rights are examined from normative and implementation perspectives. Normative results are discussed and recorded in relation to the vulnerability framework. These results are also employed, using a modified version of the Capabilities Approach, to create a unique listing of Fundamental Capabilities to underpin normative content and capabilities outcomes. Aimed at fulfilling interests of older people in human rights, the listing grounds the examination of implementation of the existing rights construct, and directs indicators of special protection rights. The outcome of all research proves a need for special protection of older people in international human rights. Therefore, progress by the UN OEWG1 is surveyed; the result demonstrating a preference for improved implementation of the existing international framework. To date, the position of older people in international human rights has stagnated in OEWG discussions.

The focus of this research project was to evaluate individual stakeholder perceptions of the implementation of Structured Decision Making (SDM) as a tool in risk assessment of elder abuse/neglect case referrals in Riverside County Adult Protective Services (APS). The researchers interviewed ten social workers from Riverside County APS, from line workers up to Deputy Director. Constructivist theory was used to develop a joint construct which indicated that the primary benefit of SDM was consistency. Consistency resulted in safety and proctection of the client, social worker and the agency.

Culture, education and of other forms of acquired capacities act on individual differences in skill to shape how individuals perform cognitive tasks such as attentional and executive control. Of interest, the use of more than one language (bilingualism) also appears to be a factor that shapes individual performance on tests of cognitive functioning. Indeed, researchers have shown that a bilingual can have better attention and executive control capacities than monolingual speakers and this is argued to be due the ability to inhibit one language while using another. Beyond behavioral differences, bilingualism seems to affect brain structure as well. Recent evidence also shows bilinguals develop more gray matter in crucial brain areas responsible for executive control, hence, providing a neurological basis for why bilinguals outperform monolinguals on many attentional control tasks. It has been postulated that this cognitive advantage offers protection to bilinguals against cognitive decline in aging. Bilingualism affords a cognitive reserve in the form of a set of skills that allows some people to cope with cognitive decline such as mild cognitive decline or Alzheimer's disease better than others. The primary aim of the studies here performed was to investigate if and how the bilingual brain becomes more resistant to cognitive decline. Three combined comparative behavioral and structural neuroimaging studies were carried out in bilingual and monolingual seniors. The overall results show a rather interesting pattern of findings that may be summarized as follows: if well matched for demographic and behavioral variables such as age, socio-economic status, education, and global cognitive functioning, bilinguals have generally increased gray matter densities as compared to monolinguals in those brain areas that are known to be more affected by physiological aging such as the orbitofrontal cortex, the temporal poles and parietal lobules, and in areas involved in cognitive control such as the prefrontal cortex and the anterior cingulate cortex. Increased gray matter in these latter areas also correlates with the superior performance of bilinguals on executive control tasks. Interestingly, in order to keep such a neural benefit (i.e. increased gray matter density) the degree of proficiency of the second language has to be relatively high and bilinguals have to be constantly exposed to their second language. Finally, specifically for the aging population, age of second language acquisition has no major role in determining putative neural differences. Any putative neural differences between bilingual speakers are determined by factors such as the degree of proficiency and exposure to a second language. In conclusion, as thoroughly investigated here, bilingualism represents a neural reserve for healthy aging. However, the benefits are most prominent when second language proficiency and exposure are kept high.
published_or_final_version
Education
Doctoral
Doctor of Philosophy

This descriptive study with quantitative aspects examined the phenomenon of elder abuse through the systematic review of 60 cases of elder abuse. Cases were randomly selected from the files of an Adult Protective Services agency in the North Central Texas area. Research questions examined the characteristics of the victims and abusers, types and duration of abuse, descriptions of abusive situations, the reporting and verification of abuse, case management strategies utilized by caseworkers, and the consequences of those strategies. The results of this study point to the probability of the elderly abuse victim being 75 years of age or older, female, white, and widowed. There did appear to be some connection between race and type of abuse with white victims more likely to experience physical and financial abuse. Approximately half of the elderly abuse victims had severe limitations in physical and/or mental functioning leading to some degree of dependence upon their abusers. However, eighty percent of the elderly victims resided in their own homes and half of these individuals were functionally independent. This study provided descriptions of the various types of abuse that were observed: physical, financial, emotional, passive neglect, and active neglect. Financial abuse was noted most frequently, and multiple types of abuse were noted in most cases with the combination of physical, financial, and emotional abuse being observed most frequently. Fifteen different categories of case management strategies were examined, averaging four different assistance strategies per case. Legal services appeared to be the most often refused form of assistance. This study also found no evidence that those who abuse the elderly are being prosecuted.

This study examined the outcomes that clients are experiencing with the Adult Protective Services System in the County of San Bernardino. The study was exploratory and discriptive. Data were extracted from closed case records from the period of September 1, 1999 until August 31, 2000.

With the aging of the baby boomers there is a concern for the liklihood of an increase in reported cases of adult and dependent abuse with Adult Protective Services (APS). This study examined what the social work implications were regarding clients who refuse APS interventions and what subsequent outcomes existed. Data was extracted from closed case files for the period of January 1, 2000 and January 31, 2001 in the high desert region of San Bernardino County.

America's growing elder population affects every segment of the social, political and economic landscape. This population has generated public concern and debate reagarding the problems faced by this often-vulnerable group, including the issue of elder abuse. This research project examined associations between dementia and elder abuse in domestic settings utilizing secondary data obtained from Adult Protective Services of San Bernardino County.

The study investigated the relationship between San Bernardino County Department of Adult Protective Services (APS) client refusal of services and the outcome of their cases. A data extraction tool was used to collect demographic information about the APS clients and their perpetrators, types and number of contacts made by the APS worker, types of abuse, reasons for refusal, and outcomes from closed APS cases for the San Bernardino, Ontario, and Rancho Cucamonga regions.

The proposed research study explored the extent and nature of financial abuse crimes amongst elders in San Bernardino County. This study utilized a descriptive research method. This study identified characteristics of victims and perpetrators, contributing factors associated with financial abuse, the degree of trauma an elder will experience depending on the type of financial crime committed. This study will provide an overview of the different types of financial abuse cases reported and determine if there is a significant difference and/or similarities of these types of crimes committed against male and female elderly in San Bernardino County.

A thesis submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy Final Submission June, 2015.
The HIV and AIDS pandemic has increased the numbers of orphans globally. The severity of the problem is greater in developing countries, especially in Sub Saharan Africa. In Malawi, as in many other developing countries, grandparents have stepped in and have embraced the role left by the deceased parents, seeing the orphans through school, providing food, clothing and shelter for them, even where the grandparents themselves have no steady source of income. Despite the heavy burden placed on grandparents as a result of HIV and AIDS, limited attention has been given by governments, scholars and researchers to documenting in detail the challenges faced by the elderly who look after orphaned children. This study examined the challenges faced by elderly people looking after children orphaned by HIV and AIDS in Malawi using the Sustainable Livelihoods Framework (SLF). This framework looks at household needs and holistically categorises them in terms of social, financial, physical, natural health, and government policies. Following a qualitative approach, this study used a phenomenology approach in documenting the challenges facing the elderly in Malawi, with a special focus on the Rumphi and Zomba districts. The livelihood approach is part of rural development theories that has moved away from the conventional approaches towards development to holistic understanding of the relationship between poverty and economic development. The study also provided a case study on the role of social pensions in Lesotho. Social protection, which is part of social development, focuses on local community development with the emphasis not only on economic development, but also on improvement of health, education, environment and standard of living as critical contributors to sustainable development. This is seen as a medium that discourages dependency and promotes the participation of people in their own development. The aim was to profile social protection benefits for the elderly in Lesotho as an example so that insights could be drawn from the experience. The study used structured and semi-structured interviews and focus group discussions as tools to elicit information from grandparents, orphans, community leaders, teachers, local leaders and policy makers. The findings of the study indicate that the level of rural poverty in elderly headed households has increased due to the challenges resulting from the HIV and AIDS pandemic. The Sustainable Livelihoods Approach presented in this paper advocates that sustained development is only successful if it is based on evidence and understanding of household or community needs holistically and systematically. This study has highlighted five key elements required to understand the elderly households through the Sustainable Livelihoods Framework. Firstly, the evidence from this research challenges the SLF in that it does not take into account all key factors necessary to understanding the elderly households’ needs, As a result, this study proposes other necessary enhancements to the SLF, such as the role of cultural practices as part of social capital in supporting elderly livelihoods, especially where patrilineal and matrilineal family systems exist. Secondly, evidence from this study indicates that the notion of social capital that includes dependency on community networks as key in improving the general livelihood of societies has completely diminished due to community fatigue in relation to offering care and support. The study further reveals enhancements in the forms of social capital like belonging to “secret friendships” or being a member of the village banking scheme. However these social networks have limited elderly membership because of community perceptions that elderly members may not contribute much, be it financially or otherwise, hence the elderly are excluded from social networks. Thirdly, as a result of the many challenges faced by the elderly, this research has highlighted an increase in negative coping strategies in elderly households due to limited support from government and other stakeholders. Negative coping strategies in this regard include engaging in activities like casual labour (ganyu), selling alcohol, school dropouts, selling green maize and begging. The more the elderly adopt negative coping strategies, the more vulnerable they become over time. Fourthly, the livelihoods framework has been used in this study to provide a full understanding of situation of the elderly headed households. This approach provides a new dimension to this body of knowledge as it is used for the first time on elderly households. The research presents a foundation that will require future researchers to look at elderly households holistically and systematically within their context using this research as a guideline or as a point of reference. Finally, this research suggests a possible framework that would address the needs of the elderly, with a combination of the livelihoods framework as the analysis tool and the social pensions as the response mechanism for alleviating the burden on elderly headed households. Social pensions will act as a poverty cushion to the elderly members of the society to meet their needs in raising orphaned children. This research conclusively reinforces the role of social protection for supporting the elderly livelihoods. The researcher’s contribution to theory is embedded in the premises of integration of livelihoods frameworks as an analysis tool that provides an holistic picture of understanding elderly household challenges and needs. Social protection through social pensions can be an intervention for supporting the household challenges of the elderly. The combination of these two frameworks results in an holistic and systematic analysis of elderly livelihoods and subsequent support necessary to respond to their challenges.
MT2016

Yes
In 2004, the author carried out a small scale study to find out the views of those living and working in private care homes in England about a range of issues connected to inspection, regulation and ways to better protect older people. This study reports on views from nineteen managers and nineteen residents about their understanding of abuse, their perceptions of the different forms of abuse and the possible action to deal with offending care staff. Although there was some consensus about the seriousness of certain types of abuse and how managers would investigate the allegation, the findings indicate that mandatory training for registered care home owners and managers is necessary to clarify their responsibilities in relation to their actions and reporting of certain offences to relevant agencies.

In Australia, home and community aged care has been a growing sector for the past two decades. To achieve higher levels of efficiency and improve the quality of care, remote monitoring systems for elderly offer interesting solutions. The data collected by the monitoring system are transmitted to the healthcare provider and stored on the healthcare provider’s server in the form of patients’ Electronic Health Records (EHR). With such a system, healthcare professionals can remotely access each patient’s EHR on their mobile devices, for instance when they are at the patients’ homes. They may need to access patients’ EHR for obtaining the history of the patient’s medical records or modifying the patient’s EHR. It is important to secure the transmission of the patient’s EHR between the healthcare provider server and the mobile device being used by the healthcare professional, as communication is via unsecure networks, such as the Internet. It is also important to ensure that a patient’s EHR is only disclosed to the authorized entities. Therefore, obviously, security services, such as privacy protection during transmission of data and remote authorized access to patients’ EHR are of paramount importance. Other security requirements that need to be addressed relate to the nature of mobile devices and their vulnerabilities to loss and theft. The approaches proposed in this study ensure that patients’ EHR are only disclosed to the authorized healthcare professional, on the registered device, at the appropriate locations. They ensure the confidentiality of information by securing its transmission, using Transport Layer Security (TLS) as the underlying protocol. Building on the strengths of this protocol, a trust negotiation approach is developed. This approach authenticates the person receiving the care, the person administering it, the mobile device used in accessing the health information, as well as the location where the healthcare is administered. This combination results in significant improvements in overcoming security related concerns compared to the traditional identity-based only access control techniques. The improvements in the security of the remote monitoring systems are achieved by providing extra protective features to the access control and authorization process before the release of any data over unsecured networks. For verification purposes, a mobile application is developed. This application gives healthcare professionals secure remote access to the EHR of the monitored elderly patients. These experimental works confirm that by applying the proposed trust negotiation approach, the expected analysis results can be achieved. The developed application is also practical and easy to adopt, as users are not required to have any additional knowledge or expertise in the use of the underlying technologies. This is also important, as in general, most healthcare professionals cannot be considered as experts in network security areas.

Thesis (Ph. D.)--Florida State University, 2006.
Advisor: Robin E. Perry, Florida State University, College of Social Work. Title and description from dissertation home page (viewed June 13, 2006). Document formatted into pages; contains ix, 162 pages. Includes bibliographical references.

Sze Pan Ching.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (leaves 162-178).
Abstracts in English and Chinese.
ABSTRACT --- p.i
ABSTRACT (IN CHINESE) --- p.iv
ACKNOWLEGEMENT --- p.vi
TABLE OF CONTENTS --- p.viii
LIST OF FIGURES --- p.xv
LIST OF TABLES --- p.xviii
LIST OF APPENDIX --- p.xx
LIST OF ABBREVIATIONS --- p.xxi
LIST OF DEFINITIONS OF TERMS --- p.xxii
Chapter I. --- INTRODUCTION --- p.1
Chapter 1.1 --- Epidemiology of hip fracture among elderly worldwide --- p.1
Chapter 1.2 --- Impact of hip fractures --- p.3
Chapter 1.2.1 --- Mortality --- p.3
Chapter 1.2.2 --- Hospitalization and institutionalization --- p.4
Chapter 1.2.3 --- Morbidity --- p.4
Chapter 1.2.4 --- Psychological impact and quality of life --- p.5
Chapter 1.2.5 --- Financial burden --- p.6
Chapter 1.3 --- Causes of hip fracture --- p.6
Chapter 1.3.1 --- Mechanisms of hip fracture --- p.7
Chapter 1.3.2 --- Degenerated protective mechanism --- p.8
Chapter 1.3.3 --- Poor hip strength indices --- p.9
Chapter 1.4 --- Prevention of hip fractures --- p.10
Chapter 1.4.1 --- Reduction of the chance of lateral fall --- p.10
Chapter 1.4.2 --- Increase hip strength indices --- p.11
Chapter 1.4.3 --- Limitations of current strategies --- p.12
Chapter 1.5 --- Hip protectors for prevention of hip fractures --- p.12
Chapter 1.6 --- Effectiveness of hip protector --- p.14
Chapter 1.6.1 --- Laboratory studies on effectiveness in force attenuation --- p.14
Chapter 1.6.2 --- Clinical studies on prevention of hip fractures --- p.16
Chapter 1.6.3 --- Cost-effectiveness study --- p.17
Chapter 1.7 --- Problems on the use of hip protectors --- p.19
Chapter 1.7.1 --- Discomfort --- p.19
Chapter 1.7.2 --- Extra effort in wearing --- p.20
Chapter 1.7.3 --- Appearance after wearing --- p.21
Chapter 1.7.4 --- Urinary incontinence --- p.22
Chapter 1.7.5 --- Oth er problems --- p.23
Chapter 1.8 --- Acceptance and Compliance of hip protectors --- p.23
Chapter 1.8.1 --- Acceptance --- p.23
Chapter 1.8.2 --- Compliance --- p.24
Chapter 1.9 --- Strategies to improve compliance of hip protector --- p.25
Chapter 1.9.1 --- Better design of hip protector --- p.25
Chapter 1.9.2 --- Encouragement/support to the user --- p.26
Chapter 1.9.3 --- Support from nursing staff/carer --- p.27
Chapter 1.10 --- Rationale and objectives of present study --- p.28
Chapter II. --- METHODOLOGY --- p.36
Chapter 2.1 --- Development of hip protector --- p.36
Chapter 2.1.1 --- Design of the pads --- p.36
Chapter 2.1.2 --- Design of the pants --- p.38
Chapter 2.1.2.1 --- Fabric materials --- p.38
Chapter 2.1.2.2 --- Anthropometric measurement --- p.42
Chapter 2.1.2.3 --- Pattern design --- p.43
Chapter 2.1.3 --- Trial use of hip protector --- p.43
Chapter 2.1.4 --- Calculation and statistical method --- p.43
Chapter 2.2 --- Mechanical test on force attenuation properties --- p.44
Chapter 2.2.1 --- Testing system --- p.44
Chapter 2.2.2 --- Simulation of impact force and identification of dropping height --- p.45
Chapter 2.2.3 --- Testing method --- p.46
Chapter 2.2.4 --- Calculation and statistical method --- p.47
Chapter 2.3 --- Compliance study --- p.47
Chapter 2.3.1 --- Setting --- p.47
Chapter 2.3.2 --- Subjects --- p.48
Chapter 2.3.3 --- Study design --- p.49
Chapter 2.3.4 --- Implementation procedure and intervening Program --- p.49
Chapter 2.3.4.1 --- Liaison with the heads and responsible staff in the elderly hostels --- p.49
Chapter 2.3.4.2 --- Education program for hostel staff --- p.50
Chapter 2.3.4.3 --- Education program for elderly subjects --- p.50
Chapter 2.3.4.4 --- Fall and fracture risk counseling --- p.51
Chapter 2.3.4.5 --- Consent and Ethical approval --- p.51
Chapter 2.3.4.5 --- Provision of hip protector and training program on wearing hip protector --- p.51
Chapter 2.3.4.6 --- Follow up and encouragement on the use of hip protector --- p.52
Chapter 2.3.5 --- Outcome measures --- p.52
Chapter 2.3.5.1 --- Primary outcome --- p.52
Chapter 2.3.5.2 --- Secondary outcomes --- p.53
Chapter 2.3.6 --- Measurement method --- p.55
Chapter 2.3.6.1 --- Compliance --- p.55
Chapter 2.3.6.2 --- Falls and fractures incidence --- p.56
Chapter 2.3.6.3 --- Adverse effect and feedback after wearing hip protector --- p.56
Chapter 2.3.6.4 --- Fear of fall --- p.57
Chapter 2.3.6.5 --- Fall and fracture history --- p.57
Chapter 2.3.6.6 --- Medical co-morbidities --- p.58
Chapter 2.3.6.7 --- Presence of urinary incontinence --- p.58
Chapter 2.3.6.8 --- Functional level --- p.58
Chapter 2.3.6.9 --- Hand function --- p.58
Chapter 2.3.6.10 --- Mobility --- p.59
Chapter 2.3.6.11 --- Cognitive function --- p.59
Chapter 2.3.7 --- Sample size calculation --- p.59
Chapter 2.3.8 --- Calculation and Statistical method --- p.60
Chapter III. --- RESULTS --- p.73
Chapter 3.1 --- Design of hip protector --- p.73
Chapter 3.1.1 --- The design of pants --- p.73
Chapter 3.1.1.1 --- The fabric materials --- p.73
Chapter 3.1.1.2 --- The size of the pants --- p.74
Chapter 3.1.2 --- The design of pads --- p.75
Chapter 3.1.2.1 --- Thickness of silicon padding --- p.75
Chapter 3.1.1.2 --- Dimension of the hard shield --- p.75
Chapter 3.2 --- Mechanical test on force attenuation properties of the pads --- p.76
Chapter 3.2.1 --- Impact force --- p.76
Chapter 3.2.2 --- Impact duration --- p.78
Chapter 3.2.3 --- Selection of th e prototype --- p.78
Chapter 3.3 --- Compliance study --- p.79
Chapter 3.3.1 --- Demograph ics --- p.79
Chapter 3.3.2 --- Primary outcome --- p.79
Chapter 3.3.2.1 --- Initial acceptance rate --- p.79
Chapter 3.3.2.2 --- Compliance rate --- p.79
Chapter 3.3.2.3 --- Percentage of people wearing hip protector across the study period --- p.81
Chapter 3.3.2.4 --- Percentage of protected fall --- p.81
Chapter 3.3.3 --- Secondary outcomes --- p.81
Chapter 3.3.3.1 --- Fall and related injury among the subjects in the study period --- p.81
Chapter 3.3.3.2 --- Reasons for non-acceptance --- p.82
Chapter 3.3.3.3 --- Feedback in using hip protector --- p.84
Chapter 3.3.3.4 --- Factors associated with compliance and non-compliance (feedback in wearing hip protector) --- p.84
Chapter 3.3.3.5 --- Factors associated with compliance and non-compliance (subject characteristics) --- p.85
Chapter 3.3.3.6 --- Effect on mobility after wearing hip protector --- p.85
Chapter 3.3.3.7 --- Fear of fall after wearing hip protector --- p.85
Chapter IV. --- DISCUSSION --- p.123
Chapter 4.1 --- Development of a hip protector for Chinese elderly --- p.124
Chapter 4.1.1 --- Successful modifications made to the pads --- p.124
Chapter 4.1.1.1 --- More comfort to wear with silicon cushioning materials added --- p.124
Chapter 4.1.1.2 --- Better mechanical properties with semi-flexible plastic and silicon pad --- p.125
Chapter 4.1.1.3 --- Smaller in dimension of the present model might improve appearance after wearing --- p.127
Chapter 4.1.2 --- No significant improvement on compliance with modification of the pants --- p.128
Chapter 4.2 --- Sufficient mechanical properties of hip protector demonstrated --- p.129
Chapter 4.2.1 --- Mechanical test set up --- p.130
Chapter 4.2.2 --- Mechanism of force attenuation --- p.132
Chapter 4.3 --- No significant improvement on compliance shown --- p.134
Chapter 4.4 --- Compliance at night time better than other studies --- p.136
Chapter 4.5 --- Determinants of compliance mostly related to subjects' feedback of using hip protector rather than on their characteristics --- p.137
Chapter 4.6 --- Better compliance observed in hostel with higher staff-to-subject ration and with occupational therapist as contact person --- p.138
Chapter 4.7 --- Better acceptance rate of hip protector shown in the present study --- p.139
Chapter 4.8 --- Identification of factors influencing acceptance --- p.139
Chapter 4.9 --- Percentage of protected fall was higher than mean compliance --- p.141
Chapter 4.10 --- No hip fracture occurred while subjects wearing hip protector --- p.141
Chapter 4.11 --- Decreased fear of falling after wearing hip protector --- p.142
Chapter 4.12 --- Limitation --- p.142
Chapter 4.13 --- Recommendation --- p.143
Chapter V. --- CONCLUSION --- p.146
Chapter VI. --- APPENDIX --- p.148
Chapter VII. --- BIBLIOGRAPHY --- p.162
Chapter VIII. --- PUBLICATIONS --- p.179

The use of neuroleptic drugs to mediate the behaviour of people with dementia living in care homes can lead to them being deprived of their liberty. Whilst regulation has been successful in reducing neuroleptic prescribing in the USA, policy guidance has been unsuccessful in reducing the use of these drugs in the UK. Yet the Mental capacity act 2005 aimed to protect the liberty of people lacking capacity and provided safeguards to ensure that they are not inappropriately deprived of their liberty in institutions. This article highlights the potential for using this law to identify when neuroleptic prescribing in care homes would deprive people with dementia of their liberty and, in turn, to act as a check on prescribing levels. However, the extent to which the Act can promote and protect the right to liberty of people with dementia is constrained by a lack of access to social rights.