Rozprawy doktorskie: „Geriatric research”

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Hast, Angelica, i Ann Björkas. "Äldre patienters upplevelser av vården på en geriatrisk vårdavdelning : En intervjustudie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-304329.

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Bakgrund: Svensk statistik tyder på att antalet multisjuka äldre kommer att öka. Hälso- och sjukvårdslagen stadgar att vården skall vara av god kvalitet och tillgodose patienternas behov av trygghet. I dagens samhälle föreligger en risk att äldre människor utsätts för ålderism, vilken kan påverka vårdens kvalitet och orsaka ett lidande för de äldre patienterna. Syfte: Att beskriva äldre patienters upplevelser av vården på en geriatrisk vårdavdelning i Mellansverige. Metod: Latent kvalitativ innehållsanalys av tolv semistrukturerade intervjuer. Resultat: Resultatet utgörs av två teman och sju subteman. Temat Upplevelser av att få en god vård beskriver att de äldre patienterna upplevde sig få en vårdande miljö samt att vårdpersonalen fungerade som en hälsoresurs vilket kunde gynna patienternas välbefinnande. Temat belyser att ett gott bemötande och att få bli sedd som en person resulterade i positiva känslor samt att delaktighet och självbestämmande var viktiga faktorer. Temat Upplevelser av att få en bristande vård beskriver att upplevelser av en otrygg omgivning och avsaknad av sjukdomshänsyntagande, bristande bemötande och kunskap samt att inte få en personcentrerad vård resulterade i negativa känslor. Slutsatser: Resultatet visar att det förekommer både positiva och negativa upplevelser av vården på avdelningen. Att de äldre patienterna upplever brister i vården uppmärksammar att det finns en risk för att ålderism existerar och påverkar vårdens kvalitet. Examensarbetet kan tillföra kunskap om och förståelse för hur äldre patienter upplever vården, vilket kan bidra till bättre förutsättningar för en god vårdupplevelse.
Background: Swedish statistics indicate that there will be an increase in the number of elderly with multiple illnesses. The Health Care Act stipulates that the care provided must be of good quality and meet the patients’ needs for security. In today's society there is a risk that older people are subjected to ageism, which can affect the quality of healthcare and expose the older patients to conditions of suffering. Aim: To describe older patients’ experiences of healthcare at a geriatric ward in central Sweden. Methods: A latent qualitative content analysis of twelve semi-structured interviews. Results: The results consist of two themes and seven subthemes. The theme Experiences of getting good health care describes that when older patients experienced a nurturing environment and the caregivers worked as a health resource, it could benefit the patients’ wellbeing. The theme emphasizes that encountering a good reception and being aknowledged as a person resulted in positive emotions, and that participation in the care process and self-determination were key factors. The theme Experiences of receiving a lack of care describes that the experience of an unsafe environment, actual diseases not being taken into account, lack of treatment and knowledge, as well as being denied person-centered care, resulted in negative emotions. Conclusions: The results indicate that both positive and negative resposnses concerning the care at the ward are experienced. The older patients who experience deficiencies in healthcare, recognize that there is a risk that ageism exists, which may affect the quality of care. The thesis provides knowledge and understanding of how older patients experience healthcare which can contribute to better conditions for the patients, in order for them to experience good healthcare.

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Azmi, Sabiha. "Research into the attitudes, perceptions and circumstances of Asian elders with respect to health and old age : a stress and coping perspective". Thesis, Bangor University, 1999. https://research.bangor.ac.uk/portal/en/theses/research-in-to-the-attitudes-perceptions-and-circumstances-of-asian-elders-with-respect-to-health-and-old-age--a-stress-and-coping-perspective(3d80fb88-9f16-44e7-a2b9-9a92da015ed4).html.

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Research into the health needs of Asian elders has been scarce, that which does exist has lacked a theoretical framework. A first attempt is made in the present research study to relate the literature on race and ethnicity to theory and practice in gerontology. A stress and coping model from the gerontological literature was adapted to account for outcomes of physical/psychological health and well-being amongst south Asian elders. In order to test the applicability of this model the first aim of the study was to gain an insight into the circumstances and situations of Asian elders on a range of demographic, support, health and well-being factors. And then-secondly, to see how these factors may interrelate according to the stress and coping model. A range of specific hypotheses were formulated on the basis of this model. Data were collected using semi-structured interviews conducted with a community sample of 70 South Asian elders who were 55 years and over. The interview schedule consisted of both standardised measures of health, stress and coping as well as structured questions on the use of formal/informal support, satisfaction with life and attitudes towards old age. Data were analysed in two phases. The results from the first phase which were largely descriptive, suggest that a significant number of Asian elders were living either alone or with their spouse. In general Asian elders were living in circumstances of material disadvantage, suffering from poor health and chronic illnesses, reporting high levels of psychological distress with little formal and informal support. Awareness and receipt of specialist support services for older adults was low. The results from the second phase involving analyses of correlations and regressions, indicate significant correlations between outcome measures of health/mental health and satisfaction with life with measures of coping, appraisals and to some extent resource variables. There were also significant correlations between positive/negative outcomes of health and well-being with positive/negative ways of coping, appraisal and some resource variables. The factor associated most strongly with outcome variables was social support (resource) rather than coping. Overall, the stress and coping model appears to account well for most of the research findings. The results were discussed in relation to previous research literature and implications for future research and clinical practice were discussed.

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Glasson, Janet Barbara. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process /". View Thesis, 2004. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20050706.140432/index.html.

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Larsson, Mauleon Annika. "Care for the elderly : a challenge in the anaesthesia context /". Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-209-8/.

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Glasson, Janet, University of Western Sydney, College of Social and Health Sciences i of Nursing Family and Community Health School. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process". THESIS_CSHS_NFC_Glasson_J.xml, 2004. http://handle.uws.edu.au:8081/1959.7/481.

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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge.
Master of Health Science (Hons)

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Paasivaara, L. (Leena). "Tavoitteet ja tosiasiallinen toiminta:suomalaisen vanhusten hoitotyön muotoutuminen monitasotarkastelussa 1930-luvulta 2000-luvulle". Doctoral thesis, University of Oulu, 2003. http://urn.fi/urn:isbn:9514269012.

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Abstract The purpose of this study was to describe and understand the evolution of the content and characteristics of Finnish geriatric nursing from the 1930s till the 2000s. The research approach was based on three underlying assumptions: historicity, multi-level analysis and the dimensions of goals and actual practice. Historicity implied both a long-term analysis of the phenomenon and the use of historical methodology. Multi-level analysis implied that the phenomenon was analyzed at both a macro-level and a micro-level. The macrolevel consisted of the societal geriatric policies (level I). The micro-level was divided into functional environments comprising the municipal context (level II) and nursing organizations (level III) as well as the nursing practice (level IV). The focal aim in the multi-level analysis was to compare the goals (at levels I-III) to the actual practice (level IV). The underlying theoretical premises of the multi-level analysis consisted of system-oriented thinking, and the data were organized in terms of the guidance model. The evolution of geriatric nursing was analyzed on the basis of official documents at the level I, the municipal documents of three municipalities in northern Finland at the level II, the documents of geriatric nursing organizations in selected municipalities at the level III, and retrospective knowledge of nursing aids and assistants and practical nurses at the level IV. In addition to this, contemporary material as well as relevant literature, magazines and research findings were used to shed light on the historico-sociocultural context. The manner of reading applied was systematic interpretation, which allowed the macro- and micro-level information of geriatric nursing in different historical periods to be integrated into a comprehensible whole. The study highlighted the basic dimensions of both goals and actual practice. Using a theoretical societal frame of analysis, they were combined into the general guidelines of geriatric nursing: the retaining nursing of the activation stage (1930-1950), the collective nursing of the preliminary stage (1950-1970), the individual nursing of the revitalizing stage (1970-1990) and the balancing nursing of the renovative stage (1990-). The findings indicated that the evolution of geriatric nursing was shaped by the goal-oriented dimensions of the geriatric policies, the municipal organizations and the functional contexts of the nursing organizations as well as the nurses' role in the actual practice. The findings also indicated that the goals defined in geriatric policies were implemented in the actual nursing practice with some delay. The purpose of the study was to produce synthesizing basic nursing research. It thus opened up a new perspective into the research questions motivated by nursing science. The findings can also be utilized in efforts to understand the value and knowledge base of geriatric nursing and in nurse education. In order to be able to develop nursing further, it is important not to approach nursing as a separate phenomenon, but to integrate it into a wider historico-sociocultural analysis. The methodological solutions made here can also be applied to other nursing research
Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla ja ymmärtää suomalaisen vanhusten hoitotyön sisällön ja luonteen muotoutumista 1930-luvulta 2000-luvulle. Tutkimuksen tarkastelunäkökulmana oli kolme perusolettamusta: historiallisuus, monitasoisuus sekä tavoitteiden ja tosiasiallisen toiminnan ulottuvuudet. Historiallisuus viittasi sekä ilmiön tarkasteluun pitkällä aikavälillä että historialliseen tutkimusmenetelmään. Monitasoisuus liitti ilmiön tarkastelun makro- ja mikrotasoille. Makrotason muodosti yhteiskunnallinen vanhuspolitiikka (I-taso). Mikrotaso jakaantui kunnalliseen (II-taso) ja hoito-organisaatioiden (III-taso) muodostamiin toimintaympäristöihin sekä käytännön hoitotyöhön (IV-taso). Monitasotarkastelun lävistävänä näkökulmana oli heijastaa tavoitteellisia ulottuvuuksia (I-III-taso) käytännön tosiasialliseen toimintaan (IV-taso). Tutkimuksen väljänä monitasotarkastelua ohjaavana teoreettisena lähtökohtana oli systeemiajattelu ja jäsennyksenä toimi ohjausmalli. Vanhusten hoitotyön muotoutumista haettiin I-tasolla virallisten dokumenttien, II-tasolla kolmen pohjoissuomalaisen kunnan kunnallisten asiakirjojen, III-tasolla valittujen kuntien vanhusten hoito-organisaatioiden dokumenttien sekä IV-tasolla apu-, perus- ja lähihoitajien muistitiedon avulla. Tämän lisäksi ajan historiallis-sosiokulttuurisen kontekstin ymmärtämiseksi hyödynnettiin aikalaisaineiston ohella myös ilmiötä koskevaa kirjallisuutta, aikakauslehdistöä ja tutkimustietoa. Tutkimuksen luentatapana oli systematisoiva tulkinta, jonka avulla integroitiin makro- ja mikrotason tiedot vanhusten hoidosta eri aikakausilta yhteen ymmärrettäväksi kokonaisuudeksi. Tutkimus tuotti sekä tavoitteellisten että tosiasiallisen toiminnan ulottuvuuksien peruslinjat. Näistä muodostettiin teoreettista yhteiskunnallista jäsennyskehystä hyödyntäen hoitotyön yleiset kehityslinjat: aktivointivaiheen säilyttävä hoitotyö (1930-1950), luonnosteluvaiheen kollektisoiva hoitotyö (1950-1970), elävöittämisvaiheen yksilöllinen hoitotyö (1970-1990) sekä uudentamisvaiheen tasapainoileva hoitotyö (1990-). Tutkimus osoitti, että hoitotyön muotoutumiseen vaikuttivat vanhuspolitiikan, kunnallisen ja hoito-organisaatioiden toimintaympäristöjen tavoitteelliset ulottuvuudet sekä hoitajan rooli tosiasiallisessa toiminnassa. Tuloksista kävi ilmi, että vanhuspolitiikan tavoitteet heijastuivat hoitotyön tosiasialliseen toimintaan viiveellä. Tutkimuksen ideana oli tuottaa kokoavaa hoitotieteellistä perustutkimusta. Tutkimus avasi siten uutta näkökulmaa hoitotieteen tieteenalasta nouseviin tutkimuskysymyksiin. Tuloksia voidaan hyödyntää myös vanhusten hoitotyön arvo- ja tietoperustan ymmärtämiseen sekä hoitotyön opetukseen. Hoitotyön edelleen kehittämisen kannalta on tärkeää, että hoitotyötä ei tarkastella vain yksittäisenä ilmiönä, vaan se liitetään laajempaan ajan historiallis-sosiokulttuuriseen tarkasteluun. Tutkimuksen menetelmällisiä ratkaisuja voidaan soveltaa myös muissa hoitotieteellisissä tutkimuksissa

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Boström, Anne-Marie. "Evidence-based care of older people - utopia or reality? : healthcare personnel's perceptions of using research in their daily practice /". Stockholm : Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-385-6/.

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Hickman, Louise D. "Patients, carers and nurses collaborators in development of a new model of nursing care for older persons in the acute care setting /". View thesis, 2007. http://handle.uws.edu.au:8081/1959.7/37238.

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Thesis (Ph.D.)--University of Western Sydney, 2007.
A thesis presented to the University of Western Sydney, College of Health and Science, School of Nursing, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

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Hickman, Louise D. "Patients, carers and nurses : collaborators in development of a new model of nursing care for older persons in the acute care setting". Thesis, View thesis, 2007. http://hdl.handle.net/1959.7/uws:48031.

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Globally the population is ageing and as a consequence people are living longer with multiple chronic conditions. A range of factors, including decreased lengths of hospital stay and a greater focus on community based care, has led to an increasing acuity of patients admitted to acute care settings, many with complex care needs. To date, models of nursing care in acute settings have been configured to focus on acute, procedural care and do not meet the unique needs of the older person. In order to ensure optimal health outcomes of older hospitalised people, nursing care needs to be responsive to the priorities and needs of patients and their families. This study sought to collaboratively develop a model of nursing care with nurse clinicians to improve the care of older people in the acute care setting. Model development was driven by an action research framework, using evidence-based principles and a comprehensive needs assessment. A three phased, mixed method design was embedded within the overarching conceptual and philosophical framework of action research. The first phase of the study comprised a needs assessment and allowed appraisal of the needs of patients as perceived by patients, carer’s and nurses, this was performed using the Caring Activity Scale [CAS]. Qualitative data and semi-structured interviews added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. Managing the discharge process and carer burden arose mainly from the carer semi-structured interviews only. Data revealed significant differences between patients, carer’s and nurses in relation to priority and satisfaction with care. Patients did not place a large importance on discharge care which contrasted with the focus of nursing initiatives. During the subsequent phases of the study a collaborative approach, using action research principles, was used to develop and implement a model of nursing care. A key feature of this model was the introduction of a team structure with a focus on patient centred care. Significant differences were identified in the pre model and post model patient groups in relation to satisfaction with care, with the post model group more satisfied than the pre group model group. Further, improvements in functional status and medication knowledge were demonstrated among patients cared for under the new model. This study has demonstrated that developing a model of care appropriate to the needs of patients, carer’s and nurses can be achieved through the use of action research principles. Study data illustrates the importance of collaboration, empowerment and change management principles in driving clinical improvement and patient satisfaction with care. The findings also underscore the importance of promoting and educating patients and carers as well as nurses about the importance of discharge planning to optimise post-discharge health outcomes.

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Monteiro, Edilene Araújo. "Validação do Questionário de Avaliação da Sobrecarga do Cuidador Informal em um amostra de cuidadores brasileiros". Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-21052014-154833/.

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O envelhecimento populacional no Brasil tem sido influenciado pela transição demográfica e epidemiológica. Em consequência, prevalecem as doenças crônicas e ocorre um decréscimo na capacidade funcional do idoso. É quando surge a necessidade do cuidador no contexto das famílias. Os objetivos deste estudo metodológico foram adaptar para uso no Brasil o Questionário de Avaliação da Sobrecarga do Cuidador Informal (QASCI) e analisar as propriedades psicométricas em uma amostra de cuidadores informais de idosos. O QASCI é composto por 32 itens cujas respostas são obtidas em valores que variam de um a cinco e integra sete domínios: Implicações na vida pessoal; Satisfação com o papel e com o familiar; Reações a exigências; Sobrecarga emocional; Apoio familiar; Sobrecarga financeira e Percepção dos mecanismos de eficácia e de controle. O escore total varia de 32 a 160, e quanto maior o valor, maior a sobrecarga. O processo de adaptação seguiu os passos metodológicos, conforme preconizado pela literatura: adaptação semântica, avaliação pelo comitê de juízes, análise semântica dos itens, obtenção da versão final e análise das propriedades psicométricas. Os dados foram coletados mediante entrevistas domiciliares, no período de setembro de 2012 a fevereiro de 2013, nas áreas cadastradas das Equipes de Saúde da Família do município de João Pessoa-PB. Participaram do estudo 132 cuidadores de idosos que apresentavam alguma dependência funcional. A validade de constructo convergente do QASCI foi avaliada com testes de correlação de Pearson entre as medidas de sobrecarga e de constructos correlatos (ansiedade e depressão); análise fatorial confirmatória (dimensionalidade) e teste para comparação de grupos conhecidos (idade, tempo de cuidado, nível de dependência); e a confiabilidade foi avaliada pela consistência interna de seus itens (alfa de Cronbach). O nível de significância adotado foi de 0,05. A maioria dos participantes era do sexo feminino (87,1%), casados (47,7%), com idade média de 50 anos e oito anos de escolaridade. Quanto ao grau de parentesco com o idoso, 63% eram filhos, e 14%, cônjuges. Cerca de 89% dos cuidadores residiam com o idoso, apresentavam média de sete anos de tempo de cuidado, e 39% não contavam com ajuda no cuidado ao idoso. Quanto às propriedades avaliadas, em relação à validade de constructo convergente da versão adaptada do QASCI, obtivemos correlação forte entre as medidas de sobrecarga e de depressão (r=0,61; p=0,001) e correlação moderada entre as medidas de sobrecarga e de ansiedade (r=0,50, p=0,001) (validade convergente). Na comparação das medidas de sobrecarga segundo a idade do cuidador (adultos e idosos) (p=0,046) e classificação da dependência do idoso (p=0,001), confirmamos nossas hipóteses iniciais. A análise fatorial confirmatória evidenciou bom ajuste do modelo de medida advindo da versão adaptada do QASCI e manteve a estrutura fatorial inicialmente assumida no modelo proposto pelos autores da versão original. Quanto à confiabilidade, obtivemos valor adequado para a consistência interna da versão adaptada do QASCI considerando o total dos itens (?= 0,92) e as dimensões (alfas variando de 0,51 a 0,88). Diante dos resultados, concluímos que a versão adaptada do QASCI atendeu aos critérios de validade e confiabilidade na amostra estudada. Sugerem-se novos estudos a fim de testar essas propriedades em outros grupos de cuidadores brasileiros
Demographic aging in Brazil has been influenced by the epidemiological and demographic transition. As a consequence, chronic diseases prevail and the functional capability of the elderly decreases. That is when the presence of a caregiver in the family context becomes necessary. The objectives of this methodological study were to adapt the Questionnaire for Assessment of Informal Caregiver Burden (QAICB) for its use in Brazil and to analyze psychometric properties in a sample of informal caregivers of elderly individuals. The QAICB is comprised of 32 items whose answers are obtained in values ranging from one to five, integrating seven domains: Implications in personal life; Satisfaction with the role and the family member; Reactions to demands; Emotional burden; Family support; Financial burden and Perception of the mechanisms of efficacy and control. The total score varies between 32 and 160, and the higher the score, the greater the burden. The adaptation process followed the methodological steps recommended in literature: semantic adaptation, evaluation by a committee of judges, semantic analyses of the items, obtainment of the final version and analysis of psychometric properties. Data were collected by means of home interviews, between September of 2012 and February of 2013, in the registered areas of the Family Health Teams of João Pessoa, state of Paraíba. Study participants were 132 caregivers of elderly individuals with some functional dependence. The validity of convergent construct of the QAICB was assessed by means of Pearson\'s correlation tests between the measures of burden and correlated constructs (anxiety and depression); confirmatory factor analysis (dimensionality) and test for comparison of known groups (age, time of care, level of dependence); and the reliability was assessed by the internal consistency of the items (Cronbach\'s alpha). The level of significance adopted was 0.05. Most of the participants were women (87.1%), married (47.7%), with a mean age of 50 years and eight years of education. Regarding the relationship of the caregiver to the elderly, 63% were children, and 14% were spouses. Approximately 89% of the caregivers lived with the elderly, presented a mean time of care of seven years, and 39% did not have any help in the care of the elderly. Regarding the properties evaluated, in relation to the validity of the convergent construct of the adapted version of the QAICB, a strong correlation was found between the measures of burden and depression (r=0.61; p=0.001) and a moderate correlation was observed between the measures of burden and anxiety (r=0.50, p=0.001) (convergent validity). In the comparison of the measures of burden as for the age of the caregiver (adults and elderly) (p=0.046) and the classification of the dependence of the elderly (p=0.001), the initial hypotheses of the authors were confirmed. The confirmatory factor analysis evidenced a good adjustment of the measure model originating from the adapted version of the QAICB and the factor structure initially assumed in the model proposed by the authors of the original version was maintained. As for reliability, an adequate value was obtained for the internal consistency of the adapted version of the QAICB, considering the total of the items (?= 0.92) and the dimensions (alpha varying between 0.51 and 0.88). In light of the results, the adapted version of the QAICB showed compliance with the criteria of validity and reliability in the studied sample. New studies are suggested so as to test these properties in other groups of Brazilian caregivers

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Hebert, Catherine. "An Exploration of Dementia Friendly Communities from the Perspective of Persons Living with Dementia". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etd/3324.

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The growing global prevalence of dementia coupled with a shift in public perception from a hopeless disease to the possibility of living well with dementia has led to the formation of dementia friendly communities (DFC). DFCs are a new phenomenon in the United States, with a gap in knowledge on input from people living with dementia (PLWD). This study investigated DFCs from the perspective of PLWD in Western North Carolina, with the following research questions: How are interactions and relationships experienced by persons living with dementia in the community? How is community engagement experienced by PLWD? To what extent and in what way is the impact of stigma associated with dementia? What are the attributes of a DFC from the perspective of PLWD? Eighteen older adults with reported dementia or memory loss were recruited from support groups or community organizations. Semi-structured interviews were conducted in participants’ homes and analyzed using conventional qualitative content analysis. Three major themes emerged from the transcribed interviews (a) transitions in cognition: vulnerable identities, (b) social connections, and (c) engagement in life activities. The dynamic experience of living with dementia revealed by participants suggested the following attributes of a DFC: (a) social inclusion, (b) support for role continuity, (c) availability of meaningful and contributory activities, (d) flexible support as cognition transitions, (e) community dementia awareness (to combat stigma), and (f) a supportive diagnostic process. The presence of care partners in the interviews was supportive, and the evaluation to sign consent tool assisted in determination of participant capacity to self-consent. The findings were interpreted through the theoretical frameworks of personhood, the social model of disability, human rights and citizenship, the environmental press model, and transitions theory. DFC development requires a contextual lens focused on well-being with input from multiple stakeholders including PLWD. Collaboration among community organizations supported by local, regional, and national policy supporting flexible service provision through cognitive transitions has the potential to provide a strong social network on which to build a DFC.

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Chae, Young Mi Lim. "Development of a behavioral nursing intervention strategy in grooming performance of elders with cognitive impairments". Diss., The University of Arizona, 1993. http://hdl.handle.net/10150/186183.

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The purpose of the study was to develop a behavioral nursing intervention strategy for specific deficits in grooming performance of elders with dementia. A quasi-experimental two-group design using switching replications with removed intervention was employed. Three residents with severe cognitive impairments and three residents with mild cognitive impairments were chosen from a special dementia care unit of a long-term care facility. Three residents among six residents were randomly selected to receive the behavioral intervention early. Baseline and post-intervention assistance was provided by nurse aides. Each resident was asked to wash hands, brush teeth, wash face, and comb hair in a sequence. Ten intervention sessions were conducted by the trained intervener for two consecutive weeks. The intervention consisted systematic prompting and social reinforcement. A total of 21 sessions were collected in the morning using videotape recordings. Interobserver agreement for the instruments designed by the investigator was measured by the trained observers. Data were analyzed in two phases. First, the quantitative data were analyzed to determine the independent functional behaviors of individuals, and the change in the intensity of nursing effort associated with grooming of elders with dementia. Data were examined by individual graphic display throughout the three phases (baseline, nursing intervention, post-intervention). Second, the qualitative data were analyzed to determine the antecedents, consequences, and resident responses associated with grooming, the caregiver problem behaviors, and resident problem behaviors associated with grooming performance. The results show that the functional behaviors of even severely demented elders can be promoted, indicating the effectiveness of nursing care strategies on the ADL task of grooming. The data in this research suggest that maintaining or improving functional ability is possible with a behavioral nursing intervention, which was a highly structured and systematic approach that involved modifying the environmental and behavioral context, through strategies such as prompting and social reinforcement, when necessary. Furthermore, through the qualitative analysis, the functional relationships between antecedents, consequences, and behaviors of demented elders allowed the investigator to analyze the caregiver problem behaviors and resident behavior problems associated with grooming.

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Paliwal, Yoshita. "UNDERSTANDING OVER-THE-COUNTER MEDICATION USE AND DECISION-MAKING AMONG COMMUNITY-DWELLING US OLDER ADULTS: A MIXED-METHODS APPROACH". VCU Scholars Compass, 2017. http://scholarscompass.vcu.edu/etd/5110.

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Introduction Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in this population. Methods Data from the National Social Life, Health, and Aging Project (NSHAP) wave 2 was utilized to examine the prevalence and characteristics of OTC medication use in a nationally representative sample (N=2,637) of community-dwelling US older adults (65 years and older). OTC medication use was characterized based on sociodemographic, intrapersonal, interpersonal, organizational, and community-level factors. Further, a mixed-methods study was conducted in two senior-living communities in Richmond, VA. The qualitative phase of this mixed-methods study used focus group methodology to explore the knowledge, attitude, beliefs, and experiences about OTC medications, and the OTC medication decision-making process in a sample (N=80) of older adults using the criterion sampling strategy of purposeful sampling. Results from the qualitative phase informed the development of a semi-structured questionnaire, which was used to collect data in the quantitative phase of the mixed-methods study. The quantitative phase used in-person interviews to quantify attitudes, beliefs, preferences, and practices associated with the OTC medication use and decision-making process in a different convenient sample (N=88) of older adults within the same settings. Results NSHAP Study: The majority of participants were women (54%), whites (82%), and with an education greater than high school (57%). Study findings indicate a high weighted prevalence (76%) of OTC medication use in a nationally representative sample of older adults. Among older adult men, education (p value=0.0038), race (p value=0.0003) and comorbidity (p value =<0.0001) significantly and independently predicted the OTC medication use. Older adult men who were whites had greater odds of using OTC medication than other races. Older adult men with higher than high school education were 1.54 times more likely (95% CI: 1.15-2.06) to use OTC medications than their counterparts. It was observed that with every unit increase in the number of co-morbid conditions, OTC medication use decreases by 26% (OR: 0.74, 95% CI: 0.65-0.84) among older adult men. Among older adult women, education (p value=0.0244), race (p value=0.0048), smoking (p value=0.0494), and social participation (p value=0.0341) showed a significant and independent association with OTC medication use. Older adult women who were whites and non-smokers had greater odds of using OTC medication than their counterparts. Older adult women with higher than high school education were 1.36 times more likely (95% CI: 1.04-1.79) to use OTC medications than their counterparts. It was observed that with every unit increase in the social participation, OTC medication use increases by 15% (OR: 1.15, 95% CI: 1.01-1.31) among older adult women. Qualitative Study: The majority of the sample were women (63%), whites (54%), and with an education greater than high school (60%). The study indicated that the OTC medications are generally considered very safe and effective for treating minor/routine symptoms by older adults. Brand version OTC medications were generally favored over generics by this sample of US older adults. There were found two types of decision-making scenarios following after the older adults make sense of their symptoms: 1) treatment decision-making and 2) purchase decision-making. The treatment decision-making comes with two approaches: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow physician’s recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person’s financial and healthcare resources, severity of the symptoms, experiences with the medication (past or current), and relationship with the physician. While purchasing OTC medication from the store, the majority of consumers first explore information on the drug-label, ask a pharmacist, compare various options (generic or brand), compare prices/deals, and make a final purchase decision favoring the maximum and fast relief, followed by the lower cost, and easy to swallow dosage forms. Quantitative study: The majority of the sample was women (55%), blacks (61%), and with an education less than or equal to high school (55%). Analgesics were the most (76%) prevalent OTC therapeutic category, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of the participants reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician-recommended use. A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most participants considered OTC medications very safe or safe (80%) and very effective or effective (80%) to use. The majority (79%) of participants felt very satisfied, and 16% felt satisfied with their OTC medication use. Brand name OTC medications were considered more safe and effective compared to generic versions. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source about OTC medications. Conclusions Older adults feel positive and satisfied with their OTC medication use, in general. Considering the self-reported high use, inappropriate use, and experiences of facing side effects, education focused toward older adults should be encouraged to aid in safe and responsible OTC decision-making.

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Kenyon, Gary M. "A philosophical analysis of scientific meanings of aging in psychosocial gerontology". Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/25814.

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This dissertation is concerned with the problem of scientific assumptions as it relates to research in gerontology. There are three major areas emphasized in the thesis. First, there is a consideration of the epistemological conditions that give rise to the problem of assumptions and meanings in science. Secondly, a number of different ways of addressing this issue are discussed and an alternative Hermeneutic approach is explicated. This approach constitutes a particular kind of philosophical analysis and is suggested by the insights of Hans Gadamer. Finally, on the basis of the Hermeneutic approach, two major characterizations of research on adult and gerontological intellectual and social competence are identified, namely, a restricted and an expanded picture. In addition, these two characterizations are further clarified by means of a discussion of the contrasting ontological orientations that are presupposed in the restricted and correspondingly, in the expanded picture. The overall purpose of the thesis is to show that a particular kind of philosophical inquiry assists in the integration of disparate forms of research in psychosocial gerontology. In addition, this procedure provides conceptual support for a different understanding of various phenomena associated with human aging that is emerging in the field, namely, the expanded picture.
Graduate and Postdoctoral Studies
Graduate

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Venturato, Lorraine V. "A practice divided: Registered nurses' experience of policy and reform in residential aged care". Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/36785/1/36785_Digitised%20Thesis.pdf.

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With the increase in the percentage of the population aged over 65 years, there is increased pressure on the health care system and the nursing profession to provide quality, cost effective care to meet this growing demand for aged care services. As a result, residential aged care services in Australia have undergone a period of extensive reform, including policy and funding changes, impacting on all areas of practice. This demand for high quality, cost effective aged care requires both the involvement of committed professionals and the development and implementation of appropriate plans and policy. This study explores the experiences of registered nurses in residential aged care facilities and how these experiences are shaped by government aged care policy and reform. By posing the research questions: How do registered nurses experience everyday practice in residential aged care? and What influence have policy and reform processes had on registered nurses' experience of their everyday practice? this study aims to further develop understanding of aged care practice and the contextual factors that define it. Thus, the purpose of this study is to challenge registered nurses to reflect on their role in residential aged care (what they do), and through examination of policy and reform (why they do it), explore nursing practices and options for service delivery aimed at creating a care environment of excellence for older Australians. The qualitative research methodology designed for this study is based on a critical hermeneutics approach informed by the works of Gadamer and Habermas. Such an approach recognises the historical, contextual and linguistic basis for interpretation and critique. While Gadamer provides direction for the study to reveal an understanding of registered nurses' experiences, Habermas provides insight into the role of critique in understanding the contextual conditions of such experience. Ultimately, this study seeks to make explicit the cultural and political meanings that operate to establish meaning and context in residential aged care in Australia. Fourteen (14) registered nurses practising in both public and charitable residential aged care facilities were interviewed as part of this study. Registered nurses from high, low and mixed care facilities were interviewed in-depth. Journal notes provided insight into assumptions and prejudices involved in interpretation and facilitated the critical examination of practice experiences within the residential aged care context. Findings suggest that residential aged care is a complex and challenging environment, full of tensions, contradictions and frustrations for registered nurses employed within the system. Three aspects of the experiences of aged care practice are revealed in this study: Searching for Value; Dealing with Change; and Dividing Practice. The search for value reveals the tensions registered nurses experience in seeking to reconcile those aspects of practice that construct meaning and value in their everyday practice with dominant social and professional values that fail to acknowledge the value of ageing and aged care. Dealing with change is an everyday aspect of practice for registered nurses as they struggle to redefine their roles and responsibilities within a changing environment. This struggle highlights the tensions that exist between traditional nursing roles and their expanding managerial responsibilities. Registered nurses also identified conflicts in caring as a result of their changing roles, which have resulted in a division of practice. These conflicts in caring contribute to the tensions experienced between registered nurses and other stakeholders in residential aged care in relation to everyday practice and quality of care. Findings indicate that aged care policy and reform have a significant impact on the experiences of registered nurses in residential aged care and contribute to the tensions, challenges and frustrations facing nurses in their everyday practice. These findings indicate that aged care policy and reform processes are integral in the restructuring of practice in residential aged care. This analysis illuminates the ways in which aged care policy constructs the tensions and evident contradictions within registered nurses' roles. Based on these findings, recommendations for practice and further research encourage cooperation between government, service providers and the nursing profession to assist registered nurses to reconcile past, present and future practices in order to redefine practice and meaning in residential aged care.

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Boynewicz, Kara, Deborah Backus, Jennifer Furze, Courtney D. Hall, Michael Thomas Lebec i Michael Anton Tevald. "Finding Your Path: Developing and Implementing a Research Agenda". Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7780.

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Developing and implementing a research agenda can be challenging, but identifying the ultimate destination and defining the intermediate steps along the path are critical. The purpose of this session is to help early-career researchers (including graduate students, postdocs, junior faculty, and those considering transitioning into academics) identify key considerations and strategies for the development and implementation of their own research agenda. The speakers will discuss identifying research topics, designing a strong research program, and building evidence of effectiveness around the agenda. The speakers represent a range of settings and experiences, allowing attendees to appreciate the diversity of types of research agenda that exist within the profession. Attendees will leave the session with specific tools and resources to help them begin to develop a research agenda that will be appropriate for a range of settings.

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Cenzer, Irena [Verfasser], i Helmut [Akademischer Betreuer] Ostermann. "Geriatrics principles in health care of older adults and the use of real-world data in aging-related research / Irena Cenzer ; Betreuer: Helmut Ostermann". München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2020. http://d-nb.info/1221960636/34.

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Berenschot, David. "A Descriptive Study of the Elderly in California Substance Abuse Treatment Programs". CSUSB ScholarWorks, 2017. https://scholarworks.lib.csusb.edu/etd/549.

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As gerontologists may know, there are a great deal of studies and a variety of academic literature on the misuse of alcohol and prescription medication amongst the elderly population. While there is a plethora of information on alcohol and prescription misuse, there is little reported data about the prevalence of other substance misuse experienced by this population. This study aims to help to fill that gap in the data by using quantitative methods to describe the scope of substance abuse of individuals 55-years or older. This study utilizes data from the Treatment Data Set Admission (TEDS-A). The TEDS-A is a public data set which includes admissions data from multiple substance abuse treatment facilities associated with the Substance Abuse and Mental Health Services Association (SAMHSA). This is a regional study, therefore this study focuses only on individuals 55-years or older who have been admitted into substance abuse treatment facilities in the state of California in the year 2014. The TEDS-A is a data set that is supported and conducted by members of SAMHSA. Most of their public data sets, including the TEDS-A, can be accessed on their website (https://www.datafiles.samhsa.gov/study/treatment-episode-data-set-admissions-teds-2014-nid16949). The data available in the TEDS-A involves a number of admission questions, including demographic data, reasons for intake, primary through tertiary substance concerns, questions regarding social status, information on medical insurance, and more. This study looks at the descriptive frequencies of the use of alcohol, crack/cocaine, marijuana/hashish, heroin, other opiates & synthetics, methamphetamine, and other substances. The study includes 13,512 cases, of which 9966 (73.8%) of cases were male, 3539 (26.2%) were female, and 7 (0.1%) were missing and/or invalid. The results of the data suggests that, while alcohol abuse is a problem, those over 55 are admitted into substance abuse clinics for many other reasons, not just alcohol abuse.

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De, Marchi Renato José. "Decisão pela extração dentária e incidência de cáries e perdas dentárias em idosos da coorte de Carlos Barbosa, RS : perspectivas qualitativa e quantitativa". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/143391.

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Introdução: A perda dentária e o edentulismo podem afetar de maneira significativa a saúde bucal e a saúde geral, a qualidade de vida, e a nutrição de idosos. A cárie e a perda dentária têm sido descritas como o resultado de processos que envolvem elementos biológicos, nas superfícies dentárias, e de uma combinação de fatores comportamentais e sociais. Além disso, o contexto histórico no qual os indivíduos estão inseridos influencia seus comportamentos e percepções em relação à saúde bucal. Uma compreensão acerca de comportamentos de saúde demanda a utilização de métodos que permitam explorar a realidade subjetiva destes fatores. Objetivo: Os objetivos deste estudo de métodos quantitativo e qualitativo foram avaliar a associação entre fatores demográficos, socioeconômicos, comportamentais e de saúde e a incidência de Cárie Coronária, Cárie Radicular, e Perda Dentária na amostra estudada, e realizar entrevistas de grupo focal com membros desta amostra para explorar suas percepções acerca da perda dentária. Métodos: Um estudo de coorte foi conduzido com uma amostra aleatória simples de indivíduos com 60 anos ou mais em Carlos Barbosa, RS, entre 2004 e 2008. Entrevistas e exames bucais foram conduzidos com 388 indivíduos dentados na linha de base, e com 273 participantes no seguimento. A incidência de perdas dentárias, cáries coronárias e radiculares e suas associações com variáveis da linha de base foram modeladas com o uso de regressão binomial negativa. Em um segundo momento, informações de natureza qualitativa foram produzidas através de uma séria de oito entrevistas de grupo focal envolvendo 41 idosos, selecionados dos participantes do seguimento do estudo. As discussões de grupo foram moderadas pelo autor, foram gravadas, codificadas e analisadas através do uso da Teoria Fundamentada em Dados. Resultados: Foi observado no modelo multivariável que, ser mais velho; do sexo masculino; viver em área rural; ser casado; ter menor escolaridade; ser fumante; e estar insatisfeito com os serviços de saúde acessados, estiveram associados com a incidência perdas dentárias. Entre as variáveis clínicas, o uso de próteses parciais removíveis e o índice de sangramento gengival foram preditores, enquanto maior taxa de fluxo salivar foi um fator protetor para o desfecho. Com relação às cáries coronárias, no modelo multivariável final foi observado que, ser mais velho; do sexo masculino; viver em área rural; e ser fumante, estiveram associados à sua incidência. Entre as variáveis clínicas, o uso de próteses parciais removíveis foi um preditor, enquanto maior taxa de fluxo salivar foi um fator de proteção para este desfecho. No modelo multivariável final tendo como desfecho a densidade de incidência de cáries radiculares, ser mais velho; viver em área rural; e escovar os dentes com frequência menor do que diária, foram preditores; ao passo que a única variável clínica associada ao desfecho foi uma maior taxa de fluxo salivar, como fator de proteção. No segmento qualitativo, as respostas dos participantes permitiram concluir que as perdas dentárias estiveram relacionadas com a falta de programas de saúde bucal; normas sociais (incluindo valores relativos ao gênero); nível limitado de informações de saúde; e reduzidas acessibilidade e disponibilidade de serviços odontológicos. Contextos de vulnerabilidade social e programática tiveram um papel fundamental no desenvolvimento de normas e valores sociais e comportamentos individuais que resultaram em extrações dentárias. Conclusão: Estes achados são importantes, porque compreender as relações causais entre práticas individuais como higiene bucal, hábito de fumar, e procura por cuidados odontológicos preventivos, e perdas dentárias, não elucida as razões para as pessoas assumirem tais comportamentos.
Introduction: Tooth loss and edentulism may have a negative impact in the oral and general health, in the quality of life, and nutrition of the elderly. Dental caries and tooth loss have been described as results of processes involving biologic factors, on the surfaces of the teeth, and of a combination of behavioral and social factors. Furthermore, the historical context in which people are placed influences their behaviors and perceptions towards oral health. The understanding of health behaviors requires the use of methods which allow for the exploration of the subjective reality of those factors. Objective: The objectives of this study using quantitative and qualitative methods were to evaluate the association between demographic, socioeconomic, behavioral and health factors and the incidence of tooth loss, coronal and root caries in the studied sample. Also, to carry on focus groups interviews with members from the sample to explore their perceptions about tooth loss. Methods: A cohort study was conducted with a simple random sample of subjects 60 years old or older in Carlos Barbosa city, southern Brazil, between the years of 2004 and 2008. Interviews and oral examinations were conducted with 388 dentate subjects at baseline, and 273 participants at follow-up. The incidence of tooth loss, coronal and root caries and their association with baseline variables were modeled with the use of negative binomial regression. Following the quantitative part of the study, information of qualitative nature was obtained through a series of eight focus groups, involving 41 participants, purposefully selected from those participating in the follow-up. The focus groups discussions’ were moderated by the author, were recorded, coded and analyzed through the use of Grounded Theory. Results: In the multivariate model it was observed that, older age; male gender; living in a rural area; being married; less schooling; being a current smoker; and being dissatisfied with the health services accessed, were associated with the incidence of tooth loss. Among clinical variables, the use of removable partial dentures, and the gingival bleeding index were predictors, whereas higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the incidence of coronal caries, in the multivariate model it was found that, older age; male gender; living in a rural area; and being a current smoker, were associated with the outcome. Among clinical variables, the use of removable partial dentures was a predictor, whereas a higher stimulated saliva flow was a protective factor for the outcome. In the final model, for the outcome defined as the incidence density of new root caries, it was observed that, older age; living in a rural area; and brushing less than daily were predictors, whereas a higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the qualitative part of the study, the answers of the participants allowed for the conclusion that tooth extractions had been related, in the past, with the lack of oral health problems; social norms (including social values related to gender); low level of health information; and limited accessibility and availability of dental services. Contexts of social and programmatic vulnerability played a major role in the development of social norms and individual behaviors which resulted in tooth extractions. Conclusion: These findings are important, because understanding the causal relations between individual behaviors such as oral hygiene, smoking, and the pursuing of preventive dental care, do not elucidate why people engage in such behaviors.

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Wright-St, Clair Valerie A. "'Being aged' in the Everyday: uncovering the meaning through elders' stories". Thesis, University of Auckland, 2008. http://hdl.handle.net/2292/3080.

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It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

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Psoinos, Charles M. "Predictors of Post-injury Mortality in Elderly Patients with Trauma: A Master's Thesis". eScholarship@UMMS, 2016. http://escholarship.umassmed.edu/gsbs_diss/863.

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Background: Traumatic injury remains a major cause of mortality in the US. Older Americans experience lower rates of injury and higher rates of death at lower injury severity than their younger counterparts. The objectives of this study were to explore pre-injury factors and injury patterns that are associated with post-discharge mortality among injured elderly surviving index hospitalization. Methods: We queried a 5% random sample of Medicare beneficiaries (n=2,002,420) for any hospitalization with a primary ICD-9 diagnosis code for injury. Patients admitted without urgent/emergent admission were excluded, as well as patients presenting from inpatient hospitalization or rehabilitation. The primary endpoint was all-cause mortality. Patients were categorized into three mortality groups: death within 0-30 days, 31-90 days, or 91- 365 days post-discharge from the index hospitalization. These groups were compared with those who survived greater than one year post-discharge. Univariate tests of association and multivariable logistic regression models were utilized to identify factors associated with mortality during the 3 examined periods. Results: 83,439 elderly patients (4.2%) were admitted with new injuries. 63,628 met inclusion criteria. 1,936 patients (3.0%) died during their index hospitalization, 2,410 (3.8%) died within 0-30 days, 3,084 (4.8%) died within 31-90 days, and 5,718 (9.0%) died within 91- 365 days after discharge. In multivariable adjusted models, advanced age, male sex, and higher Elixhauser score were associated with post-discharge mortality. The presence of critical injury had the greatest effect on mortality early after injury (0-30 days, OR 1.81, CI 1.64-2.00). Discharge to anywhere other than home without services was associated with an increased odds of dying. Conclusions: Socio-demographic characteristics, disposition, and co-morbid factors were the strongest predictors of post-discharge mortality. Efforts to reduce injury-related mortality should focus on injury prevention and modification of co-morbidities.

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Thomason, Danae Katherine Standley Jayne M. "Evidence-based research for the geriatric population". Diss., 2007. http://etd.lib.fsu.edu/theses/available/etd-10252007-122919/.

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Thesis (M.M.) Florida State University, 2007.
Advisor: Jayne Standley, Florida State University, College of Music. Title and description from dissertation home page (viewed 4-1-2008). Document formatted into pages; contains 49 pages. Includes biographical sketch. Includes bibliographical references.

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Krishnan, Anand. "MINING CAUSAL ASSOCIATIONS FROM GERIATRIC LITERATURE". 2013. http://hdl.handle.net/1805/3416.

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Indiana University-Purdue University Indianapolis (IUPUI)
Literature pertaining to geriatric care contains rich information regarding the best practices related to geriatric health care issues. The publication domain of geriatric care is small as compared to other health related areas, however, there are over a million articles pertaining to different cases and case interventions capturing best practice outcomes. If the data found in these articles could be harvested and processed effectively, such knowledge could then be translated from research to practice in a quicker and more efficient manner. Geriatric literature contains multiple domains or practice areas and within these domains is a wealth of information such as interventions, information on care for elderly, case studies, and real life scenarios. These articles are comprised of a variety of causal relationships such as the relationship between interventions and disorders. The goal of this study is to identify these causal relations from published abstracts. Natural language processing and statistical methods were adopted to identify and extract these causal relations. Using the developed methods, causal relations were extracted with precision of 79.54%, recall of 81% while only having a false positive rate 8%.

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李思瑩. "Resilience and Leisure Activity in Sarcopenia Geriatric Population With Heart Disease-A Trajectory Research". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/qmqdd9.

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博士
國立臺北護理健康大學
護理研究所
106
Abstract Background: Sarcopenia is an important factor affecting the health status for the geriatric population, and the proportion of elderly people suffering from chronic diseases is relatively high. The study of the psychology and leisure activity of elderly patients with sarcopenia combined with heart disease is insufficient. There is insufficient evidence for the findings of changes in mental state and leisure activity. Therefore, the relationship between resilience and leisure activity of this ethnic group and long-term trajectory trends are explored. Purpose: To examine the relationship between resilience and leisure activity in elderly people with sarcopenia combined with heart disease and change long-term trajectory. The first stage of the research project (systematic literature review phrase):review of resilience and leisure activity literature reviewing results, the second stage of the research project (long-term trajectory): tracking longitudinal tracking studies, detection of longitudinal data tracking for resilience and leisure activity in different time points. Method: This study is a two-stage research project. The first stage is the review and analysis of systematic literature, and analyzes the related variables of physical activity and resilience of elderly people in the databases. The second stage of research is the long-term trajectory study. The number of 96 samples was collected at the first outpatient (baseline) after the case was collected. Data collection included analysis of demographics data, resilience, leisure activity, and other variables, and the detection of longitudinal data at different time points (three and six months). Six months later, we discussed the changes of psychological indicators (psychological resilience) and physical activities (leisure activities) in elderly patients with sarcopenia combined with heart disease. Results: The first stage of the study: the review of literature found that physical activity intervention has significant improvement in muscle mass, walking speed, or grip strength for elderly people, and intervention plan include at least two types of exercises, however, the type of exercise, intensity, and duration were no consistency in each research. Besides, the tools for examining the effectiveness after interventions lack of consistency and standardization. The second stage of the study: The subjects of this study were older than 65 years old, more males than females, married, living with family members, education in senior high school, belief in Buddhism, exercise time less than 30 minutes per each time. Chronic diseases are mainly heart diseases and hypertension. The state of resilience was significantly different from gender (p=.02), age (p=.03), and self-care (p<.01). There were significant differences between leisure activity and age (p = .01), significant differences with education (p = .02), and family income and exercise time (p = .01, p < .01). There was a positive correlation between resilience and leisure activity (r=.42, p<.01), and the level of resilience was predictive of the participation rate of leisure activities, with significant significance (p=0.00). The model could explain the overall situation. The total variation of leisure activities reached 17.3%. The resilience and leisure activity gradually increased at different time points (baseline, 3 months, and 6 months) across the long-term trajectory. In the Group-Based trajectory analysis, the second group of patients after clustering four groups showed significant differences in the resilience of the second group of subjects under control variables of age, gender, and self-care (Β = 4.2, SE = 1.46, p<0.00), showing that there is a significant increase in resilience; the first group of leisure activities changes with time, their frequency of participation in leisure activities increased significantly; and leisure activities in the first group of research objects show significant differences (Β =2.7, SE = 1.24, p = 0.03), indicating a significant increase in leisure activities Conclusion: The results of the study confirm that resilience and leisure activities play an important role in the elderly patients with sarcopenia combined with heart disease. The psychological state of the elderly will affect the frequency of their participation in physical (leisure) activities, and for patients with sarcopenia. It is benefit for elder people to prevent disability, falls, or loss of self-care ability due to sarcopenia. In the ageing society in Taiwan, the psychological statues and the ability to adjust chronic are important factors for older people. We can encourage them to take part in appropriate leisure activities in order to increase physical activity and promote mental health. Clinical and Practical Applications: The results of this study focus on patients with sarcopenia combined with heart disease, as well as to explore the long-term changes in resilience and physical activity in individual. It is help for clinical staff to design intervention to improve the nursing care quality, which in advance to lower medical costs and the occurrence of sarcopenia, thereby improving the quality of life for elderly people and promoting successful aging. Key words: Resilience, Physical activity, Leisure activity, Sarcopenia, geriatric population, heart disease

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CHEN, SHENG-HSIN, i 陳勝興. "A Research on Indigenous Peoples’ Geriatric Education— Case Study at the KingFong City in Taitung County". Thesis, 2002. http://ndltd.ncl.edu.tw/handle/59872549890397005477.

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碩士
臺東師範學院
教育研究所
90
The main goal of this research is to realize the geriatric educational status of those geriatric people in indigenous community and to give helpful suggestions on geriatric education policy for government, based on our investigation at the KingFong City in TaiTung County. To achieve the goal above, this research adopts the methods of investigating when participating and of inquiry to analyze the need of geriatric education and the indigenous learning style. We found some facts as follows: 1. Indigenous communities distribute so wide as to promote the possibility of equally distribution of social resources. 2. The activities promoted by Indigenous Community Development Council, Community Administrator, and Community Official, highly affect the chance for indigenous elder people to participate in learning. 3. Church is an important part of indigenous people’s life. It is better that teachers are also missionaries, live in the same community, and can speak indigenous language. 4. Indigenous geriatric people have a strong sense on community. They learn for use. 5. It is better to design courses to meet the fitness for their life style and to meet the need of the community and locality. 6. Indigenous geriatric people want to learn more. 7. Indigenous geriatric people feel a great interest when participating in various activities, especially cultural activities. 8. Communities distribute so wide as to have a good communication with one another. It is better to design courses for each community. To sum up, we conclude that: 1. The age of the so-called indigenous geriatric people is recommended to be lower than that of general geriatric people. 2. Enrich the professional education and social education for indigenous people by joining the resources of schools and church. 3. Indigenous language, customs and culture should be promoted by government. 4. Set up learning centers and design various activities for indigenous geriatric people. Reduce the chance of drinking wine. 5. The welfare policy should take into account the specialty of indigenous community environment. 6. Advance the full improvement of the indigenous community. Enforce the realization of full life learning and encourage them to learn various types of culture.

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Mabuza, Eunice Mkhetsile. "A strategy for facilitating the mobilization of resources to meet the basic needs of the elderly in the Hhohho Region in Swaziland". Thesis, 2014. http://hdl.handle.net/10210/10853.

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D.Cur. (Community Nursing Science)
The purpose of the study was to develop a strategy to assist community nurses facilitate the mobilization of resources for meeting the basic needs of the elderly in the peri-urban and rural communities within the Hhohho region in Swaziland. Qualitative, exploratory, descriptive and contextual research designs were used to explore and describe the basic needs and the resources for meeting the needs of the elderly. In order to achieve the study objectives and be logical, this study was organized into two phases namely: phase one and two. Phase one focused on the first objective namely: to explore and describe the basic needs and resources of the elderly in the peri-urban and rural communities in the Hhohho region in Swaziland. The second phase focused on the second objective namely: to develop and describe the strategy for mobilizing the resources meeting the basic needs of the elderly. Purposive sampling was utilized to select participants who met the inclusion criteria. Data were collected using focus groups and individual indepth face-toface interviews. Tesch method of qualitative data analysis was utilized to identify themes. From the study findings the researcher and the independent coder identified the following themes from the focus groups and individual indepth face-to-face interviews with the elderly and the key informants in the peri-urban and rural communities in the Hhohho region: • Theme 1: Need for resources because of poverty • Theme 2: Need for support because of burden for caring for others • Theme 3: Need for health care because of health challenges • Theme 4: Need for company because of loneliness • Theme 5: Need for protection because of abuse of the elderly persons The study highlighted a lack of resources including food security, housing accommodation, clothing, water supply and basic sanitation, electricity supply and lack of financial resource. The burden of caring for grandchildren who were orphans due to HIV/AIDS related illnesses and others as well as chronic illnesses were also reported...

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Bromberg, Chaim Emil. "Longitudinal association between clinical dementia ratings, geriatric depression scale scores and measures of neuropsychological functioning in the mildly cognitively impaired elderly /". 2004. http://wwwlib.umi.com/dissertations/gateway.

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Thesis (Ph. D.)--New School for Social Research, 2004.
Typescript. Includes bibliographical references (leaves 62-74). Also available in electronic format on the World Wide Web. Access restricted to users affiliated with the licensed institutions.

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Perold, Annalette. "Koste-effektiewe benutting van verpleegpersoneel in ouetehuise". Thesis, 2012. http://hdl.handle.net/10210/7230.

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D.Cur.
Limited funds for the delivering of health and social services necessitate the cost-effective utilization of all categories of nursing personnel in old age homes. Professional nurses are being retrenched and supervision over weekends and after hours is being scaled down due to a lack of guidelines for the cost-effective utilization of nursing personnel in old age homes. A combined quantitative-qualitative approach had been applied in this empirical study to explore and describe the utilization of nursing personnel in old age homes. The goal of the study was to compile guidelines for the cost-effective utilization of nursing personnel in old age homes. Data collection and data analysis were conducted during three phases. A survey of the population of old age homes in South Africa was first conducted to determine the composition of the residents and nursing personnel in these old age homes and to explore the cost implications of the personnel composition. The contents of job descriptions of professional nurses working in old age homes were analysed on a computer by the researcher using NUDtIST software during the second phase of the study. The third phase consisted of conducting and analysing focus groups with professional nurses regarding. their expectations of their own duties, tasks and responsibilities and those of nursing auxiliaries and lay caregivers in old age homes. The three phases were conducted simultaneously and the results of the three phases were triangulated and subjected to a limited literature control. The results were verified during visits to nursing homes in the USA, Canada and the UK. A conceptual framework and guidelines for the cost-effective utilization of nursing personnel in old age homes were developed from the findings of this study. Respondents from the first phase of the study and experts verified the guidelines for being applicable, important, clear and accessible. The findings indicated that most of the residents of the old age homes are very old and are in need of 24 hours nursing/care due to their level of frailty. The nursing personnel budget forms a significant portion of the operating budget of the old age homes and managers are of the opinion that professional nurses are expensive but an essential component of the nursing personnel. The duties, tasks and responsibilities of professional nurses were identified as well as those which are shared with nursing auxiliaries and lay caregivers in old age homes. The conceptual framework which was established from the results of the study indicates that the goal, costeffective utilization of nursing personnel, is reached when quality care has been delivered within the constraints of the budget limitations. The process has been described as the compiling of guidelines for all categories of nursing personnel regarding clinical nursing, nursing management and nursing education as well as the handling of non nursing tasks while considering the personnel standards and job descriptions. The role players are the manager, all categories of nursing personnel, lay caregivers, family and volunteers which perform within the restrictions of the personnel composition and the appropriate code of conduct regulations. The context for the utilization of nursing personnel is the old age home where nursing/care giving is delivered on a continuum and the dynamics which influence the cost-effective utilization of nursing personnel include applicable legislation and policies of government departments and non government organizations.

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Glasson, Janet. "Improving aspects of quality of nursing care for older acutely ill hospitalised medical patients through an action research process". Thesis, 2004. http://handle.uws.edu.au:8081/1959.7/481.

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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge.

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Hickman, Louise D., University of Western Sydney, College of Health and Science i School of Nursing. "Patients, carers and nurses : collaborators in development of a new model of nursing care for older persons in the acute care setting". 2007. http://handle.uws.edu.au:8081/1959.7/37238.

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Globally the population is ageing and as a consequence people are living longer with multiple chronic conditions. A range of factors, including decreased lengths of hospital stay and a greater focus on community based care, has lead to an increasing acuity of patients admitted to acute care settings, many with complex care needs. To date, models of nursing care in acute settings have been configured to focus on acute, procedural care and do not meet the unique needs of the older person. In order to ensure optimal health outcomes of older hospitalised people, nursing care needs to be responsive to the priorities and needs of patients and their families. This study sought to collaboratively develop a model of nursing care with nurse clinicians to improve the care of older people in the acute care setting. Model development was driven by an action research framework, using evidence-based principles and a comprehensive needs assessment. A three phased, mixed method design was embedded within the overarching conceptual and philosophical framework of action research. The first phase of the study comprised a needs assessment and allowed appraisal of the needs of patients as perceived by patients, carer’s and nurses, this was performed using the Caring Activity Scale [CAS](1). Qualitative data and semi-structured interviews added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. Managing the discharge process and carer burden arose mainly from the carer semi-structured interviews only. Data revealed significant differences between patients, carer’s and nurses in relation to priority and satisfaction with care. Patients did not place a large importance on discharge care which contrasted with the focus of nursing initiatives. During the subsequent phases of the study a collaborative approach, using action research principles, was used to develop and implement a model of nursing care. A key feature of this model was the introduction of a team structure with a focus on patient centred care. Significant differences were identified in the pre model and post model patient groups in relation to satisfaction with care, with the post model group more satisfied than the pre group model group. Further, improvements in functional status and medication knowledge were demonstrated among patients cared for under the new model. This study has demonstrated that developing a model of care appropriate to the needs of patients, carer’s and nurses can be achieved through the use of action research principles. Study data illustrates the importance of collaboration, empowerment and change management principles in driving clinical improvement and patient satisfaction with care. The findings also underscore the importance of promoting and educating patients and carers as well as nurses about the importance of discharge planning to optimise post-discharge health outcomes.
Doctor of Philosophy (PhD)

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Cheu, Mei-Cheng Tammy. "Critical nursing behaviors in care of the dying patient and family hospice and hospital nurses' self evaluation : a research report submitted in partial fulfillment ... for the degree of Master of Science (Geriatric Nurse Practitioner) ... /". 1999. http://catalog.hathitrust.org/api/volumes/oclc/68901170.html.

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Berkemer, Esther. "Palliative Care bei Demenz: Das Verständnis von Palliative Care bei Demenz und die Bedeutung für das Pflegehandeln im Kontext der stationären Langzeitpflege". Doctoral thesis, 2017. https://repositorium.ub.uni-osnabrueck.de/handle/urn:nbn:de:gbv:700-2017051815923.

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Hintergrund: Menschen mit Demenz zählen zu einer wichtigen, aber bislang vernachlässigten Zielgruppe in der palliativen Pflege und Betreuung. Viele dieser Personen haben palliative Versorgungserfordernisse, die in der stationären Langzeitpflege häufig weder wahrgenommen noch angemessen erfüllt werden. Das Versorgungskonzept Palliative Care gewinnt vor diesem Hintergrund zunehmend an Bedeutung für die Begleitung von Menschen mit Demenz. Es existieren normative Vorgaben und theoretische Überlegungen zur palliativen Versorgungspraxis, ohne dass näher konkretisiert wird, wie dies in der pflegerischen Alltagspraxis in Einrichtungen der stationären Al-tenhilfe umgesetzt werden soll. Hinzu kommt, dass die pflegerische Einschätzung zu palli-ativen Bedarfen anspruchsvoller wird, da die Demenzspezifik im fortgeschrittenen Stadium der Erkrankung verbale Kommunikationsräume verringert. Leibliche Kommunikation, Intuition, Erfahrungswissen und die Kontextualisierung im Sinne eines hermeneutischen Fallverstehens (Remmers, 2000) können bei Demenz als Zugang für die Bedürfniserfassung und das spezifische Situationsverstehen bedeutsamer sein als objektiv ermittelte Parameter. Unklar ist bislang, wie sich die hier dargestellten Dimensionen pflegerischer Handlungen in der Begleitung von demenzerkrankten Personen in stationären Pflegeeinrichtungen gestalten und wie Kontextfaktoren die palliative Pflegepraxis beeinflussen. Ziele: Ziel der vorliegenden Studie ist es, einen Beitrag zu einem vertieften Verständnis von Merkmalen, Ausdrucksformen und Wirkungsweisen in der palliativpflegerischen Ver-sorgungspraxis von Menschen mit Demenz im Handlungsfeld der stationären Langzeit-pflege zu leisten. Studiendesign und Methode: Um die subjektiven Vorstellungen von Palliative Care bei Demenz, Kontextfaktoren und Ausdrucksformen alltäglicher pflegerischer Handlungen im Kontext von palliativen Erfor-dernissen bei Demenz zu erfassen und nachzuzeichnen, wurde ein offenes, qualitatives Verfahren gewählt. In Anlehnung an die Grounded-Theory-Methodology (vgl. Corbin & Strauss, 2008) wurden 22 leitfadengestützte Interviews mit professionellen Akteuren aus vier Pflegeheimen durchgeführt und Bedingungsfaktoren und Handlungsorientierungen im Hinblick auf Palliative Care bei Demenz identifiziert. Ergebnisse: Es existiert ein heterogenes Verständnis von Palliative Care bei Demenz und es zeigen sich widersprüchliche Ausdrucksformen pflegerischen Handelns in der palliativen Versorgungspraxis von Menschen mit Demenz in der Langzeitpflege. In der zentralen Kernkategorie „Sich zwischen Gewissheit und Ungewissheit arrangieren“ lassen sich die pflege-spezifischen komplexen Deutungsprozesse und Handlungsorientierungen zur Gestaltung einer palliativen Versorgungspraxis von Menschen mit Demenz abbilden. Die palliativ-pflegerischen Handlungsorientierungen werden von den angewendeten Strategien der Pflegenden maßgeblich beeinflusst. Aufbauend auf dem subjektiven Verständnis von Palliative Care bei Demenz gruppieren sich die Ergebnisse palliativpflegerischer Handlungen um das identifizierte Phänomen. Verschiedene intervenierende Bedingungen (u. a. Charakteristika von Pflegenden, Zuschreibungsprozesse als Sterbende, Arten der Bedürfnisermittlung in der Pflegebeziehung sowie spezifische Versorgungsformen) bilden im Kontext des beruflichen Pflegehandelns die Voraussetzungen und Hindernisse für Palliative Care bei Menschen mit Demenz. Deutlich wurde, dass proaktiv-steuernde Strategien wahrscheinlicher und frühzeitiger zu einem an palliativen Maßstäben orientierten Pflegehandeln führen. Umgekehrt führen passiv-reaktive Verhaltensweisen von Pflegenden tendenziell zu einem verzögerten oder ausbleibenden Übergang hin zu palliativen Versorgungskonzepten. Diskussion und Schlussfolgerungen: Auf Grundlage der Diskussion der Ergebnisse wurden fundierte Handlungsempfehlungen und praxisbezogene Anforderungen an eine demenzspezifische Palliative Care in der stationären Langzeitpflege abgeleitet.

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VRZALOVÁ, Monika. "Role sestry ve screeningu deprese u seniorů". Master's thesis, 2016. http://www.nusl.cz/ntk/nusl-260905.

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The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.

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