Orientador: José Marcos Pinto da Cunha / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas / Made available in DSpace on 2018-08-17T23:55:20Z (GMT). No. of bitstreams: 1 Alonso_FabioRobertoBarbolo_D.pdf: 1239251 bytes, checksum: 4d4bcbdf5c04c0965e94e4428f55380a (MD5) Previous issue date: 2011 / Resumo: O envelhecimento populacional é um fenômeno mundial. O idoso adquire um papel central nas relações sociais, principalmente no que diz respeito à sua inserção na esfera familiar. O objetivo deste trabalho é analisar a família enquanto uma importante rede de suporte social para os indivíduos, podendo-se considerar esta instituição como uma das mais determinantes que cada sujeito tem à sua disposição em caso de necessidade. A inserção do idoso na esfera familiar pode ocorrer de formas diversas, e até antagônicas, sendo possível encontra-lo tanto na forma de provedor econômico do seu domicílio e responsável em grande parte por filhos e netos, como também na condição de dependente dos seus parentes mais jovens, no caso de idosos mais fragilizados fisicamente e economicamente. Em ambos os casos a família estará sendo decisiva para a viabilização de condições mínimas de qualidade de vida dos seus membros, seja através do apoio no sentido do idoso para seus parentes mais jovens quanto no suporte dos filhos, netos ou outros parentes em relação ao seu familiar idoso. A partir daí, buscaremos observar a direção do fluxo de apoio intergeracional na dinâmica familiar e os seus desdobramentos com referência nas características do idoso ali inserido, utilizando-se para isso orientações de análise diversas para este indivíduo, tais como o sexo, a condição no domicílio enquanto chefe ou não, o estado conjugal, o grupo etário, o rendimento domiciliar per capita, e a condição de ocupação, dentre outros / Abstract: The population aging is a world-wide phenomenon. The aged one acquires a central paper in the social relations, mainly in what it says respect to its insertion in the familiar sphere. The objective of this work is to analyze the family while an important net of social support for the individuals, being able itself to consider this institution as one of most determinative than each citizen has to its disposal in necessity case. The insertion of the aged one in the familiar sphere can occur of diverse forms, and until antagonistic, being possible it in such a way finds it in the form of economic supplier of its responsible domicile and to a large extent for children and grandsons, as well as in the condition of dependent of its younger relatives, in the case of more physically weak and economically poor. In both the cases the family will be being decisive for the agregation of minimum conditions of quality of life of its members, either through the support in the direction of the aged one for its younger relatives how much in the support of the children, grandsons or other relatives in familiar relation to its aged one. From then on, we will search to by referring observe the direction of the flow between the generations support in the familiar dynamics and its unfoldings in the characteristics of aged the there inserted one, using itself for this diverse orientations of analysis for this individual, such as the sex, the condition in the domicile while head or not, the conjugal state, the age group, the per capita domiciliary income, and the condition of occupation, amongst others / Doutorado / Demografia / Doutor em Demografia

Introdução: O envelhecimento populacional acelerado reafirma a necessidade da prestação de cuidados de longa duração e a instituição de longa permanência para idosos (ILPI) é uma das modalidades disponíveis. Pela demanda de cuidado, os enfermeiros estão inseridos na maioria dessas residências. Objetivo: compreender a vivência de enfermeiros no cuidado ao idoso que reside em instituição de longa permanência. Método: trata-se de pesquisa qualitativa, com abordagem fenomenológica, realizada com 11 enfermeiros que trabalham em ILPI. Os dados foram coletados por meio de entrevistas individuais, gravadas em áudio, com as seguintes questões norteadoras: Fale sobre sua vivência no cuidado ao idoso que reside em instituição de longa permanência e O que você espera com a sua atuação em ILPI? Os conteúdos foram transcritos e analisados individualmente, segundo o referencial da fenomenologia social de Alfred Schütz. Resultados: a partir da análise dos discursos foi possível identificar sete categorias concretas do vivido: dificuldades no trabalho, desvalorização profissional, vínculo, valorização do trabalho, oferecer assistência de boa qualidade, ser reconhecido e valorizar o idoso. A vivência do enfermeiro nesse mundo vida é permeada pela escassez de recursos financeiros, materiais e humanos, alta rotatividade de profissionais e qualificação insuficiente para o trabalho, gerando sentimento de insegurança. Também é marcado pela falta de autonomia, baixos salários, preconceitos e desrespeito nas relações interpessoais. Apesar das dificuldades vivenciadas, a formação de vínculos afetivos significativos com os idosos leva o enfermeiro a refletir sobre o processo de envelhecimento e promover uma assistência mais humanizada. A partir da percepção do valor social do trabalho, projeta melhorar a qualidade da assistência oferecida, por meio de qualificação adequada dos profissionais que atuam em ILPI, adequação do quantitativo de recursos humanos e a eliminação da sobrecarga de trabalho. Dessa forma, busca reconhecimento profissional, financeiro e social. Por fim, da vivência desse contexto emerge, no grupo social estudado, a consciência sobre a importância e a premência da mudança do valor do idoso em nossa sociedade. Espera-se que isso aconteça por meio de intervenções educacionais, com enfoque na redução do preconceito, na difusão do envelhecimento saudável e pela ampliação e efetividade de políticas públicas que priorizem a população idosa. Considerações finais: o presente estudo possibilitou a compreensão da ação de cuidar de idosos residentes em ILPI, sob a perspectiva de enfermeiros, evidenciando a vivência desse grupo social, marcada pela dificuldade no trabalho, pela aproximação afetiva com os idosos e pelas expectativas de transformar a realidade do cuidado ao idoso, vislumbrando um envelhecimento digno a todos. / Introduction: Accelerated populational aging reaffirms the need for long-term care, and long-term care institutions for the elderly (LTCI) is one of the available modalities. Given the care demands, nurses are inserted in the majority of these residences. Objective: to understand nurses experience in the care for elderly living in a long-term institution. Method: this is a qualitative research of phenomenological approach, conducted with 11 nurses working in LTCI. Data were collected through individual audio-recorded interviews with the following guiding questions: Talk about your experience in the care of the elderly living in a long-term institution and What do you expect from your performance at the LTCI?. The contents were transcribed and analyzed individually according to Alfred Schützs social phenomenology framework. Results: from the analysis of discourses, it was possible to identify seven concrete categories of the experience: work difficulties, professional devaluation, bonding, valorization of work, provision of good quality care, being recognized and valuing the elderly. Nurses experience in this world is permeated by the scarcity of financial, material and human resources, high turnover of professionals and insufficient qualification for the work, generating a feeling of insecurity. It is also marked by lack of autonomy, low salaries, prejudices and disrespect in interpersonal relationships. Despite the difficulties experienced, the formation of significant affective bonding with the elderly leads nurses to reflect on the aging process and promote a more humanized care. Based on the perception of the social value of work, nurses plan to improve the quality of care provided by means of adequate qualification of professionals working in LTCI, adequate human resources quantitatively, and the elimination of work overload. This way, they seek professional, financial and social recognition. Finally, from the experience in this context, in the studied social group emerges the awareness about the importance and urgency of changing the elderlys value in our society. This is expected to happen through educational interventions focused on reducing prejudice, disseminating healthy aging, and by the expansion and effectiveness of public policies that prioritize the elderly population. Final considerations: the present study enabled an understanding about the action of caring for elderly people living in LTCI from the nurses perspective. It showed the experience of this social group is marked by work difficulties, affective approximation to the elderly and expectations of transforming the reality of care for the elderly, with the view of aging with dignity for all.

Too many elderly women suffer rapid aging decline, frailty and hypokinetic disease simply because of inadequate levels of physical activity. While the biopsychosocial benefits of regular exercise are now well-known, explanations are lacking for the reluctance of aging Canadian females to take up, or keep up, healthful forms of leisure-time physical activity. The purpose of this study was to examine and explain the variability of participation in health-promoting form sof exercise in elderly women. Several health behavior theories and personal attributes have shown promise in explaining exercise behavior, and thus, a second purpose of the study was to test the utility of a composite theoretical model. The composite model included ten personal and situational attributes as well as five cognitive beliefs about physical activity adapted from Social Cognitive Theory and a belief about personal control over one's health from Health Locus of Control Theory. A city-wide sample of 327 Vancouver women aged 70 and 98 years filled out survey questionnaires providing information on the 16 model variables in addition to kilocalorie estimates of exercise in the past week. Multiple regression analysis was used to explain late life exercise in three stages: 1) regression on the ten personal and situational attributes; 2) regression on the six cognitive beliefs; and 3) combined regression on all the significant predictors. From the life situational variables, health, childhood movement confidence, school location, and age were significant factors explaining 18% of the variability seen in current exercise level. From the cognitive variables, current self-efficacy to exercise and current social support to engage in physical activity were the only significant predictors (R2 = 22%). A full regression model was tested by including the four statistically important situational variables and the two cognitive variables from the previous analyses. The utility of the Composite Model was supported in that both situational variables and self-referent beliefs played significant and independent roles in explaining late life exercise (R2 = 26%). The main reasons that older women were physically active were: 1) they perceived high levels of social support to exercise (b = .239, p< .01); 2) they felt efficacious for fitness-types of activities (b = .185, p< .01), 3) they had satisfactory health (b = .174, p < .01), and 4) they were educated in foreign countries (b = -.125, p < .01). Health locus of control offered some explanation but was not able to demonstrate significance alongside other cognitive beliefs (b = -.106, p < .06). Education, socioeconomic status, work role, family size, and marital status were not able to explain late life exercise. This study found that health difficulties do indeed interfere with women’s activity patterns. However, women are also influenced by perceptions of declining social support, lower levels of movement confidence, and chronological age, to reduce their physical activity. Thus, regardless of their health situation, the explanation of exercise involvement in older women rests to a large degree on the amount of social encouragement they perceive from family, friends and physicians, their self-efficacy for fitness activity, as well as perceptions of age-appropriate behavior. Older women who were educated as children outside of Canada, Britain and the U.S. appear to be culturally advantaged for late life physical activity participation. Moreover, childhood movement confidence stands as a significant predictor among the situational variables. These findings suggest that participation in physical activity, and positive beliefs about exercise in late oo, are rooted in competencies and experiences acquired in childhood. Perceptions of inadequate encouragement appear to be limiting females, from childhood on, to develop and sustain confidence in their physical abilities that would promote a more active lifestyle into their oldest life stage. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

Health, housing and much more recently, assistive technology, are key determinants of elderly independence in British Columbia. This thesis discusses these three determinants in some detail, and also stresses their interrelationship with each other. Throughout the entire thesis, the elderly's preference to age-in-place (Blackie, 1986; Wheeler, 1982) is stressed. In the issue of health, the current community-based health care delivery system of the British Columbia Ministry of Health's Continuing Care Division is compared and contrasted with a "counterpart" in the United States: the On Lok Health Services System in San Francisco, California. On Lok is discussed to highlight its effectiveness in delivering a community-based holistic health care system for a group of aging-in-place elderly in need of long term care with relatively low cost. In the issue of housing, the thesis investigates three avenues in which architects can apply their skills to maximize aging-in-place possibilities for our elderly in the context of British Columbia. Constraints by building codes, health care regulations, real estate market expectations and the aging characteristics of British Columbia's elderly are also highlighted to bring context to the discussion. In the issue of assistive technology, given the huge range of product development, the thesis focuses on one particularly interesting communication device - the Videophone. The Videophone is discussed to explore its potential impact for elderly independence, especially for the future. / Applied Science, Faculty of / Architecture and Landscape Architecture (SALA), School of / Graduate

The purpose of this study is to investigate the program focus and contributing factors to program composition of five health promotion programs for seniors. The programs are selected using opportunistic sampling from five different local areas in metropolitan Vancouver. The five areas together constitute metropolitan Vancouver. A theoretical framework based on health promotion as a process which enables people to take control of their health promotion programming and recognizes that social, political, and organizational interventions are as important as individual actions, is used to support the purpose of this study. An ethnographic approach is used to collect observational, interview and documentary data on program focus, process and organization. The data are analyzed qualitatively to further the understanding of health promotion as a process central to individual and group empowerment in program focus and organization. The findings confirm that these programs focus predominantly on individual behaviour change efforts and only minimally on underlying environmental and community change factors. In the process of examining these health promotion programs for seniors, themes emerged which shed light on which factors most influence program composition. Program organization and process which involves multiple historical, theoretical and organizational factors are seen to most heavily influence program composition. / Graduate and Postdoctoral Studies / Graduate

Orientador: Zélia Zilda Lourenço de Camargo Bittencourt / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T14:19:30Z (GMT). No. of bitstreams: 1 Neves_BarbaraCorreia_M.pdf: 1135191 bytes, checksum: 42bf9b41fd0f2013a2a815f6470e9fa8 (MD5) Previous issue date: 2014 / Resumo: As mudanças demográficas e epidemiológicas nos levam a refletir sobre o que traz qualidade de vida na velhice, não só para idosos da comunidade, mas principalmente para aqueles mais vulneráveis, como os institucionalizados. Objetivo: Avaliar e comparar a qualidade de vida de idosos institucionalizados e não institucionalizados residentes em um município de pequeno porte do interior do Estado de São Paulo. Métodos: Foram entrevistados 21 idosos de uma instituição de longa permanência para idosos (ILPI) e 322 da comunidade. Aplicaram-se os questionários de qualidade de vida WHOQOL¿BREF e WHOQOL-OLD e realizou-se levantamento de dados sócio demográficos e do estado de saúde. Na comparação dos escores dos domínios de ambos os instrumentos utilizou-se a Análise de Variância e o teste post-hoc de Tukey para as amostras independentes utilizou-se o teste "t". Testes com nível de significância de 0,05. Resultados: Predominaram as seguintes características: mulheres na comunidade (61,8%), homens na ILPI (71,43%), nível fundamental de escolaridade (77,95%) na comunidade e 85,71% na ILPI; idosos casados (65,53%) na comunidade e 28,57% na ILPI. A participação e frequência a clubes e associações foram relatadas por 75,78% de idosos da comunidade e 61,90% da ILPI. Quanto aos instrumentos utilizados os idosos da comunidade obtiveram maiores escores que os institucionalizados. Idosos da ILPI que participavam e frequentavam clubes e associações obtiveram maiores escores em todos os domínios de QV dos dois instrumentos e a renda mensal obteve significância estatística para maiores escores em idosos da comunidade. No WHOQOL-BREF a maior pontuação obtida pelos idosos da comunidade foi no domínio psicológico (70,83) e a menor no domínio físico (60,71). Para os da ILPI a maior pontuação foi para o domínio psicológico (58,33) e os menores no domínio social e nas questões gerais (50,0). Na avaliação pelo WHOQOL-OLD enquanto que para os idosos institucionalizados o domínio morte e morrer apresentou o menor score (12,50), para os idosos da comunidade este foi o domínio de maior pontuação (81,25). Conclusão: Os achados do estudo evidenciaram que idosos institucionalizados apresentaram piores escores de QV comparativamente aos da comunidade revelando que a inclusão social e participação em diferentes atividades contribuem significativamente para a melhoria da qualidade de vida / Abstract: Demographic and epidemiological changes lead us to reflect on what brings quality of life in old age, not only to community-based elderly, but, more importantly, to the most vulnerable, the institutionalized individuals. Objective: To evaluate and compare the quality of life of institutionalized and non-institutionalized elderly in a small city in the state of São Paulo. Methods: Twenty-one people in a long-term care facility for the elderly (LTCF) and 322 living in the community were interviewed. The WHOQOL-BREF and WHOQOL-OLD quality of life questionnaires were applied and sociodemographic and health status variables were recorded. Analysis of variance tests was used to compare scores of the domains of both instruments; the post-hoc Tukey test was used when the p-value <0.05. The t-test was used for independent samples. The level of significance was set at 0.05 in all statistical tests. Results: The following characteristics prevailed: women in the community (61.8%), men in LTCF (71.43%); elementary education, 77.95% in the community and 85.71% in LTCF; married people, 65.53% in the community and 28.57% in LTCF. Participation and attendance in clubs and associations was reported by 75.78% and 61.90% of the community-based and LTCF elderly, respectively. Moreover, community-based elderly had higher scores than institutionalized individuals according to the instruments used. LTCF elderly who participated in clubs and associations had higher scores in all QOL domains of the two instruments and monthly income was associated with higher scores in community-based elderly. The highest score obtained by non-institutionalized elderly in the WHOQOL-BREF was for the psychological domain (70.83) and the lowest score for the physical domain (60.71). For the LTCF elderly, the highest score was for the psychological domain (58.33) and the lowest for the social domain and general issues (50.0). While the lowest scoring domain of the WHOQOL-OLD for institutionalized elderly was death and dying (12.50), it was the highest scoring domain (81.25) for the community-based elderly. Conclusion: The study findings show that institutionalized elderly have worse quality of life scores compared to community-based individuals demonstrating that social inclusion and participation in different activities contribute significantly to improving the quality of life / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Introdução: O envelhecimento populacional acelerado reafirma a necessidade da prestação de cuidados de longa duração e a instituição de longa permanência para idosos (ILPI) é uma das modalidades disponíveis. Pela demanda de cuidado, os enfermeiros estão inseridos na maioria dessas residências. Objetivo: compreender a vivência de enfermeiros no cuidado ao idoso que reside em instituição de longa permanência. Método: trata-se de pesquisa qualitativa, com abordagem fenomenológica, realizada com 11 enfermeiros que trabalham em ILPI. Os dados foram coletados por meio de entrevistas individuais, gravadas em áudio, com as seguintes questões norteadoras: Fale sobre sua vivência no cuidado ao idoso que reside em instituição de longa permanência e O que você espera com a sua atuação em ILPI? Os conteúdos foram transcritos e analisados individualmente, segundo o referencial da fenomenologia social de Alfred Schütz. Resultados: a partir da análise dos discursos foi possível identificar sete categorias concretas do vivido: dificuldades no trabalho, desvalorização profissional, vínculo, valorização do trabalho, oferecer assistência de boa qualidade, ser reconhecido e valorizar o idoso. A vivência do enfermeiro nesse mundo vida é permeada pela escassez de recursos financeiros, materiais e humanos, alta rotatividade de profissionais e qualificação insuficiente para o trabalho, gerando sentimento de insegurança. Também é marcado pela falta de autonomia, baixos salários, preconceitos e desrespeito nas relações interpessoais. Apesar das dificuldades vivenciadas, a formação de vínculos afetivos significativos com os idosos leva o enfermeiro a refletir sobre o processo de envelhecimento e promover uma assistência mais humanizada. A partir da percepção do valor social do trabalho, projeta melhorar a qualidade da assistência oferecida, por meio de qualificação adequada dos profissionais que atuam em ILPI, adequação do quantitativo de recursos humanos e a eliminação da sobrecarga de trabalho. Dessa forma, busca reconhecimento profissional, financeiro e social. Por fim, da vivência desse contexto emerge, no grupo social estudado, a consciência sobre a importância e a premência da mudança do valor do idoso em nossa sociedade. Espera-se que isso aconteça por meio de intervenções educacionais, com enfoque na redução do preconceito, na difusão do envelhecimento saudável e pela ampliação e efetividade de políticas públicas que priorizem a população idosa. Considerações finais: o presente estudo possibilitou a compreensão da ação de cuidar de idosos residentes em ILPI, sob a perspectiva de enfermeiros, evidenciando a vivência desse grupo social, marcada pela dificuldade no trabalho, pela aproximação afetiva com os idosos e pelas expectativas de transformar a realidade do cuidado ao idoso, vislumbrando um envelhecimento digno a todos. / Introduction: Accelerated populational aging reaffirms the need for long-term care, and long-term care institutions for the elderly (LTCI) is one of the available modalities. Given the care demands, nurses are inserted in the majority of these residences. Objective: to understand nurses experience in the care for elderly living in a long-term institution. Method: this is a qualitative research of phenomenological approach, conducted with 11 nurses working in LTCI. Data were collected through individual audio-recorded interviews with the following guiding questions: Talk about your experience in the care of the elderly living in a long-term institution and What do you expect from your performance at the LTCI?. The contents were transcribed and analyzed individually according to Alfred Schützs social phenomenology framework. Results: from the analysis of discourses, it was possible to identify seven concrete categories of the experience: work difficulties, professional devaluation, bonding, valorization of work, provision of good quality care, being recognized and valuing the elderly. Nurses experience in this world is permeated by the scarcity of financial, material and human resources, high turnover of professionals and insufficient qualification for the work, generating a feeling of insecurity. It is also marked by lack of autonomy, low salaries, prejudices and disrespect in interpersonal relationships. Despite the difficulties experienced, the formation of significant affective bonding with the elderly leads nurses to reflect on the aging process and promote a more humanized care. Based on the perception of the social value of work, nurses plan to improve the quality of care provided by means of adequate qualification of professionals working in LTCI, adequate human resources quantitatively, and the elimination of work overload. This way, they seek professional, financial and social recognition. Finally, from the experience in this context, in the studied social group emerges the awareness about the importance and urgency of changing the elderlys value in our society. This is expected to happen through educational interventions focused on reducing prejudice, disseminating healthy aging, and by the expansion and effectiveness of public policies that prioritize the elderly population. Final considerations: the present study enabled an understanding about the action of caring for elderly people living in LTCI from the nurses perspective. It showed the experience of this social group is marked by work difficulties, affective approximation to the elderly and expectations of transforming the reality of care for the elderly, with the view of aging with dignity for all.

This study is the first of its kind undertaken at Groote Schuur Hospital. It is an attempt to provide a holistic profile of their elderly patients with a view to encouraging further, more specific research, and to provide information for use in the planning of efficient health care for the aged. The study was based on three premises: (i) there is an interrelationship between the ageing process and disease; (ii) a non-disease-specific approach which focusses on the functional status of elderly patients can be used as a predictor of health services consumption; and (iii) any study which promotes understanding of the dynamics of health care of the elderly must also take into account the ageing process and its effect on a particular population within a specific social context. The research spanned 52 weeks (1 March 1989 - 27 February 1990). A sample of nine patients per week was selected from the total population of patients aged 65 and over admitted to the Emergency Unit of Groote Schuur Hospital. Two adult female researchers, using structured questionnaires, constructed in English and comprising subtests, utilising indexes and scales, interviewed respondents and/or household members in their own homes. Data was also obtained from the hospital files. Although essentially descriptive by nature, use was made of groups in regard to variables such as "first admission" (admission to the Emergency Unit), and "readmission" (a previous overnight admission in the preceding year). Statistical analysis, where indicated, was by means of non-parametric tests.

Pain symptoms in aging populations have significant public health impact. The aim of this study was to determine risk factors for the incidence of pain in older adults, focusing on those factors that can be modified. Secondary analyses were performed of survey data from the nationally representative Health and Retirement Study of US adults older than 50 years. Generalized estimating equations logistic regressions were used to evaluate the effect of selected variables on the incidence of pain using biennial (1992 through 2006) data, determining the relationship between the incidence of pain and the potential risk factors. Of the 18,439 survey respondents in 2006, 34.1% (95% CI: 33.2%, 35.0%) reported that they were often troubled by pain; 24.3% reported having moderate to severe pain; and 22.3% reported that their daily life was affected by pain. Between 1992 and 2006, 7967 individuals reported new onset of pain in 169,762 person-years of follow-up, an incidence of 4.69 (4.59, 4.80) per 100 person-years. Depression and being overweight were independent predictors associated with an increased likelihood of incident pain. Current smoking increased the likelihood of incident pain only in those subjects who also reported depression. In conclusion, pain is a common symptom in older adults. Depression, smoking, and overweight are potentially modifiable risk factors and could be considered in the prevention and management of pain in older adults.

The purpose of this study is to give a historical account of the San Francisco Council of Churches Senior Citizen Projects. Also, the following will be discussed: Why is research being conducted in the areas of senior citizens? What are the problems of the senior citizen? What is this Agency doing for the senior citizens in San Francisco?