L'évolution des soins médicaux en milieu hospitalier se caractérise par une intensité accrue des soins et de l'utilisation des médicaments, ces derniers étant de plus en plus nombreux et souvent onéreux. De plus, les personnes âgées, en nombre croissant dans notre société, souffrent fréquemment de pathologies concomitantes et nécessitent donc une polythérapie. Il devient dès lors de plus en plus complexe d'assurer un usage optimal (efficace, non toxique, et économique) des médicaments, et également d'assurer un suivi adéquat du traitement lorsque ces patients sont transférés entre milieux de soins aigus et chroniques. De nombreuses publications ont mis en évidence, à l'étranger, une prévalence élevée d'utilisation inappropriée des médicaments en gériatrie (sous forme d'overuse, de misuse, et d'underuse). Les facteurs explicatifs d'une utilisation inappropriée n'ont cependant jamais été étudiés dans cette population. Or, cette étape d'identification est indispensable pour le développement d'interventions appropriées. Elle a donc constitué la première partie du travail de recherche (1). Ensuite, certaines études ont tenté d'évaluer l'impact de diverses approches permettant d'améliorer la prescription (y compris la pharmacie clinique), mais peu ont utilisé une méthodologie robuste. De plus, l'intérêt de cette approche de pharmacie clinique n'a jamais été évaluée en Belgique, alors qu'il existe un potentiel certain pour la développer. C'est dans ce cadre que s'est effectuée la deuxième partie du travail (2). (1) Pour répondre au premier objectif, une étude qualitative combinant des données issues d'entretiens et d'observations avec des professionnels et patients au sein de services de gériatrie a été réalisée. Trois grandes catégories de facteurs sous-jacents à une utilisation inappropriée des médicaments ont été identifiés : référence au modèle de soins de santé aigus pour des adultes en général ; attitude d'apprentissage passive; prise de décisions paternaliste. A l'inverse la prise en charge par un gériatre et la communication multidisciplinaire permettent une meilleure utilisation des médicaments. Les mesures d'optimisation potentielles devraient donc entre autres concerner les compétences individuelles, les relations médecin-patient et médecin-médecin, et les systèmes de transfert d'informations entre milieux de soins. (2) Afin de quantifier la qualité de prescription, et l'impact d'une collaboration avec un pharmacien clinicien, une étude randomisée contrôlée a été réalisé, et a inclus 200 patients hospitalisés au sein d'un service de gériatrie. Les résultats montrent que l'intervention d'un pharmacien clinicien permet de réduire de façon significative l'overuse, l'underuse et le misuse des médicaments. L'acceptation des interventions est excellente, et leur pertinence clinique élevée.Enfin, l'intervention s'accompagne d'une tendance à une diminution de la mortalité et de la morbidité des patients, un an après leur sortie de l'hôpital. Ce travail démontre donc l'intérêt de la pharmacie clinique dans le contexte belge, et ouvre plusieurs perspectives, dont une évaluation de la généralisation à d'autres services cliniques, et une évaluation de son rapport coût-efficacité.

Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2006.

Invasive procedures are often painful and distressing for children and disturbing for their parents. The purpose of this study was to develop a substantive theory of parental perceptions of their school-aged child's responses to an outpatient minor surgical procedure with nitrous oxide. The sample included 22 parents of 21 children who underwent a nitrous procedure. Participants were recruited from the pediatric surgery department at a children's hospital. Semi-structured, audio-recorded interviews were conducted with each participant. Grounded theory method was used to simultaneously collect and analyze the data using the constant comparative method. The findings of the study revealed parental impressions involving a process of various emotions and behaviors. The identified process began at procedural scheduling, progressing through the procedure, and terminated going home. The core category derived from the data was Weathering the Storm before the Calm by Securing Connections. This core category describes the complexity of parental impressions and all categories subsumed by the core category. Six major categories and seven subcategories derived from the data represent parental impressions. Parental feelings of anxiety and fear arose during initial phases of the process. Parents attempted to deal with these stormy feelings in several ways. Parents experienced a sense of calmness after the procedure upon realizing their child was safe. The theme that weaves through the entire process is the parental-child connection and parental presence during the nitrous procedure. Parents also identified barriers and facilitators they faced during this process. The substantive theory that emerged provides nurses with an understanding of the stormy and subsequent calm phases parents endured. This information offers clinicians unique interventions to help parents get through this process. Future research needs extension to other settings such as radiology and other specialties such as plastic surgery and urology. Further research warrants investigating children's perceptions to their procedure with nitrous oxide.

Thesis (Ph. D.)--University of Minnesota, 2000. / Includes bibliographical references (leaves 134-146). Also available on the World Wide Web as a PDF file.

Thesis (Ph. D.)--Ohio State University, 1982. / Includes vita. Includes bibliographical references (leaves 124-126). Available online via OhioLINK's ETD Center.

This study focuses on the effects of Mild Cognitive Impairment and other minor memory impairments on a person’s ability to successfully use the Internet. Participants over sixty-five years of age were recruited from retirement communities and were selected based on self-reports of Mild Cognitive Impairment or other cognitive difficulties when using the Internet. Interviews with the participants focused on their abilities to use Email, Chat/Instant Messenger and the World Wide Web. Participants were then asked to step through several Internet-related tasks in order to further identify problem areas. Seven participants were interviewed, and six of them completed the optional observation session. The data collected from the interviews and observation sessions were then broken down into different categories, based on the type of difficulties experienced during Internet use. Finally, recommendations were made for good Web design practices intended to overcome the difficulties identified during the study.

<p>The international concern about human rights, gender equality, domestic violence and the increase in the aging populations has brought elder abuse into the public focus. Elder abuse is a complex, multi-faceted health, social, criminal justice, international public health and human rights issue. The widely divergent and varying definitions is a controversial problem to understanding elder abuse. The elderly have been excluded from national gender-based programs on domestic violence and the abuse of women and children. In South Africa victims of elder abuse are often physically and or cognitively unable to speak for themselves which necessitates that the public be empowered and trained to become advocates for the aged. Lachs &amp / Pillemer ( 2004 : 1265 ) states that &ldquo / the physical and psychological impairement of elder persons could be predisposing factors for elder abuse &ldquo / . Statistical evidence on the incidence and prevalence rates of elder abuse is lacking as elderly persons are reluctant to identify care givers for fear of abandonment, retaliation and being left destitute ( Lachs &amp / Pillemer, 2004 : 1265 ). Despite the Bill of Rights as set out in the South African Constitution and the Older Persons Act, No. 13 of 2006 which was developed to deal with the empowerment and protection of elder persons and promote and maintain their status, rights, safety, security and well being the abuse of elder person continues to occur ( Older Persons Act, No. 13 of 2006 ). This qualitative research study is allied with the phenomenological approach in an attempt to understand elder person&rsquo / s perception, viewpoints and perspectives from their lived experiences and personal lives. Three (3) focus group discussions and eighteen (18) one-on-one interviews were conducted with elder persons living in the suburbs of Cape Town. Data from participants were audio-taped, transcribed verbatim before an inductive analysis lead to the emergence of broad themes and patterns. The main findings of the research study concluded that elderly persons were informed but not empowered about financial, emotional and verbal abuse. The abuse of the elder person in old age homes also featured prominently. The findings of the research study can be used to provide education and empower elder persons and the general public on specific aspects related to elder abuse which are : Financial, Emotional, Verbal and the abuse by staff at old age homes. These findings could be utilized by health and social welfare advocates and organisations who offer community educational and development programs to advocate against elder abuse.</p>

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The increasing elderly population is creating a greater need for care providers. Research indicates that while caregiving can be rewarding, it can also generate stress which, in turn, impacts individual well-being. Social support, however, may foster the well-being of persons who are experiencing stressful events. The purpose of this study was to examine the contribution of perceived social support from close family (siblings, spouse, and children) and background characteristics to well-being for a sample of women caring for mothers who were not cognitively impaired. The sample for this study (N=65) was drawn from a larger five year western Oregon study of women caregivers (Walker, 1986), and included only those women who: participated during the third year of the larger study; were married; and had at least one child and one sibling. Data were collected via face-to-face interviews. Pearson correlations and multiple regressions were used to assess the contribution of family support and background characteristics to well-being. Well-being, as measured by the CES-D scale, was the dependent variable in all regressions. The independent variables included the caregiver's self-reported health, and her perceptions of support (measured by supportiveness, positivity of contact, and conflict) from siblings, spouse, and children. Overall, results from this study indicated that women caregivers' perceptions of relationships with close family did impact their well-being. While measures designed to tap supportiveness and positivity of contact were not significantly related to well-being, conflict was. Specifically, conflict with a spouse was associated with lower well-being. Second to conflict with a spouse, respondent's health was the strongest predictor of wellbeing: poor health was significantly associated with lower well-being. In general, recommendations and implications focused on the need for: (a) repeating this type of research among other caregiver populations; (b) developing multidimensional measures of family support; (c) services that provide individuals with positive ways to deal with lifetensions that foster interpersonal conflict; and (d) services that target caregivers who are in poor health. / Graduation date: 1992

The main purposes of this thesis were to evaluate a high-intensity functional weight-bearing exercise pro­gramme, regarding its applicability (attendance, achieved intensity, adverse events) as well as its effect on physical functions and activities of daily living (ADL) among older people living in residential care facilities, with a special focus on people with dementia. Furthermore, a main purpose was to systematically review the applicability and effects of physical exercise on physical functions, cognitive functions, and ADL among people with dementia. A high-intensity functional weight-bearing exercise programme that includes lower-limb strength and balance exercises in standing and walking, was evaluated in a randomised controlled trial among 191 older people, dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ten or more. One hundred (52.4%) of the participants had dementia. Participants were randomised to an exercise programme or a control activity, consisting of 29 supervised sessions over 3 months, as well as to an intake of a protein-enriched energy supplement or a placebo drink immediately after each session. The effect on physical functions was evaluated using the Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in a leg press machine measuring lower-limb strength. The effect on ADL was evaluated using the Barthel Index. These outcome measures were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. The evaluation of the applicability of the high-intensity functional weight-bearing exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and all except two adverse events were assessed as minor or temporary and none led to manifest injury or disease. No statistically significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, the applicability of the programme was not associated with the participants’ cognitive function. Significant long-term effects of the exercise programme were seen regarding functional balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. Age, sex, depression, dementia disorder, nutritional status, and level of functional balance capacity did not influence the effect on functional balance of the high-intensity functional weight-bearing exercise programme. There were no significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a significantly smaller proportion of participants in the exercise group had deteriorated regarding indoor mobility at 3 and 6 months. For people with dementia, there was a significant difference in overall ADL performance in favour of the exercise group at 3 months, but not at 6 months. In a systematic review, randomised controlled trials, evaluating the effects of physical exercise among people with dementia, were identified according to pre-defined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodological quality. Ten studies were included in the review and the majority of the participants were older people with Alzheimer’s disease living in residential care facilities. Four studies reached “moderate” methodological quality and six “low”. The results showed that among older people with Alzheimer’s disease in residential care facilities, combined functional weight-bearing exercise over 12 months at an intended moderate intensity seems applicable for use regarding attendance and adverse events and there is some evidence that the exercise improves walking performance and reduces ADL decline. Furthermore, there is some evidence that walking exercise over 16 weeks performed individually, where the participant walks as far as possible during the session, reduces decline in walking performance, but adverse events need to be evaluated. In conclusion, among older people who are dependent in ADL, living in residential care facilities, and have an MMSE score of 10 or more, a high-intensity functional weight-bearing exercise programme is applicable for use and has positive long-term effects on functional balance, gait ability, and lower-limb strength and seems to reduce ADL decline related to indoor mobility. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. In people with dementia, the exercise programme may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. The positive results regarding applicability and effects of combined functional weight-bearing exercise among people with dementia is confirmed when the scientific literature is systematically reviewed. It seems to be important that exercise interventions among people with dementia last for at least a few months and that the exercises are task-specific and intended to challenge the individual’s physical capacity. Whether physical exercise can improve cognitive functions among people with dementia remains unclear. There is a need for more exercise studies of high methodological quality among people with dementia disorders.