<p>The aim of the study was to examine the background and prerequisites for social services responsibility for carers according to the carers’ section in the Social Services Act. How the legislation is perceived and implemented in practice was also studied. The study’s theoretical basis was jurisprudence and the sociology of law. Preparatory work and other sections of importance for the interpretation of the carers’ section in the Social Services Act were also scrutinized. Interviews with four municipal politicians and four local civil servants were conducted. Various factors which affect the prerequisites for the social services duty of care towards carers were identified in the study. By studying the direct effects of legislation various indirect effects were also highlighted. The results showed that legislation is a weak instrument of control in municipalities’ planning and implementation of support for carers. Therefore social services responsibility for carers is unclear and imprecise. For carers themselves it is difficult to know what support they can demand or ask for from social services – municipalities have to offer support for carers but the carers’ section does not give carers any legal right to support.</p>

The aim of the study was to examine the background and prerequisites for social services responsibility for carers according to the carers’ section in the Social Services Act. How the legislation is perceived and implemented in practice was also studied. The study’s theoretical basis was jurisprudence and the sociology of law. Preparatory work and other sections of importance for the interpretation of the carers’ section in the Social Services Act were also scrutinized. Interviews with four municipal politicians and four local civil servants were conducted. Various factors which affect the prerequisites for the social services duty of care towards carers were identified in the study. By studying the direct effects of legislation various indirect effects were also highlighted. The results showed that legislation is a weak instrument of control in municipalities’ planning and implementation of support for carers. Therefore social services responsibility for carers is unclear and imprecise. For carers themselves it is difficult to know what support they can demand or ask for from social services – municipalities have to offer support for carers but the carers’ section does not give carers any legal right to support.

Despite work-life balance being an area of interest to many researchers, there is little reference to any effects related specifically to elder care. Current demographics indicate that the proportion of elderly in the community is increasing, and with greater workforce participation (particularly among women workers) the availability of family caregivers is less guaranteed. Women are more likely to be responsible for elder care, and as they seek to manage their work and life, are also more likely to seek workplace flexibility, sometimes through self-employment. The effect that elder care may be having on the work-life balance of self-employed women is the focus of this research project. Using work-family border theory as a lens, this research documented the effect that elder care had on the lives of a group of self-employed women who also had elder care responsibilities. Eight women from the Wellington region participated in this research, which was carried out from a broadly phenomenological perspective. Each participant shared information, using a case study approach, about their business and elder care responsibilities. The results of this research indicate the profound effect of emotions in the elder care situation, and also the effect of expectations from others whose influences affected the ability of the participants to achieve work-life balance.

Basic theoretical standpoints: This Dissertation has been focused on problems on functional changes and illnesses in old age and seniors' activation. An aging of the population is constantly growing in developed countries of which could be deducted naturally increasing interest in this issue. Health care staff is confronted with greater number of elderly people thus as very important aspects are the ability of nurses to recognize their needs and to look at the old age as a natural part of human life. The support of seniors' self-care and their activation should be the main objective of health care staff. Aims of the Dissertation: Three aims were identified to find out specific problems of nursing care with communications between the nurse and the elderly, to examine options of their activation such as a prevention of communications barriers and lastly to discover nurses' knowledgeable regarding the seniors' activation in the context of effective leadership communication. Following research questions for these targets were established: What are the most common problems that nurses deal with regarding the activation in communication in nursing care homes for elderly? What are the possibilities of seniors' activation as prevention of complications in communications in nursing care homes for elderly? What the nurses' skills are regarding seniors' activation in communications in nursing care homes for elderly? Methodology: This Dissertation "Problems of seniors' activation in the context of nursing care communication in nursing care homes for elderly" is composed according to qualitative research method laid out in two parts. The first one, data collection was implemented by depth semi-structured interviews with nurses from nursing care homes for elderly. The exact transcription of the interviews were analysed by open-coding technique, codes were sorted into categories a arise subcategories, arranged into clear diagrams. Covert surveillance method was used as a second part of this research. Those records were entered into the observation chart and then subsequently described. The research took place from 12th February to 20th April 2015. Results: This research shows that all nurses know specific problems of communication with seniors in the context of their care in nursing care homes for elderly, who are also psychologically stressful for them. It also shows that greater number of nurses deemed seniors' activation as activation programs only provided by nursing care homes for elderly. The elderly, according to some senior nurses, are due to deterioration of their mental or physical condition without any activation. Almost all nurses are educated in the seniors' activation and communication by seminars and lectures organized by nursing care homes for elderly which are paid by the employer. All nurses considered their education in activation and communication area as a contribution to increase knowledge and improve nursing care. During this second phase was found that four out of ten nurses performed almost the entire care of the morning hygiene for seniors without their help. Some of the nurses neglected to ask whether seniors would wish to perform their own hygiene without their help. Therefore four nurses do not activate seniors during the morning hygiene and some nurses communicate with seniors inappropriately. Conclusion:We think that nurses should have more education in activation and communication area. Their education will mainly bring theoretical knowledge that helps them to deal with problematic situation in nursing care for elderly. The outcome of this Dissertation was meeting with head nurses from nursing care homes for elderly where we presented our results gained by this research. They promised to consult it with rest of the nurses and to implement other seminar on seniors activation with communication.

Made available in DSpace on 2015-05-08T14:47:51Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 556239 bytes, checksum: 93a9113107e526b234009a4ecd5c7a38 (MD5) Previous issue date: 2009-10-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: The aging problem is a set of current relevance and concern of Public Policy for the Elderly. When In studying this problem from the point of view as is thought by health service users and their use as a public good with an emphasis on social representations is important to know the care provided to older people in public service, particularly in Unit Family Health. Study Objectives: apprehend the social representations of aging constructed by elderly patients at USF; know the care provided to elderly at USF from the social representations and whether the care provided to older people meet their expectations. Methodology: This was an exploratory study in a quantitative and qualitative approach developed seventy elderly (n = 70) who agreed to participate in the study and met the inclusion criteria. To collect data we used a semi-structured interview and the Test of Free Association of Words with the following stimuli: 'aging' and 'care for the elderly. " Data from the interviews were organized in databases and processed by software Alceste Evoc 4.8 and, after analysis of thematic content. Results: For the elderly, aging is represented by associating it with: old, old age, elderly and aging, accounting for 23.44% of the words evoked. This was considered a very strong category consists of 7 different words, with 34 occurrences. It can be seen in the speeches of the elderly emphasis elderly person as a person with a reduced functional capacity, represented by fatigue, difficulty walking and moving, thus showing the importance of physical activity for prevention and health promotion. On the one hand, the service is represented by the elderly poor and slow in the elderly should conform, on the other, or getting old age is natural, which is confirmed by the appearance of white hair. Conclusion: We identified social representations of aging constructed by elderly patients in USF's involvement in the presence of disease, the care provided to elderly at USF is suitable for the elderly and partially serves your needs. / Introdução: O envelhecimento se configura uma problemática de relevância atual e uma preocupação das Políticas Públicas do Idoso. Ao se estudar essa problemática do ponto de vista de como é pensada a saúde pelos usuários dos serviços; sua utilização como um bem público com ênfase nas representações sociais é importante para se conhecer o atendimento oferecido aos idosos no serviço público, em particular, em Unidade de Saúde da Família (USF). Objetivos do Estudo: apreender representações sociais sobre envelhecimento construídas por idosos atendidos nas USF; conhecer o atendimento oferecido aos idosos em USF a partir das representações sociais e verificar se o atendimento oferecido aos idosos atende as suas expectativas. Metodologia: Tratou-se de um estudo exploratório em uma abordagem quanti-qualitativa desenvolvido com setenta idosos (n = 70) que aceitaram participar do estudo e atenderam aos critérios de inclusão. Para coleta de dados utilizou-se uma entrevista semi-estruturada e o Teste da Associação Livre de Palavras com os seguintes estímulos: «envelhecimento» e «atendimento ao idoso». Os dados obtidos das entrevistas foram organizados em bancos de dados e processados pelos softwares Alceste 4.8 e Evoc, após análise de conteúdo temática categorial. Resultados: Para os idosos o envelhecimento é representado associando-o a: velho, velhice, idoso e envelhecimento, correspondendo a 23,44% das palavras evocadas. Esta foi considerada uma categoria bastante forte formada por 7 palavras diferentes, com 34 ocorrências. Observa-se nas falas dos idosos uma ênfase a pessoa idosa como um portador de uma diminuição da capacidade funcional, representado por cansaço, dificuldade de andar e se movimentar, mostrando assim a importância da atividade física para a prevenção e promoção da saúde. Por um lado, o atendimento é representado pelo idoso por ruim e devagar em que o idoso deveria se conformar; por outro, envelhecer ou ficar velho é natural, que é confirmado com o aparecimento dos cabelos brancos. Considerações finais: Identificou-se representações sociais sobre envelhecimento construídas por idosos atendidos nas USF associando-o a presença de doenças; o atendimento oferecido aos idosos em USF é para os idosos satisfatório e atende em parte as suas expectativas.

Made available in DSpace on 2014-12-17T14:13:42Z (GMT). No. of bitstreams: 1 CristinaKTTM_TESE.pdf: 549363 bytes, checksum: afa94799ea5ee42e9c27c33251ee6e4f (MD5) Previous issue date: 2011-11-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aims to identify the social representations built on senior care health workers of Primary Care. This is an exploratory research within the subsidized social representations held in 100 Basic Health Units in the city of Jo?o Pessoa-PB, with a sample of n= 204 workers of both sexes, who agreed to participate. To collect the data used to set an interview in two parts: the first looked at the Test of Free Association of Words using the inductive stimulus "senior care". The interviews were analyzed with the help of a software for quantitative analysis of textual data ALCESTE (version 2010). The results were interpreted from the theoretical framework of social representations. The study included 178 women (87.25%) and 26 men (12.75%), working in Family Health Units in the city of Jo?o Pessoa, the majority are aged between 40-49 years of age ( 28.92%), and have higher education with 81.86%. The results of Alceste link to the term inducer six (6) where the hierarchical classes representing senior care workers as synonymous with care and attention, showing situations neglect of the elderly, for that patience is required to promote the increase of disease prevention and living with the elderly to generate humanization in health services. It is considered that the social representations of health workers on assistance to the elderly may support modeling of strategic actions in health services with health promotion programs for large groups, able to modify practices and behavior in elder care and strengthening the policy was directed at the elderly / Este estudo teve os objetivos de apreender representa??es sociais sobre envelhecimento e o atendimento oferecido aos idosos constru?dos por trabalhadores de sa?de que atuam na Aten??o B?sica no munic?pio de Jo?o Pessoa, Para?ba, Brasil Trata-se de um estudo explorat?rio com abordagem qualitativa, com a participa??o de desenvolvimento com a participa??o de duzentos e quatro (n=204) trabalhadores de sa?de. Para coleta de dados utilizou-se uma entrevista semiestruturada e o Teste da Associa??o Livre de Palavras com o seguinte est?mulo: ?envelhecimento? e ?atendimento ao idoso?. Os dados obtidos das entrevistas foram organizados em bancos de dados e processados pelos softwares SPSS 17.0, EVOC 2000 e o Alceste vers?o 2010, ap?s an?lise de conte?do tem?tica categorial. Os resultados apontaram que o envelhecimento est? diretamente associado a condi??es e a qualidade de vida dos indiv?duos. A avalia??o para a aten??o ?pessoa idosa implica a ado??o de m?ltiplos crit?rios de natureza biol?gica, psicol?gica e socioculturais, pois v?rios elementos s?o apontados como determinantes ou indicadores de bem-estar no processo de envelhecimento. Tamb?m apresentou que o acolhimento ? considerada de fundamental import?ncia ? reorganiza??o do processo de trabalho de maneira a oferecer o atendimento priorit?rio ao idoso. Evidenciou-se neste estudo, como aspecto positivo o que os trabalhadores de sa?de que ao assistirem ao idoso esperam que sejam atendidas suas expectativas para maior qualifica??o dos profissionais com tamb?m o oferecimento atividades diferentes em grupo e de lazer, para que seja promovido um adequado Envelhecimento Ativo e Saud?vel

The diploma thesis "Comparison of the pastoral and charitable care for the elderly in the Archdiocese of Prague" enquires into the relation between the pastoral and charitable care for the elderly in the Archdiocese of Prague and the quality of accessible local services. It seeks to define the meaning of being old in the 21st century, deals with the questions of ageing and old age and the perception of these phenomenons in the broad social context. The thesis underlines the dignity of old men as well as their specific psychological and spiritual needs. The second part of the paper inquires into the principles of the charitable and pastoral care and it tries to sort out the accessible services. The last, empirical part contains the methodology and interpretation of the research among the charitable and pastoral institutions and parishes. The Conclusion summarizes informations from the previous chapters. Keywords elderly, pastoral care, charity care, the Catholic Church, Archdiocese of Prague

Made available in DSpace on 2016-04-27T18:12:40Z (GMT). No. of bitstreams: 1 Cecilia Penha de Lima Venancio.pdf: 2054110 bytes, checksum: 3d0f20cdabab81592dd49f0c2a20be7d (MD5) Previous issue date: 2009-02-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This dissertation is part of a research service project, and analyzes the employment of art theraphy perspectives and techniques used in a speach therapy program for the elderly at the São Paulo Municipal Public Hospital (HSPM-SP) The elderly who participated in the program are medically diagnosed as depressive or senile, besides having communication difficulties, related to their advanced age, as well as social and emotional issues, such as lonlieness, isolation or social social discrimination. The object of the research was to evaluate the relevance in the use of art therapy in speach therapy with regard to communicative rehabilitation and the recuperation of the elderly, capable of communicating in different situations and interactive contexts, especially if they are listened to and their needs are met, and therefore validated in their human condition. Art therapy works through the esthetic expression as a framework to help the participants in the elaboration, expression of, and dealing with their conflicts. Their articulation through speach therapy, in the management of relational and subjective dimensions, potentializes the work with the language and communication of the research participants, expanding their communication and interaction skills / A dissertação se configura como uma pesquisa em serviço, que analisa o emprego de perspectivas e técnicas da arteterapia em um programa fonoaudiológico com idosos do Ambulatório Geronto-geriátrico do Hospital do Servidor Público Municipal de São Paulo (HSPM-SP). Os idosos participantes possuem diagnóstico médico, entre outros, de depressão e problemas de memória, além de alterações de linguagem ou dificuldades de comunicação, derivadas de problemas orgânicos próprios à velhice, bem como de questões sociais e afetivas como, por exemplo, solidão e isolamento ou discriminação social. O objetivo da pesquisa foi analisar a pertinência do uso da arteterapia no trabalho fonoaudiológico, com vistas à reabilitação comunicativa e ao resgate dos idosos como interlocutores capazes de circular por várias situações e contextos discursivos, sobretudo se ouvidos em suas necessidades e validados na condição de sujeitos. A arteterapia opera por meio da expressão estética como dispositivo para ajudar os sujeitos na elaboração, na expressão e no equacionamento de seus conflitos. Sua articulação com a fonoaudiologia, no manejo com dimensões relacionais e subjetivas, potencializou o trabalho com a linguagem e com a comunicação dos participantes da pesquisa, ampliando possibilidades dialógicas e interacionais

Le travail de cette thèse s’interroge sur les réponses à apporter en terme d’organisation de l’offre médico-technique et de sa juste répartition sur les territoires en particulier pour les patients âgés poly-pathologiques. Il part de l’hypothèse qu’il existe un espace pour des concepts de petits établissements de santé ambulatoires pluridisciplinaires, dotés d’un petit plateau médico-technique, qui permettraient de participer à fluidifier et optimiser les parcours de soins. La méthode a consisté d’une part à étudier des structures plus petites de proximité en Allemagne, les MVZ, avec une expérience plus ancienne que celle dont nous disposons en France avec les MSP ou les Centres de Santé, et d’autre part à analyser les données PMSI pour faire émerger à la fois l’existence de groupes homogènes de co-morbidités et de groupes homogènes de parcours de soins. Les résultats sont constructifs, à la fois dans l’analyse par les sciences des réseaux et par l’automatisation de représentations de parcours de soins complexes. Ils ont permis de faire émerger des patterns représentatifs de groupes, d’en caractériser la consommation de soins, en matière de dispositifs médicaux et de ressources humaines, de quantifier les distances parcourues cumulées et les coûts cumulés par les patients selon leur lieu d’habitation et les institutions de santé auxquelles elles sont adressées. Nous en tirons des éléments pour la définition et la labellisation de nouvelles structures de santé de proximité satellites d’hôpitaux plus importants. Ce travail représente une avancée particulièrement utile, à la fois conceptuelle et pratique, pour les études de données de santé complexes des personnes âgées. / This work questions the answer to be given in terms of organization of the health technical offer and its fair distribution in the territories especially for the elderly patients with multimorbidities. It is based on the assumption that there is space for a concept of small multi-disciplinary outpatient health facilities, with a small health-technical platform, which would help to streamline and optimize care pathways. The method consisted on the one hand to study in Germany smaller community interdisciplinary health care center (the MVZ) in operation for a longer time than the the French multidisciplinary médical care centers. And on the other hand it analyzed the national heath data to reveal both the existence of comorbidités related groups and homogeneous care pathways related groups. The results are positive, both in network science analysis and in the automation of representations of complex care pathways. They made it possible to create representative patterns of groups, to characterize the consumption of care, in terms of medical devices and human resources, to quantify the cumulative distances traveled and the costs accumulated by patients according to their place of residence and the health institutions to which they are sent. We get addition elements for the definition and labeling of small community health centers, satellite of larger hospitals. This work represents a particularly useful step, both conceptual and practical, for complex health data studies of elderly.

Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use. The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care. The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education. The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007. During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls. A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant. In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls.