In Western Europe and North America, acute myeloid leukaemia (AML) is predominantly a disease of the elderly, with a median age at the time of presentation in excess of 60 years. However, many clinical trials in AML fail to recruit elderly adults due to a combination of strict entry criteria, or physician or patient bias. Thus, clinical outcome data from many trials may not be readily applicable to older patients with the disease. Furthermore, because the clinical outcome for many older patients with AML is frequently poor, elderly patients who receive intensive chemotherapy with curative intent are frequently selected for treatment on clinical criteria rather than on objective prognostic criteria that may define clinical outcome. The karyotype at the time of presentation may be considered one of the most important prognostic factors in adult AML. Therefore, the aim of this thesis were firstly to analyse the clinical outcome data from a cohort of elderly patients managed at a single centre in order to document the cytogenetic features of AML in an elderly population, to define the prognostic importance of presentation karyotype in the elderly, and to identify other prognostic factors. Retrospective analysis clearly demonstrated improved clinical outcome for older patients with AML over time, primarily as a consequence of improved supportive care and the delivery of more intensive chemotherapy. In addition, 'unfavourable' presentation karyotype, increasing age and raised serum LDH were found to correlate with poor clinical outcome Molecular cytogenetic techniques based upon fluorescence in-situ hybridisation technology offer the chance to detect and analyse cytogenetic aberrations at a higher resolution than can be achieved with conventional techniques. The cytogenetic data provided by comparative genomic hybridisation and mulitplex fluorescence in-situ hybridisation when used in the analysis of elderly patients with AML were found to correlate well with results obtained by conventional methods. Importantly, additive cytogenetic data were more likely to be provided if multiplex-fluorescence in-situ hybridisation was used in the analysis of cases with marker chromosomes or in cases with complex karyotype, although the technique was limited by an inability to reliably detect telomeric translocations. In addition, although both techniques can be used to complement conventional G-banding analysis, conventional FISH methods are often required to confirm the results.

Vitamin B-6 status was examined in a group of 46 elderly subjects who were selected from nursing home residents, hospital patients, and free living individuals in Denton County. Subjects were limited to men and women over 60 years of age. Erythrocyte aspartate aminotransferase stimulation with pyridoxal phosphate (in-vitro) was studied as the biochemical criterion of vitamin B-6 status. The pyridoxine status of these 46 subjects (the reference group) was measured in order to be able to identify people with a relatively poor B-6 status. A sub-group of the reference group was composed of 4 subjects who took B-6 supplements (supplemented group). There was no significant difference (0.05 level) in the basal activity, stimulated activity, percentage stimulation, or body weight, after treatment with 10 mg pyridoxine hydrochloride for 4 weeks, even though all 4 subjects had an improved B-6 status (based on percentage stimulation) after taking the supplement. The data indicated that of the 4 subjects tested, 2 showed a large change in the basal activity, stimulated activity, and percentage stimulation. The lack of significant difference (0.05 level) was probably due to a small sample size. One subject reported an increased appetite and body weight after treatment with pyridoxine.

The present research has focused on an often-neglected segment of society—the aged. A number of phenomena which appear relevant to a study of aging have been discussed and the pertinent literature reviewed. Specifically, learned helplessness, depression, internal-external locus of control, and disengagement versus activity have been examined. The present research was divided into two studies. Study Number 1 has investigated internal-external locus of control in an elderly sample and related it to indices of activity and morale. Study Number 2 has extended Seligman's (1975) theory of learned helplessness to an elderly population and investigated the phenomenon in individuals with either an internal or an external locus of control. The locus of control construct (Rotter, 1966) and the theory of learned helplessness (Seligman, 1975) appear to have immediate relevance for the treatment of aging individuals. The present study suggests that exposure to controllable reinforcement may break-up or alleviate learned helplessness in elderly individuals.

With aging, there is a putative loss of taste and smell that may lead to decreased food enjoyment. We determined the relationships among age, detection, and recognition thresholds for taste and smell, and preference for flavored milk. Ninety young (20-40 years) and 90 elderly (over 64 years) subjects evaluated chocolate mint-, lemon-, or strawberry-flavored milk. Detection and recognition thresholds were determined for sucrose and for the assigned flavor in milk systems. Sucrose was dissolved in milk, and flavors were dispersed in milk with flavor identification. Preference was determined using a 9-point hedonic scale to evaluate all combinations of five sucrose and five flavor levels in milk. Subjects also answered a questionnaire regarding individual chemosensory function, sweet beverage enjoyment, general perception of food flavors, and circumstances that might influence their taste and smell function. Compared to young, elderly had higher detection and recognition thresholds for the tastant sucrose for the olfactants lemon and strawberry, and for the olfactory/trigeminal stimulant of chocolate mint in milk systems. This suggest elderly have lower chemosensory function regarding taste, smell, and trigeminal sense. Differences between detection and recognition thresholds were larger for elderly than for young subjects, especially for flavors, implying cognitive as well as sensory losses with aging. Despite lower chemosensory function, elderly did not report greater taste or smell dysfunction. The loss of chemosensory function may be too gradual to be noticed. Elderly also did not complain about foods and beverages more than young. Most said foods in general were "just right The loss of chemosensory function with aging may not be great enough to alter food perception. Elderly preferred equal or lower levels of sucrose and flavors. In addition, high detection and recognition thresholds were not related to preference for higher levels of any stimulant. Elderly also did not make more comments regarding flavor weakness. The active, healthy elderly probably do not require increased flavor levels for optimal food enjoyment.

Large numbers of baby boomers and a shift towards home-based long-term care designate a need for a greater understanding of caregiver attitudes surrounding the financing of long-term home-based care. This study examined more fully the types of home-based long-term care services that family caregivers were utilizing for their parents. In addition, the willingness and ability of caregivers to privately fund these services for aging parents were explored. The study utilized a preexisting data set of qualitative interviews that were conducted with 30 family caregivers helping to provide long-term care for an elderly parent or older-generation relative. Participants in the sample used many home- and community-based services such as home health aides and nurses, physical therapists, cleaning services and adult day centers. Often these services were funded via Medicare, Medicaid, care recipient funds, state programs, and caregiver funds. In addition, caregivers were often willing, but unable to pay for long-term parent care on their own. Many caregivers in the study found paying for long-term parent care unnecessary. Family expectations, moral and religious responsibility, and a high aversion to nursing home care were cited as reasons for willingness to fund long-term care at home. Similarly, lack of family support and other personal obstacles were noted as reasons for inability to pay for care. Those who found payment for care unnecessary noted that care recipients had sufficient funds for their own long-term care.

The purpose of this study was twofold: (a) to determine the therapeutic effectiveness of group counseling with visually-impaired elderly adults, and (b) to provide information concerning the effectiveness of group counseling to practitioners in the field. The study reviewed the literature regarding aging and vision, psychosocial reactions to vision loss, and group counseling with the visually-impaired and the elderly. Twenty subjects, who were above age 65 and had recently experienced a severe loss of vision, were selected to participate in the study. Ten subjects were assigned to an experimental counseling group and 10 subjects were assigned to a no-treatment control group. The experimental group participated in 1-1/2 hour group sessions once a week for 10 weeks. Both the experimental group and the control subjects were administered pre- and post-tests. The tests measured depression, anxiety, self-esteem, and life satisfaction.

Bakgrund: På ett flertal akutmottagningar ökar belastningen och vistelsetiderna blir längre, dessutom är vistelsetiderna längre för äldre patienter. Den växande äldre befolkningen i vårt samhälle löper även större risk att drabbas av vårdskador i samband med långa vistelsetider på landets akutmottagningar.  Syfte: Syftet med denna studie var att beskriva interventioner riktade mot äldre som söker akutmottagning och interventionernas påverkan på vistelsetiden. Metod: Metoden som valdes var en litteraturöversikt med systematisk ansats. Databassökning genomfördes i PubMed och CINAHL och genererade 16 artiklar till resultatet. Strukturerad kvalitetsgranskning av artiklarna genomfördes och resultatet presenterades efter en integrerad analys.  Resultat: Fem kategorier identifierades: Snabbspår, äldreprotokoll, omvårdnadsåtgärder, tvärprofessionellt teamsamarbete samt samverkan med externa vårdgivare. I 10 av studierna blev vistelsetiden på akutmottagningen kortare, i tre oförändrad och i tre längre. Slutsats: Det finns ett flertal interventioner riktade mot äldre som söker vård på akutmottagningar med varierande påverkan på vistelsetiden. Snabbspår kan vara effektivt och säkert för att förkorta vistelsetiden till specifika grupper av äldre patienter. Handläggningen av äldre patienter är ofta komplicerad. Införande av tvärprofessionella team med specifik geriatrisk kompetens kan bidra till ett effektivare omhändertagande och en kortare vistelsetid. Det är viktigt att identifiera de äldre personer som är sköra eller löper hög risk att drabbas av vårdskador. Omvårdnadsåtgärder riktade mot dessa personer behöver inte förlänga vistelsetiden och kan minska risken för vårdskador. Litteraturöversiktens resultat åskådliggör potentiella förbättringsområden för att förebygga att äldre personer, som söker vård på akutmottagningar, drabbas av vårdskador. / Background: In a number of emergency departments, the workload is increasing and the length of stay is longer, and the length of stay is also longer for older patients. The growing elderly population in our society is also at greater risk of suffering injuries in connection with long stays in the emergency departments. Purpose: The purpose of this study was to describe interventions aimed at elderly people who seek emergency care and the intervention's impact on length of stay. Method: The method chosen was a literature review with a systematic approach. Database search was conducted in PubMed and CINAHL and generated 16 articles as a result. Structured quality review of the articles was carried out and the results were presented after an integrated analysis. Results: Five categories were identified: Fast track, elderly protocols, nursing care, interprofessional team collaboration and collaboration with external care providers. In 10 of the studies, the length of stay at the emergency department was shorter, in three it was unchanged and in three it was longer. Conclusion: There are several interventions aimed at elderly people who seek care inemergency departments with varying effects on the length of stay. Fast-track can be effectiveand safe in shortening length of stay for specific groups of elderly patients. The managementof elderly patients is often complicated. Introduction of interprofessional teams with specificgeriatric competence can contribute to more efficient care and a shorter length of stay. It isimportant to identify the elderly people who are frail or are at high risk of suffering injuriesfrom care. Nursing measures aimed at these people do not need to extend the length of stayand can reduce the risk of nursing injuries. Results of the literature review illustrate potentialareas for improvement to prevent elderly people who seek care in emergency departmentsfrom suffering care-related injuries.

No description available.

På mindre än en generations livstid har Sverige gått från ett samhälle där få hade telefon i sitt hem till en totalt uppkopplad tillvaro. I det digitaliserade Sverige är tillgången till och användarkompetensen av den digitala teknologin en förutsättning för samhällsdeltagandet, vilket ofta ses som problematiskt för den äldre generationen som är den grupp som har haft svårast att anpassa sig enligt den digitala utvecklingen. Syftet med studien är att studera hur åldersdiskrimineringen i det digitaliserade samhället upplevs för den äldre generationen. Målet är att bidra med kunskap och förståelse för den sociala och kulturella tillhörigheten för äldre i det digitaliserade samhället. Det här kommer att göras utifrån frågeställningarna: (1) Hur upplevs den sociala och kulturella tillhörigheten i ett digitaliserat samhälle som äldre? (2) Hur upplever äldre att digitala ersättningar påverkar deras samhällsdeltagande och vilken betydelse har det för deras välbefinnande? (3) Vilken roll spelar varma experter för social och kulturell inkludering hos äldre?  Studiens teoretiska ramverk består av två infallsvinklar. Age Studies, som belyser åldrande som en social och kulturell process med ett personligt perspektiv. Den andra infallsvinkeln är medialiseringsteorin som förklarar hur media i ett digitaliserat samhälle formar den mänskliga relationen till verkligheten, och används främst utifrån ett ersättningsperspektiv. Undersökningen genomfördes genom en semistrukturerad kvalitativ intervjustudie på fyra kvinnor och fyra män över 75 år för att skapa en djupare förståelse av deras upplevelser. Intervjumaterialet har kodats enligt in vivo kodning som har fokuserat på att framhäva intervjupersonens egna resonemang och har sedan analyserats och framställts i en tematisk analys. Resultatet visar att äldres upplevelse av den sociala och kulturella tillhörigheten i ett digitaliserat samhälle har en stor variation. För den uppkopplade äldre upplevs tillhörigheten som inkluderande och digitala ersättningar som något som oftast förenklar vardagen. Däremot skildrar många äldre en snabb utveckling som ständigt ställer krav på anpassning gentemot samhällets nya förutsättningar och en risk eller rädsla för att falla undan och förlora sin tillgång till väsentliga tjänster och sin tillhörighet. Flera äldre upplever att den yngre generationen använder teknologi på ett annat sätt och befinner sig i en annan kulturell sfär som är svår att relatera till. De äldre som är frånkopplade från det digitala skildrar en tillhörighet som präglas av ett utanförskap, där de digitala ersättningarna har skapat ett hinder för samhällsdeltagandet och man har blivit utelåst från stora delar av samhället. Varma experter spelar en stor roll för äldres sociala och kulturella inkludering genom att agera som stöd, hjälp vid problem och introducera nya typer av produkter och tjänster. Även de som hanterar EICT bäst har ett behov av varma experter vilket innebär att de som står utan får en mer utmanande tillvaro. / In less than a generation's lifetime Sweden has gone from a society where few had phones in their homes to a totally connected presence. In the digitalised Sweden the access to and the literacy of digital technology is a prerequisite to participate in society, which is often seen as problematic for elderly adults as they are the group who has had the most difficult time adjusting to the digital development. The purpose of this study is to see how ageism in the digitalised society is perceived by elderly adults. The aim is to contribute with knowledge and understanding of the social and cultural belonging of elderly in the digitalised society. This will be done through the research questions of:  (1) How do elderly adults perceive their social and cultural belonging in the digitalised society? (2) How do elderly adults perceive that digital substitutions affect their ability to participate in society and what meaning does this have for their wellbeing? (3) What role does warm experts play for the social and cultural inclusion of elderly adults? The study's theoretical framework consists of two angles. The first, Age Studies highlights ageing as a social and cultural process and allows a personal perspective of the matter. The second theoretical approach is the theory of mediatisation which defines the view of the media as a logic that forms the humans relation to reality, which will primarily be applied from the function of substitution. The study was conducted through a semi structured qualitative interview study on four females and four males over the age of 75 to create a deeper understanding of their experiences. The material has been coded according to in vivo coding with an intention of capturing the interviewees own words and has then been analysed and presented through an thematic analysis. The result has shown that elderly's perception of their social and cultural belonging has large variations. For the digital elderly the belonging is depicted as inclusive and the digital substitutions often simplify the everyday life. On the other hand, many elderly describe a fast development that constantly creates demands for adjustment according to society's new prerequisites as well as risk or fear of losing their abilities and therefore losing their access to essential services and their societal belonging. Many elderly perceive that younger people use technology in a different way and therefore exist in a different cultural sphere that is difficult to relate to. The disconnected elderly depicts a belonging defined by exclusion, where the digital substitutions act as an obstacle and hinder societal participation. Warm experts play a pivotal role for elderly's cultural and social inclusion by offering support and help with difficulties as well as introducing new products and services. Even those who are the most comfortable with EICT describe a need for warm experts which indicates that those who have no one to support them are faced with a more difficult life.

xiii, 109 p. : ill. / Falls are a significant source of physical, social, and psychological suffering among elderly adults. Falls lead to morbidity and even mortality. Over one-third of adults over the age of 65 years will fall within a calendar year, with almost 10,000 deaths per year attributed to falls. The direct cost of falls exceeds $10 billion a year in the United States. Fall incidents have been linked to multiple risk factors, including cognitive function, muscle strength, and balance control. The ability to properly identify balance impairment is a tremendous challenge to the medical community, with accurate assessment of fall risk lacking. Therefore, the purpose of this study was to assess balance control during gait among young adults, elderly adults, and elderly fallers; determine which biomechanical measures can best identify fallers retrospectively; demonstrate longitudinal changes in elderly adults and prospectively assess fall risk; and provide a method for mapping clinical variables to sensitive balance control measures using artificial neural networks. The interaction of the whole body center of mass (CoM) in relation to the base of support (BoS) assessed static and dynamic balance control throughout gait. Elderly fallers demonstrated reduced balance control ability, specifically a decreased time to contact with the boundary of the BoS, when compared to young adults at heel strike. This decreased time might predispose older adults to additional falls due to an inability to properly respond to perturbations or slips. Inclusion of these balance control measures along with the Berg Balance Scale and spatiotemporal measures demonstrated sensitivity and specificity values of up to 90% when identifying 98 elderly fallers and non-fallers, respectively. Additionally, 27 older adults were followed longitudinally over a period of one year, with only the interaction of the CoM with the BoS demonstrating an ability to differentiate fallers and non-fallers prospectively. As the collection and analysis of these biomechanics measures can be time consuming and expensive, an artificial neural network demonstrated that clinical measures can accurately predict balance control during ambulation. This model approached a solution quickly and provides a means for assessing longitudinal changes, intervention effects, and future fall risk. This dissertation includes both previously published and unpublished co-authored material. / Committee in charge: Dr. Li-Shan Chou, Chair; Dr. Andrew Karduna, Member; Dr. Marjorie Woollacott, Member; Dr. Ronald Stock, Member; Dr. Arthur Farley, Outside Member