This thesis is focused on frailty in old age. The frailty syndrome is the newest geriatric syndrome and can be aptly called the ultimate geriatric syndrome due to the complexity of its causes and the wide range of adverse outcomes it may lead to in older persons. Several of the important correlates of frailty, namely falls, underweight and sarcopenia, are discussed in the context of their relationship with frailty. These entities are geriatric syndromes in their own rights, sharing many common risk factors and arriving at adverse health outcomes either directly or via the pathway of frailty. In the publications that arose from this work, the risk factors of falls, in particular the relationship between medications and chronic diseases in causing falls; risk factors and outcomes of sarcopenia, in particular its relation to diabetes mellitus and other chronic diseases; and how underweight poses survival risks in both community-living and institutionalized older people, are discussed. The final publication of this series of studies demonstrated the reversibility of the frailty syndrome, showing that not all who were in the pre-frailty stage will decline. Risk factors associated with improvement or decline in the pre-frail stage were identified in the local population, and a period of relative stability opened for possible interventions was observed. This thesis thus examines the complex interplay of these syndromes in old age. It is hoped that these publications will enable further research into the underlying mechanisms of frailty and to elucidate modifiable risk factors, hence enabling older people, in particular those in the pre-frail stage, to live healthier and longer lives. / Lee Shun Wah Jenny. / Thesis (M.D.)--Chinese University of Hong Kong, 2015. / Includes bibliographical references. / Title from PDF title page (viewed on 15, September, 2016).

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 48-50).

The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research methodology for this study comprised the following steps: Firstly, the demographics of the world and South Africa were researched. The concept of frail (long-term) care in the United States of America and New Zealand was investigated to determine what is available. The subsidisation concept of the South African Government towards caring for the elderly was also investigated. Secondly, a questionnaire was sent to the residents of five retirement complexes in George to determine their interest in such a plan. The records of the frail care unit that these residents utilise were analysed to determine the number of residents needing frail care. A comparative study of the cost of frail care in the Southern Cape was undertaken. Thirdly, two options to partly subsidise the cost of frail care were examined, where the first option covers the running cost, and the second option, subsidising one third of the frail care cost, builds up a sustainable fund after the first five year period. The funds of the second option can then be utilised in the subsequent years to increase the subsidisation portion of frail care cost. The final step of this study entailed the formulation of recommendations to implement the frail care nursing levy as soon as possible, with special attention given to the following: a) It must be compulsory for new residents to join the fund. b) A yearly capital amount of R100 000 or more is needed to sustain the fund. c) A contract must be drafted to set out all the rules and regulations to the residents. d) An attitude change amongst some residents is required. Individuals must realise that the success of this plan depends upon themselves and with the necessary support could make a significant contribution towards their own peace of mind if and when frail care is needed.

研究背景: 居住於安老院舍的長者通常患有多種不可逆轉的慢性疾病或未期病症。相對其他組群，他們將更快面對臨終與死亡的問題。因此，了解他們對「臨終問題」的態度、臨終地方的選擇意向及其預測因素是非常重要的。研究所得資將有助提供優質的“善終“服務予這群弱勢的長者。 / 研究目的: 本研究旨在探討有關居於香港安老院舍的長者對「臨終問題」的態度、臨終地方的選擇意向、是否視安老院舍如同自己的家及其預測因素。 / 研究方法: 本研究採用橫斷面量性研究的方法，以便利抽樣方式在香港不同地區的安老院舍進行研究。研究對象為年齡65歲或以上，及簡短智能測試達6分或以上，並能以廣東話溝通的安老院舍長者。研究採用結構性問卷以面對面訪談形式進行，作者把「對臨終問題的態度調查問卷」翻譯成中文版本用作調查長者對臨終問題的態度。並採用EQ-5D和Barthel Index (20) 以評估長者的自我健康評估及日常生活自我照顧能的狀況。調查問卷亦包括探討長者對安老院視為自己的家的看法和死亡地點的選擇。收集之數據採用了二分類邏輯回歸進行各因素與結果變量之間的單因關聯分析，那些p值<0.25的因素被選定為候選自變量，然後利用逐步多因素邏輯回歸分析來劃定結果變量的獨立相關因素。 / 研究結果: 合共317名來自20間安老院舍的長者參與了此項研究，包括248名女性(78.2%)和69名男性(21.8%)，年齡介乎65至99歲，平均年齡為84歲(標準差6.6)。多因素分析顯示多種預測因素與「臨終問題」的態度有著相關性；對於有家庭財政支持的長者來說，他們較傾向不同意由醫生作出所有有關照顧上的決定；有接受教育和患有較多慢性病的長者較傾向同意訂立預前指示；那些在安老院舍居住時間較長的長者較傾向不同意使用藥物讓他們可以隨時選擇結束生命；但患有糖尿病者較傾向同意安樂死；有宗教信仰者較傾向同意靈性或宗教的支持對他們是重要的。此外，310名安老院舍長者(97.8%)認為安老院舍如同自己的家。有261名長者 (68.1%) 表示希望在目前的安老院去世。那些認為安老院舍如同自己的家、有獨立經濟支持、及同意安樂死的院舍長者，較傾向希望在目前的安老院去世。 / 研究結論: 本研究譂述了居於香港安老院舍的長者對「臨終問題」的態度及其相關因素的實證結果。研究發現幾乎所有安老院舍的長者視安老院舍如同自己的家，明顯地相當多的長者表示如果條件允許下，希望在目前的安老院舍去世。這種強烈的聲音指出我們需要發展院舍的臨終照顧以滿足院舍長者的需要及期望。而從獲悉長者對「臨終問題」的態度及臨終地方的選擇意向，可讓醫護專業人員在安老院舍裡更有效地規劃臨終照顧服務，並能讓長者善終與好死。 / Background: Older people living in residential care homes for the elderly (RCHEs) have high incidences of irreversible chronic illnesses and terminal diseases. They are the most significant group facing impending death and dying. It is vital to understand their attitudes toward end of life (EOL) issues and their preference for EOL care in order to promote their quality of life. / Objective: This study aims to examine the attitudes toward EOL issues, the preference for place of death, the perception of RCHE as a resident’s own home and their predictors amongst older RCHE residents in Hong Kong. / Method: A cross-sectional quantitative study with convenience sampling was conducted in RCHE in different regions of Hong Kong. RCHE residents aged ≥65 achieving abbreviated mental test score ≥6 and who were able to communicate in Cantonese were recruited. Face-to-face interviews were conducted with the aid of a structured questionnaire. Demographic and clinical characteristics were collected. Health and functional status were measured by Euroqol-5D and Barthel Index (20). The “Attitudes of older people to end of life issues questionnaire“ was translated from the English version into a Chinese version and employed to examine the attitudes toward EOL issues. The perception of RCHE as own home and the preference for place of death were examined. Univariate analysis on the association between the outcome variables was performed. Factors with a p value <0.25 in univariate analyses were selected for multivariable logistic regression to delineate factors independently associated with the outcome. / Results: A total of 317 participants including 248 (78.2%) women and 69 (21.8%) men from 20 RCHE participated in the study. Their mean age was 84 ± 6.6 (mean ± SD). As showed in multivariate analysis, respondents financially supported by their family were less likely to allow doctors to make all the decisions about their care. Those respondents with higher number of morbidities and had higher education were more likely to agree with making a living will. Those who lived longer in RCHE were less likely to agree to having a drug at their disposal to end their life. Respondents with diabetic mellitus were more likely to agree with euthanasia. Respondents who followed a religion were more likely to agree on the importance of spiritual or religious support. Furthermore, 310 (97.8%) respondents perceived RCHE as their own home. Two hundred and sixteen (68.1%) residents wished to die in their present RCHE. Residents with the means to support themselves financially, agreed with euthanasia and who perceived RCHE as their own home were more likely to wish to die in RCHEs. / Conclusion: Nearly all residents perceived RCHEs as their own home and a significant proportion wished to die there if conditions allowed. This asserts that EOL care in RCHE should be developed to meet the wishes of the older residents. This study delineated significant factors associated with the attitudes of older people toward EOL issues. Knowing those factors allows health care professionals to plan for quality EOL care services in RCHEs more effectively and foster good death for this vulnerable population. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Law, Po Ka. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 160-173). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter 1. --- CHAPTER ONE: INTRODUCTION AND BACKGROUND / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Epidemiology data of ageing in Hong Kong --- p.3 / Chapter 1.3 --- Impact of ageing population --- p.4 / Chapter 1.4 --- Residential care services in Hong Kong --- p.5 / Chapter 1.5 --- Quality of residential care homes for the elderly (RCHEs) in Hong Kong --- p.7 / Chapter 1.6 --- Definition of end of life care, palliative care and hospice care --- p.9 / Chapter 1.7 --- End of life care in residential care homes in Hong Kong --- p.11 / Chapter 1.8 --- Dying in place --- p.14 / Chapter 1.9 --- Perception of RCHEs as own home --- p.15 / Chapter 1.10 --- Factors influencing attitudes to end of life issues --- p.15 / Chapter 1.11 --- The proposed framework --- p.18 / Chapter 1.12 --- Aim of the study --- p.20 / Chapter 1.13 --- Operational definitions of key terms --- p.20 / Chapter 1.14 --- Significance of the study and its impact on the society and future service development --- p.22 / Chapter 1.15 --- Overview of each chapter of the thesis --- p.24 / Chapter 2. --- CHAPTER TWO: LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.25 / Chapter 2.2 --- Literature search --- p.26 / Chapter 2.3 --- Search results --- p.27 / Chapter 2.4 --- Unmet need for end of life care in RCHEs in Hong Kong --- p.28 / Chapter 2.5 --- EOL care in RCHEs of other Western and Asian countries --- p.33 / Chapter 2.6 --- Preference for place of death --- p.34 / Chapter 2.7 --- Attitudes toward end of life issues --- p.38 / Chapter 2.8 --- Factors affecting older residents when choosing to die in RCHEs --- p.41 / Chapter 2.9 --- Barriers to EOL care in RCHEs --- p.43 / Chapter 2.10 --- Conclusion --- p.45 / Chapter 3. --- CHAPTER THREE: RESEARCH DESIGN AND METHOD / Chapter 3.1 --- Introduction --- p.47 / Chapter 3.2 --- Aim of the study --- p.47 / Chapter 3.3 --- Objectives of the study --- p.47 / Chapter 3.4 --- Research questions --- p.48 / Chapter 3.5 --- Research design --- p.50 / Chapter 3.6 --- Sample size --- p.51 / Chapter 3.7 --- Study setting --- p.52 / Chapter 3.8 --- Sampling method --- p.52 / Chapter 3.9 --- Data collection --- p.54 / Chapter 3.10 --- Study instruments --- p.55 / Chapter 3.11 --- Translation process for the AEOLI questionnaire --- p.60 / Chapter 3.11.1 --- Establishing the semantic equivalence --- p.64 / Chapter 3.11.2 --- Establishing the content and face validity --- p.66 / Chapter 3.12 --- Pilot study --- p.67 / Chapter 3.12.1 --- Testing the feasibility --- p.67 / Chapter 3.12.2 --- Test-retest --- p.68 / Chapter 3.13 --- Data cleaning --- p.70 / Chapter 3.14 --- Data analysis --- p.70 / Chapter 3.15 --- issues and consent Ethical --- p.72 / Chapter 4. --- CHPATER FOUR: RESULTS / Chapter 4.1 --- Introduction --- p.74 / Chapter 4.2 --- Recruitment of participants --- p.74 / Chapter 4.3 --- Characteristics of the study sample / Chapter 4.3.1 --- Socio-demographic characteristics --- p.76 / Chapter 4.3.2 --- Clinical characteristics --- p.79 / Chapter 4.3.3 --- Functional and health status --- p.81 / Chapter 4.4 --- Descriptive statistics of AEOLI-C, preference for place of death and perception of RCHEs as residents’ own home / Chapter 4.4.1 --- Descriptive statistics of AEOLI-C --- p.83 / Chapter 4.4.1.1 --- Decision making (Attitude 1) --- p.83 / Chapter 4.4.1.2 --- Pain (Attitude 5, 9, 20) --- p.83 / Chapter 4.4.1.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.84 / Chapter 4.4.1.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.84 / Chapter 4.4.1.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.85 / Chapter 4.4.1.6 --- Ageism (Attitude 13, 16, 23) --- p.85 / Chapter 4.4.1.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.85 / Chapter 4.4.1.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.85 / Chapter 4.4.1.9 --- Societal awareness (Attitude 12) --- p.86 / Chapter 4.4.2 --- Descriptive statistics of the perception of RCHEs as residents’ own home --- p.86 / Chapter 4.4.3 --- Descriptive statistics of the preference for place of death --- p.86 / Chapter 4.5 --- Correlational and logistic regression results / Chapter 4.5.1 --- Correlational and regression results of the predictive factors associated with AEOLI-C --- p.89 / Chapter 4.5.1.1 --- Decision making (Attitude 1) --- p.89 / Chapter 4.5.1.2 --- Pain (Attitude 5, 9, 20) --- p.90 / Chapter 4.5.1.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.91 / Chapter 4.5.1.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.93 / Chapter 4.5.1.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.95 / Chapter 4.5.1.6 --- Ageism (Attitude 13, 16, 23) --- p.97 / Chapter 4.5.1.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.99 / Chapter 4.5.1.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.100 / Chapter 4.5.1.9 --- Societal awareness (Attitude 12) --- p.101 / Chapter 4.5.2 --- Correlational and regression results of the predictive factors associated with the perception of RCHEs as residents’ own home --- p.104 / Chapter 4.5.2.1 --- Relationship with socio-demographic characteristics, clinical characteristics, health and functional status --- p.104 / Chapter 4.5.2.2 --- Relationship with AEOLI-C --- p.108 / Chapter 4.5.3 --- Correlational and regression results of the predictive factors associated with preference for place of death --- p.110 / Chapter 4.5.3.1 --- Relationship with socio-demographic characteristics, clinical characteristics, functional and health status --- p.110 / Chapter 4.5.3.2 --- Relationship with AEOLI-C --- p.114 / Chapter 4.6. --- Summary of the results --- p.116 / Chapter 5. --- CHAPTER FIVE: DISCUSSION / Chapter 5.1 --- Introduction --- p.117 / Chapter 5.2 --- Characteristic of the participants --- p.118 / Chapter 5.3 --- The attitudes toward end of life issues --- p.120 / Chapter 5.3.1 --- Decision making (Attitude 1) --- p.121 / Chapter 5.3.2 --- Pain (Attitude 5, 9, 20) --- p.123 / Chapter 5.3.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.125 / Chapter 5.3.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.128 / Chapter 5.3.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.131 / Chapter 5.3.6 --- Ageism (Attitude 13, 16, 23) --- p.133 / Chapter 5.3.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.135 / Chapter 5.3.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.136 / Chapter 5.3.9 --- Societal awareness (Attitude 12) --- p.137 / Chapter 5.4 --- The perception of RCHEs as residents’ own home --- p.138 / Chapter 5.5 --- The preference for place of death --- p.140 / Chapter 5.6 --- Summary --- p.143 / Chapter 6. --- CHAPTER SIX: CONCLUSION / Chapter 6.1. --- Introduction --- p.145 / Chapter 6.2 --- Limitations of the study --- p.145 / Chapter 6.2.1 --- Generalization of the results --- p.145 / Chapter 6.2.2 --- Lack of theoretical construct of the translated questionnaire --- p.147 / Chapter 6.2.3 --- Limitations of quantitative study and cross-sectional design --- p.149 / Chapter 6.3 --- Contributions of the study --- p.150 / Chapter 6.4 --- Recommendations and implications to nursing practice --- p.152 / Chapter 6.5 --- Implications to the EOL Care Practice in Residential Care Setting --- p.154 / Chapter 6.6 --- Implications to residential care policy --- p.155 / Chapter 6.7 --- Recommendations for further studies --- p.156 / Chapter 6.8 --- Conclusion --- p.158 / Chapter 7. --- REFERENCES --- p.160 / Chapter 8. --- APPENDICES --- p.174

Thesis (M.S.) -- Mississippi State University. College of Architecture, Art and Design. / Title from title screen. Includes bibliographical references.

Background: The number of frail elderly people is increasing in society which places great demands on the health system. In municipal homecare nurses often work alone which can lead to uncertainty in emergency assessments. To make informed decisions about continuing care of the frail elderly is vital. From an economic aspect is the correct care at the right level also significant. Aim: The aim of this study is to highlight nurses' experiences of acute assessment of frail elderly persons with deteriorating health in municipal home care. Method: The method used was qualitative with an inductive approach where data was analyzed with a qualitative content analysis. There were 11 registered nurses/district nurses working in municipal home care interviewed. Results: From the analysis of the data emerged three categories; to make informed, long-term planning, collaboration on patient involves with seven subcategories. Conclusion: For nurses to experience good support in the acute assessment requires effective cooperation especially with doctors. The result shows that insecurity in the assessment often leads patients to be sent to the hospital. The medical care plans have proven to be a great help in the assessments and needs to be implemented on many frail elderly persons in municipal homecare. / Bakgrund:Antalet sköra äldre ökar i samhället vilket ställer stora krav på sjukvården. Inom den kommunala hemsjukvården arbetar sjuksköterskor många gånger ensam vilket kan leda till osäkerhet i akuta bedömningar. Att fatta välgrundade beslut om fortsatt vård av den sköra äldre är viktigt. Ur samhällsekonomiskaspekt är rätt vård på rätt nivå också betydelsefullt. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av akuta bedömningar av sköra äldre vid försämrat hälsotillstånd inom kommunal hemsjukvård. Metod: I denna studie användes kvalitativ metod med induktiv ansats där datamaterialet analyserades med kvalitativ innehållsanalys. Data insamlades genom individuella intervjuer med 11 sjuksköterskor/distriktssköterskor inom kommunal hemsjukvård. Resultat: Ur analysen av datamaterialet framträdde tre kategorier; att fatta välgrundade beslut, långsiktig planering skapar trygghet i den akuta bedömningen, samverkan kring patienten med sju underkategorier. Konklusion: För att sjuksköterskor ska uppleva ett bra stöd i akuta bedömningen krävs ett fungerande samarbete framförallt med läkarna. Resultatet visar att otrygghet i bedömningen ofta leder till att patienten skickas in till sjukhus. De medicinska vårdplanerna har visat sig vara en stor hjälp i bedömningarna och behöver implementeras på många sköra äldre i den kommunala hemsjukvården.

published_or_final_version / Social Work / Master / Master of Social Work

Background: Frail elderly is described as multi diseased, vulnerable, in need of medication and hospital care. The group of patients is a growing part of the population in the western world. Theories of patient centered care, health literacy and hand over problems are also described in the background. Aim: to describe a group of frail elderly patients experiences of hospital readmission and identify possible organizational flaws. Method: Qualitative data was collected from 20 patients during their second visit at the hospital and a content analysis was performed. Results: Findings were; experiences of ill being ever since the first hospitalization period due to not being well enough, being sent home to quickly or relatives not being strong enough to handle the situation. Experiences of not being informed or being informed in a noisy surrounding about the given care, and how to rehab when returning home. Findings also described situations of misunderstanding related to informant´s present medication and finally a need for appropriate discharge calls for the frail elderly patient. Conclusion: The results highlight a need to act according to the patient´s legal rights to be informed and participate in the decision-making. An implementation of patient centered care can make it possible. An increased number of nursing specialists in the elderly care might also lead to improved continuity and give support to the frail elderly.

Trata-se de um estudo exploratório, quanti-qualitativo, acerca do senescente cuidador de idoso dependente em domicílio, que teve como objetivos: identificar e avaliar as percepções sobre o cuidado e suas representações sociais no cotidiano do cuidador; identificar as alterações físicas e psicossociais vivenciadas por este, decorrentes do ato de cuidar; avaliar o grau de dependência dos idosos dependentes considerando o estado físico e mental. A Representação Social foi o referencial teórico escolhido e o método hermenêutico-dialético empregado para análise dos discursos. Os sujeitos do estudo foram 32 idosos, sendo 16 cuidadores e 16 dependentes, residentes na área urbana do município de Cascavel- PR inscritos no PSF e PAID, entre 60 a 96 anos de idade. A coleta de dados foi desenvolvida entre novembro de 2006 a janeiro de 2007, por meio da entrevista semi-estruturada. Os cuidadores possuíam entre 60 e 76 anos (média = 64,1 ± 17,3 anos), 81,2% eram mulheres, 41,2% cônjuges, 50,0% não freqüentaram escola e o período de cuidador variou entre três meses a 23 anos (média = 5,4 anos DP ±1,2 anos). A Escala de Depressão Geriátrica mostrou que 93,7% apresentavam grau de depressão leve e segundo o índice de Zarit, a maioria não apresentou sobrecarga provocada pelo ato de cuidar. Dentre os idosos dependentes, 12,5% estavam inscritos no PSF e 87,5% no PAID; com idade entre 60 e 96 anos (média = 71,4 21,2 anos), sendo 56,2% do sexo masculino. Seqüelas do acidente vascular cerebral foram encontradas em 31,2% dos idosos dependentes e quanto ao índice de Katz, 62,5% apresentaram o grau G. Os discursos deram origem as seguintes unidades temáticas: determinação do valor sócio-cultural; repercussão do cuidar no cotidiano do cuidador; a rede de apoio. Sentimentos como conformismo/resignação, medo da perda, espiritualidade, compromisso e compaixão, vínculos sociais relacionados a imposição familiar e pelo idoso dependente e as relações de gênero, foram identificados como determinantes na escolha do cuidador. Dentre as repercussões do cuidar no cotidiano, foram destacadas as alterações à saúde orgânica funcional; alterações emocionais e alterações na situação econômica. Quanto à rede de apoio, as unidades temáticas identificadas se relacionaram ao sistema de referência e contra referência e a capacitação do cuidador informal. Os resultados evidenciaram o estado de vulnerabilidade a qual o cuidador senescente encontrava-se exposto, revelando a inexistência de uma política social de apoio efetivo ao cuidador de idosos, bem como programas específicos voltados para esta necessidade. O modelo de assistência domiciliar no qual um membro da família é o cuidador principal e, em particular, o senescente, exige dos profissionais de saúde, em especial os enfermeiros, atuação mais efetiva e dinâmica, principalmente no que se refere a prevenção de desgastes, considerando que este se torna tão, ou mais vulnerável que o próprio doente / One is about a exploratory, quanti-qualitative study, concerning senescent caretaker of aged dependent in domicile, that had as objective: to identify and to evaluate the perceptions on the social care and its representations in the daily one of the caretaker; to identify the physical and psicossociais alterations lived deeply by this, decurrent of the act to take care of; to evaluate the degree of dependence of the aged dependents being considered the physical and mental state. The Social Representation was the theoretical referencial chosen and the used hermeneutic-dialétical method for analysis of the speeches. The citizens of the study had been 32 aged ones, being 16 caretakers and 16 dependents, residents in the urban area of the city of Cascavel- PR enrolled in PSF and PAID, enter the 60 96 years of age. The collection of data was developed between November of 2006 the January of 2007, by means of the half-structuralized interview. The caretakers heve been between 60 and 76 years (average = 64.1 ± 17,3 years), 81.2% were women, 41.2% spouses, 50.0% had not frequented school and the period of caretaker varied enters three months the 23 years (average = 5,4 years DP ±1,2 years). Tehe Geriatrical Depression Scale showed that 93.7% presented degree of light depression according to and index of Zarit, the majority did not present overload provoked for the act to take care of. Amongst the aged dependents, 12.5% were enrolled in PSF and 87.5% in the PAID; with age between 60 and 96 years (average = 71,4 (21,2 years), being 56.2% of the masculine sex. Sequels of the cerebral vascular accident had been found in 31,2% of the aged dependents and how much to the index of Katz, 62.5% had presented degree G. The speeches had given to origin the following thematic units: determination of the partene-culturall value; repercussion of taking care of in the daily one of the caretaker; the support net. Feelings as conformism/resignation, fear of the loss, spirituality, commitment and compassion, social bonds related the familiar imposition and for the aged dependent and the relations of sort, had been identified as determinative in the choice of the caretaker. Amongst the repercussions of taking care of in the daily one, the alterations to the functional organic health had been detached; emotional alterations and alterations in the economic situation. How much to the support net, the identified thematic units if had related to the system of reference and against reference and the qualification of the informal caretaker. The results had evidenced the vulnerability state which the caretaker senescent met displayed, disclosing the inexistence of one social politics of effective support to the caretaker of aged, as well as specific programs come back toward this necessity. The model of domiciliary assistance in which a member of the family is main cuidador e, in particular, senescent, demands of the professionals of health, in special the nurses, performance more effective and dynamics, mainly with respect to prevention of consumings, considering that this if becomes so, or more vulnerable than the proper sick person

Em termos de atenção à saúde é reconhecido que a parcela da população que mais utiliza de serviços especializados, como internações hospitalares, são os indivíduos com mais de 60 anos de idade. No Rio Grande do Sul (RS), a maior concentração de idosos se encontra nos municípios pequenos, com menos de 10 mil habitantes e com atividades econômicas relacionadas à produção agrícola. E pouco se sabe sobre essa população, principalmente do idoso aposentado rural, seus riscos de fragilização, sua condição de saúde-doença e utilização de serviços de saúde. Este estudo, então, propôs-se a avaliar a mobilidade corporal da população rural idosa e os riscos de internação hospitalar em diferentes regiões do estado do RS. Para tanto, foi realizada uma pesquisa exploratória de base populacional e delineamento ecológico e transversal. A construção do processo investigatório se deu em 3 etapas. A primeira consistiu em uma pesquisa direta com 604 trabalhadores rurais aposentados e com mais de 60 anos de idade, residentes em diferentes regiões do estado, em que, foram avaliadas a mobilidade funcional através do Timed Up and Go test, a fragilidade referida e a Probabilidade de Internações Repetidas (PIR), através de teste e instrumentos validados para o Brasil. Na segunda parte, foram investigadas as Internações por Condições Sensíveis à Atenção Primária (ICSAP) de pessoas com mais de 60 anos de idade residentes no RS, no ano de 2015, através do departamento de informática do Sistema Único de Saúde do Brasil (DATASUS). Na terceira etapa da pesquisa, foram estabelecidas relações entre ICSAP, PIR, Fragilidade e mobilidade da população idosa rural do estado, considerando a idade, sexo e local ou região de residência. O estudo resultou em 6 artigos: o primeiro, uma revisão da literatura sobre a população rural idosa do RS; o segundo, assim como o terceiro e quarto, foram produtos da primeira etapa do estudo, que resultaram nos títulos Síndrome de fragilidade em idosos rurais no estado do RS, Risco de internação hospitalar em trabalhadores rurais idosos no estado do Rio Grande do Sul e Mobilidade funcional e a fragilidade de idosos agricultores do RS; o quinto artigo é sobre Internações por condições sensíveis à atenção primária de idosos no Rio Grande do Sul e é resultado da segunda etapa da pesquisa; o último artigo, Risco de hospitalização e mobilidade de idosos rurais no Rio Grande do Sul, corresponde à última etapa do estudo, que estabelece relações entre ICSAP no estado, a PIR, a fragilidade referida e a mobilidade da população idosa rural. O processo de investigação, bem como os desfechos, identifica uma população de idosos trabalhadores rurais, jovens em franca atividade, homens em sua maioria, que percebem a sua saúde como frágil e mantêm um baixo risco de internação. O estudo nos mostrou uma relação entre fragilidade, mobilidade funcional e ICSAP compatível com riscos de internação de idosos no estado. Também identificou algumas particularidades em relação a questões de saúde-doença da população rural idosa gaúcha, que sugerem a necessidade de incremento da atenção primária à saúde do trabalhador do campo. No entanto, há necessidade de se promover outras pesquisas com essa população, considerando as suas características culturais, sociais e demandas de políticas sociais adequadas a uma manutenção de qualidade de vida, visto que a área oferece obstáculos em relação a serviços públicos e outros inerentes à condição do envelhecimento no campo. / When it comes to attention to health, the share of population who most uses specialized services, such as hospital admissions, are those with more than 60 years of age. At Rio Grande do Sul (RS), the biggest concentration of elderly people is found at small towns, with less than 10 thousand inhabitants and who perform economic activities related to agriculture. Little is known about this population, mainly the rural elderly, their risk of frailty, their health-disease conditions and their use of health services. Therefore, this study aims at evaluating corporal mobility in the rural elderly mobility and the risks of hospitalization in different regions inside RS. To this end, an exploratory research, with populational basis, and ecological and cross-sectional basis was conducted. The construction of the investigatory process happened in three different stages. The first one consisted of a direct research with 604 retired rural elders, with more than 60 years of age, residing in different locations within the state, evaluating the functional mobility through the Time Up and Go Test, the referred frailty and the Probability of Repeated Hospitalizations (PIR), through tests and instruments validated in Brazil. In the second part, hospitalizations due to primary care-sensitive conditions (ICSAP) of people with over 60 years of age, residing in RS, in the year of 2015. The data was collected from the Brazilian Unified Health System (DATASUS). In the third phase of this research, the relationships between ICSAP, PIR, Frailty and mobility from the rural elderly population in the State were established; considering their age, sex and their place or region of residency. The study resulted in 6 papers: the first, a review of the literature about the rural elderly population at RS; the second, as well as the third and fourth, were products of the first part of the study and that resulted in the titles Frailty syndrome in rural elderly people in the state of Rio Grande do Sul, Risk of hospitalization in rural elderly people in the state of Rio Grande do Sul, and Functional mobility and the frailty of elderly farmers from RS. The fifth paper is about the hospitalization due to primary care-sensitive conditions of elderly people in Rio Grande do Sul and results from the second phase of the research. The last paper, Risk of hospitalization and mobility in rural elderly people in Rio Grande do Sul, corresponds to the last part of the study and stablishes the relationships between ICSAP within the state, the PIR, the referred frailty and the mobility of the rural elderly population. The investigation process, as well as its disclosures, identifies a population of rural elderly, young in activity, mostly male, who perceive their health as frail and maintain a low risk of hospitalization. The study showed a relationship between frailty, mobility and ICSAP compatible with risks of hospitalization of elders in the state. It also identified some particularities regarding health-disease conditions from the rural elderly population in RS, which suggest the necessity of improvement in primary health care for farmers. However, there is a necessity of promoting other researches with this population, considering their cultural and social characteristics and the demand of social policies adequate to the maintenance of their life quality, since the area offers obstacles with respect to public services and others inherent to aging in the country.