No description available.

Source: Masters Abstracts International, Volume: 46-05, page: 2648. Adviser: Stephanie McFall. Includes bibliographical references.

published_or_final_version / Zoology / Master / Master of Philosophy

Geriatric Education Centers (GECs), as funded by the Health Resources and Services Administration, promote interdisciplinary geriatric education and training for more than 35 health-professions disciplines including medicine, dentistry, pharmacy, nursing, and social work. GECs are charged with becoming self-sustaining beyond the period of their funding. Sustainability in this application means that a GEC can fund itself through the generation of multiple revenue sources. This study seeks to explore changes in the structure, activities, and relationships of GECs over time in their pursuit of sustainability, and hypothesizes that GECs have shifted from the old economy, or the public good knowledge regime, to the new economy, or the academic capitalist knowledge/learning regime, and from the manufacturing to the networking economy. The theoretical framework of academic capitalism and the knowledge/learning regime will be used as a lens in this qualitative multiple case study.Sources included structured, in-depth, on-site interviews and observations, as well as documentary and virtual (website) evidence. While GECs are engaging in market-like behaviors, creating markets and circuits of knowledge, developing interstitial and intermediary organizations, and expanding managerial capacity, they have been unable to connect with related markets, as these markets lack a profit motive, and have ultimately been unsuccessful in their pursuit of sustainability. Continued federal funding for GECs is justified based on the public good argument that without public encouragement, these services would not be provided by the private sector. The study concludes with recommendations to enhance opportunity structures for GECs.

Abstract          Background: End of life is difficult to establish in patients with dementia and many patients die due to complications related to the disease. To document that care are palliative in this group of patients is not common among nurses and physicians. This may depend on that the palliative course is extended and not similar to the palliative course common among patients with cancer. Aim: To describe how the registered staff in nursing homes document the care of persons with dementia in a late palliative phase. Method: A retrospective record study with a deductive approach. Nursing (n = 50) and medical records (n = 50) for departed patients were reviewed using a review guide based on the Liverpool Care Pathway (LCP). Data were analyzed with a manifest content analysis.  The occurrence of documentation in the records was also counted. Results: Three categories were formulated from the analysis: Initial assessment, Coherent assessment and Follow-up. According to medical records the nurses and physicians knew that patients with dementia were dying, but the position on palliative care was not always decided. Nurses and physicians knew that patients with dementia were dying but they did not take a stand that the patient needed palliative care.  Mainly physical symptoms were documented and to a lesser degree psychological, social or existential/spirituality needs. Discussion: It was difficult to form a true picture of patients’ situation from out the documentation. Partly because all caring actions were not documented and the review guide was limited as all parts provided to give a holistic care was not represented. That relative had been provided information that the patient was palliative was accurately documented. Conclusion: The holistic care that patients with dementia need in a palliative phase is not elucidated in the documentation in nursing homes in spite of nurses and physicians knowledge of that the patient are dying.

Inadequate numbers of physicians skilled at providing specialized care of the elderly, has initiated inquiry as to how medical schools will ensure tomorrow’s physicians are capable of providing the most appropriate care for Canada’s growing population of aging seniors. The Canadian Geriatrics Society has responded to such concerns with the establishment of recommended geriatric learning objectives. This thesis examined the geriatric content of the undergraduate curriculum of Canada’s newest medical school, the Northern Ontario School of Medicine, and compared these findings to the Canadian Geriatrics Society’s recommended ‘Core Competencies in the Care of Older Persons for Canadian Medical Students’. While there was a respectful compliance with the recommendations, findings reveal that five of the twenty recommended competencies were absent in the curriculum objectives. Further, present competencies were found to be unequally distributed across the curriculum in relation to both the year and the teaching setting. The results suggest areas for improvement as recommended competencies are intended as a minimum standard for performance in caring for the elderly.

No abstract available. / Thesis (M.Med.)-University of Natal, 1986.

Urinary tract infection (UTI) is a common bacterial infection in women of all ages but the incidence and prevalence increase with age. Despite the high incidence of UTI, little is known about its impact on morale or subjective wellbeing and daily life in old women. UTI in older people can be a complex problem in terms of approach to diagnosis, treatment and prevention because in these patients it frequently presents with a range of atypical symptoms such as delirium, gastrointestinal signs and falls. Even if UTI has been shown to be associated with delirium it has frequently been questioned whether UTI can cause delirium or if it is only accidentally detected when people with delirium are assessed. The main purpose of this thesis was to describe the prevalence of UTI, to identify factors associated with UTI among very old women and to illuminate the impact of a UTI on old women’s health and wellbeing.  This thesis is based on two main studies, the GErontological Regional DAtabase (GERDA) a cross-sectional, population-based study carried out in the northern parts of Sweden and Finland during 2005-2007 and a qualitative interview study in western Sweden 2008-2009. Data were collected from structured interviews and assessments made during home visits, from medical records, care givers and relatives. UTI was diagnosed if the person had a documented symptomatic UTI, with either short- or long-term ongoing treatment with antibiotics, or symptoms and laboratory tests judged to indicate the presence of UTI by the responsible physician or the assessor. One hundred and seventeen out of 395 women (29.6%) were diagnosed as having suffered from at least one UTI during the preceding year and 233 of these 395 (60%) had had at least one diagnosed UTI during the preceding 5 years. These old women with UTI were more dependent in their activities of daily living, and had poorer cognition and nutrition. In these women, UTI during the preceding year was associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia. Eighty-seven of 504 women (17.3%), were diagnosed as having a UTI with or without ongoing treatment when they were assessed, and almost half (44.8%) were diagnosed as delirious or having had episodes of delirium during the past month. In all, 137 of the 504 women (27.2%) were delirious or had had episodes of delirium during the past month and 39 (28.5%) of them were diagnosed as having a UTI. Delirium was associated with Alzheimer’s disease, multi-infarct dementia, depression, heart failure and UTI. Forty-six out of 319 women (14.4%) were diagnosed as having had a UTI with or without ongoing treatment and these had a significantly lower score on the Philadelphia Geriatric Center Morale Scale (PGCMS), (10.4 vs 11.9, p=0.003) than those without UTI, indicating a significant impact on morale or subjective wellbeing among very old women. The medical diagnoses significantly and independently associated with low morale were depression, UTI and constipation. The experience of suffering from repeated UTI was described in interviews conducted with 20 old women. The interviews were analysed using qualitative content analysis. The participants described living with repeated UTI as being in a state of manageable suffering and being dependent on alleviation. Being in a state of manageable suffering was described in terms of experiencing physical and psychological inconveniences, struggling to deal with the illness and being restricted regarding daily life. Being dependent on alleviation was illustrated in terms of having access to relief but also experiencing receiving inadequate care. In conclusion, UTI is very common among old and very old women and is a serious health problem. UTI seems to be associated with delirium and to have a significant impact on the morale or subjective wellbeing of old women and those affected suffer both physically and psychologically and their social life is limited. UTI was also associated with vertebral fractures, urinary incontinence, inflammatory rheumatic disease and multi-infarct dementia which might raise the suspicion that UTI can have serious medical effects on health in old women. / Embargo t o m 2011-11-11

No description available.

Background: In South Africa there data is lacking on the health of the older population. This study aims to report on actions taken by general practitioners on abnormal blood pressure, blood glucose and osteoporosis screen identified by registered nurses, conducting home based visits to older clients. Methods An agency piloted the Comprehensive geriatric assessment (CGA) tool in an urban affluent population. In this cross sectional secondary study analysis, 465 participants aged 60 years and over had a nurse visit in their homes and a subsequent General Practitioner (GP) visit. The prevalence of specific geriatric problems was assessed as well as the frequency of initiated procedures by the GP. This study will focus on initiated actions by the General Practitioners in response to abnormal blood pressures, blood glucose, and osteoporosis screen. Results Frequency tables were utilised to identify prevalence of the abnormal blood pressures, blood glucose and osteoporosis screen. . Abnormal blood pressures were detected (230/465, 49%) of the subjects , the GP initiated actions on only 15/465 (3.2%) of clients. Abnormal blood sugars were detected 106/465 (23%) of the GP initiated actions on 23/465 (5%) of clients. Clinical risk factors for the development of osteoporosis were detected in 252 /465 (54%) subjects GP initiated actions on 11/465 (3%) Conclusion This study explored the relationships between comprehensive geriatric assessment and subsequent GP actions and found using the CGA in this population will be successful in identifying abnormal health findings which will enable intervention. However, due to challenges in the communications and marketing of this service, GP’s were not well informed of their role and did not act on majority of the abnormal findings detected by nurses / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.