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<p>The project explores decision making in the context of end-of-life (EOL) care choices among adults with few social and economic resources. Although most American adults believe that planning for EOL is important, only about 30% report making formal EOL plans such as Advance Directives, wills, trusts, or any other formal documentation. Using qualitative methodology, 25, participants who were all living at the same long term care facility, were interviewed during two different waves of data collection. The transcribed interviews were analyzed using thematic analysis and guided by Normative Rhetorical Theory framework. Remarkable conclusions were that without social and economic resources, participants reported they did not make choices about EOL and care, but rather their decisions were made by default.</p>

Submitted by Diogo Misoguti (diogo.misoguti@gmail.com) on 2017-06-27T13:39:46Z No. of bitstreams: 1 Tese-14578.pdf: 1193764 bytes, checksum: 6ab1fff997077ec898efedda6997338a (MD5) / Made available in DSpace on 2017-06-27T13:39:46Z (GMT). No. of bitstreams: 1 Tese-14578.pdf: 1193764 bytes, checksum: 6ab1fff997077ec898efedda6997338a (MD5) Previous issue date: 2014 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A presente pesquisa tem como tema central a constituição dos discursos sobre a velhice e o envelhecimento no Brasil. A análise e a metodologia foram orientadas pela Psicanálise e pela Antropologia, que se articulam na Saúde Coletiva ao considerarem os fenômenos humanos e sociais a partir do registro simbólico. O trabalho de campo envolveu como estratégias metodológicas o exame de documentos e publicações científicas, a observação de apresentações orais em eventos e congressos dedicados à velhice e ao envelhecimento e a realização de entrevistas com profissionais protagonistas desse campo. O contato com um universo mais amplo que a geriatria a gerontologia durante o processo investigativo suscitou a compreensão e a definição da noção de ¿Campo do Envelhecimento¿, como um território que abrange diversos personagens, disciplinas, abordagens, instituições e discursos. Foi possível, assim, demonstrar a existência de movimentos dissidentes, disputas por prestígio, competência e autoria de conceitos e apropriação de discursos. Neste campo ¿ heterogêneo ¿ prevalecem discursos que visam positivar o envelhecimento, tentando dissociá-lo das imagens de doença, pobreza e abandono. O ¿envelhecimento ativo¿ é representativo desse esforço, ao alçar a atividade como um bem maior: desenvolvido na Organização Mundial da Saúde, passa a ser a principal referência para as políticas públicas no Brasil, sendo apresentada em diversos dispositivos legais. A análise possibilitou localizar o envelhecimento ativo como sucessor do discurso higienista-preventivista do final do século XIX e início do século XX, ao privilegiar a prevenção e a promoção da saúde como atitudes que devem ser assumidas pelos indivíduos, sendo estes vistos como os principais responsáveis por sua saúde. Ao defender a atividade como uma positividade que deve ser estimulada na velhice, este discurso acabou por estabelecer uma polaridade, em que a fragilidade passa a ser associada a uma falha moral e não a uma condição inerente ao envelhecimento e à vida como um todo. Por não conseguir romper com as noções de normalidade, saúde e doença na qual se baseia a biomedicina, esse discurso acabou por recriar a noção de normalidade em outros termos. A tentativa de positivação foi observada prioritariamente entre os profissionais, e não entre os idosos, indicando dificuldades desses em lidar com a fragilização inerente ao processo de envelhecimento. / This research is focused on the creation of discourses on old age and aging in Brazil. The analysis and methodology were driven by Psychoanalysis and Anthropology, which are articulated in Public Health considering the human and social phenomena from symbolic registers, assigned by social rules. The fieldwork involved, as methodological strategies, the examination of documents and scientific publications, observation of oral presentations at events and conferences dedicated to aging and interviews with key professionals in this field. The contact with a wider universe than geriatrics and gerontology during the investigative process raised the understanding and definition of "Field of Aging" as a territory that covers several characters, disciplines, approaches, institutions and discourses. It was possible to demonstrate the existence of dissident movements and disputes over prestige, competence and concepts and discourses authorship. In this heterogeneous field, prevail discourses aimed to positivity aging, in an attempt to separate it from the images of illness, poverty and abandonment. The "active aging" represents this effort when it raises the activity as a greater good: developed by the World Health Organization, this discourse became the main reference for public policies in Brasil, as can be seen in various legal devices. The analysis made possible to locate it as the successor of the Hygienist-Preventative discourse of the late nineteenth century and early twentieth century, by prioritizing prevention and health promoting, that must be met by individuals, these being primarily responsible for their own health. In defending an activity as the positivity that should be encouraged in old age, this discourse ultimately established a polarity, in which frailty becomes associated with a moral failure and not as a condition inherent to aging. By not being able to break with the notions of normality, health and pathology on which biomedicine is based, that discourse eventually recreated the notion of normality in other terms. This attempt of positivization was primarily observed among professionals, and not among the elderly, indicating the difficulty of those in dealing with the embrittlement related to the aging process.

I performed a secondary analysis of existing data and determined that when interacting with physicians during primary care visits for chronic illness treatment, patients using opioids are less likely to continue presenting concerns designed to reinforce their social and emotional uniqueness during the second half of primary care visits when physicians provide empathic support of their concerns in the first half of visits.

<p>  </p> <p><strong>Background:</strong> Older adults have a higher prevalence of pain compared to other age groups and are more likely to become long-term opioid users. The clinical benefits of long-term opioid therapy (LTOT) are not clearly known, however, LTOT has been found to increase the risk of all-cause mortality, opioid overdose, constipation, fractures, and myocardial infarction. </p> <p><br></p> <p><strong>Objective: </strong>The study was conducted to estimate the incidence of LTOT and risk factors associated with LTOT in older adults aged 65 years and older.</p> <p><br></p> <p><strong>Methods:</strong> This was a retrospective cohort study based on Medicare claims data obtained from Research Data Assistance Center (ResDAC). Opioid naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome was LTOT which was defined as an opioid use episode lasting longer than 90 days and having more than 60 cumulative days of supply. The independent variables (risk factors) were patient characteristics (demographics, comorbidities, substance use disorders), characteristics of initial/index opioid dispensed (opioid type, duration of action of opioid, opioid dose, number of days’ supply, concomitant medications), and pain conditions. Multivariable logistic regression was performed to assess the association between the risk factors and LTOT. To address statistical interactions among variables, secondary analyses were conducted after stratifying the dataset by pain conditions.</p> <p><br></p> <p><strong>Results:</strong> Among 162,287 opioid naive patients, 10,296 (6.3%) transitioned to LTOT. Demographic characteristics associated with LTOT were age greater than 85 years (adjusted odds ratios [AOR]: 1.1, 95% confidence interval [CI]:1.03-1.18) and being black (AOR: 1.11, 95% CI: 1.01-1.22). Risk factors related to substance use disorders included drug use disorder (AOR: 1.59, 95% CI: 1.30-1.95), alcohol use disorder (AOR: 1.26, 95% CI: 1.06-1.49), tobacco use disorder (AOR: 1.33, 95% CI: 1.21-1.45), and a history of opioid use disorder (OUD) (AOR: 1.63, 95% CI: 1.34-1.98). Patients with more than 5 comorbidities had 1.56 times higher odds (95% CI: 1.46-1.66) of LTOT compared to patients with 0-2 comorbidities. Characteristics of initial/index opioid associated with LTOT were dispensing long-acting opioids (AOR: 1.73, 95% CI: 1.22-2.46), concomitant use of benzodiazepines (AOR: 1.19, 95% CI: 1.11-1.28), gabapentinoids (AOR: 1.59, 95% CI: 1.49-1.69), and non-steroidal anti-inflammatory drugs (NSAIDs) (AOR: 1.23, 95% CI: 1.16-1.30). Starting therapy with tramadol increased the odds of LTOT compared to hydrocodone in patients with osteoarthritis and joint pain (AOR: 1.22, 95% CI: 1.06-1.41) as well as abdominal and bowel pain (AOR: 1.53, 95% CI: 1.05- 2.22). However, starting therapy with oxycodone decreased the odds of LTOT in patients with osteoarthritis and joint pain (AOR: 0.69, 95% CI: 0.53-0.90). For all pain conditions, initial opioid supply of ≥30 days led to 10-16 times higher odds of LTOT compared to days’ supply of 1-3 days.</p> <p><br></p> <p><strong>Conclusions:</strong> Higher age, black race, comorbidities, substance use disorders, and history of OUD are the patient-related risk factors of LTOT in older adults. Moreover, specific patterns of initial/index opioid prescription/dispensing such as greater number of days’ supply, dispensing long-acting opioids, and concomitant use of benzodiazepines, gabapentinoids, and NSAIDs increase the odds of LTOT. Prescribers should take these factors into consideration when prescribing opioids to older adults.</p>

Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to. / Thesis (PhD)--University of South Australia, 2010

<p dir="ltr">Individuals with typical audiometric sensitivity exhibit varying speech perception abilities in noisy environments, which may decline with age. Temporal processing plays a pivotal role in speech perception, especially in challenging listening conditions. Auditory decline due to aging involves both peripheral pathology and central auditory system changes, impacting temporal processing. To delineate the contributions of these changes, measurements of within- and across-channel temporal processing were conducted in a wide age range of normal-hearing individuals. Robust perception of within-channel temporal cues requires precise coding at both peripheral and central auditory pathway levels, while cross-channel processing relies on central mechanisms. Comprehensive data collection involved behavioral and electrophysiological measures, revealing age-related increases in behavioral thresholds, less robust cortical responses to gaps and temporal-coherence changes, and declining SPIN performance. Cross-channel measures proved to be more predictive of speech perception outcomes, emphasizing the significance of central auditory changes in age-related perceptual deficits.</p><p dir="ltr">A mini-EEG cap to record cortical EEG auditory responses to gaps in chinchillas using a new sedation protocol was validated. This advancement enhances translational potential and paves the way for exploring cortical auditory processing using complex stimuli in animal models. By facilitating simultaneous exploration of both subcortical and cortical consequences of auditory system pathologies, this development contributes to a more comprehensive understanding of auditory processes across species.</p>

Made available in DSpace on 2016-04-27T18:47:36Z (GMT). No. of bitstreams: 1 Rogerio Clovis de Oliveira.pdf: 684774 bytes, checksum: 7f3df545fe43219d67bc63d37c5016c9 (MD5) Previous issue date: 2009-12-03 / This study stems from a personal attempt to discuss interdisciplinary concepts associated with a geriatric and gerontological hospital. It underscores the story of the researcher, sharing empirical experiences that were significant in the theoretical basis of the content, highlighting theoretical concepts and analyzing aspects that are relevant in the population aging process. It describes the so called conceptual references of interdisciplinarity and health, going into an epistemological basis as well as into the concept of team building, pointing out the inconsistencies of high specialization. It discusses the suggestions of continuous education for teams, the power of corporate communication in organizational culture and its relationship with interdisciplinarity. It suggests an organizational arrangement for a geriatrics and gerontology hospital defining its organizational objectives, the structure of teams and the mechanisms involved in the integration process / A pesquisa parte de uma busca pessoal na tentativa de trazer para discussão conceitos de interdisciplinaridade na concepção de um hospital geriátrico e gerontológico. Assinala a trajetória do explorador, por meio do compartilhamento de experiências empíricas as quais foram representativas na fundamentação teórica do conteúdo, pontuando conceitos teóricos, onde são analisados os aspectos relevantes ao processo do envelhecimento populacional. Descreve os chamados referenciais conceituais da interdisciplinaridade e saúde, onde há uma imersão nas bases epistemológicas, bem como o conceito de formação de equipe, apontando para as incongruências da alta especialização. Aborda as propostas para a educação continuada das equipes, o poder da comunicação corporativa na cultura organizacional e suas relações com a interdisciplinaridade. Apresenta a configuração organizacional proposta para um Hospital Geriátrico e Gerontológico, definindo seus objetivos organizacionais, a estruturação das equipes e os mecanismos envolvidos no processo de integração

It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.