As the average age of life expectancy continues to rise, so too has the number of elderly individuals seeking long-term care. Performing daily tasks becomes a struggle while those affected by Alzheimer's disease and dementia risk their safety by living alone. Aged individuals lacking the means or faculties to live independently often seek assisted living and memory care facilities as the most viable options for the growing elderly population. Typical facilities are compact and sterile where residents are under watchful supervision to perform basic daily activities. As a result, aged individuals spend every day inside the facility with a structured, monotonous routine. A repetitive lifestyle within the same surroundings and with little autonomy can lead to feelings of isolation, depression, and disengagement from the same facility designed to care for the elderly population. My thesis aims to create an assisted living and memory care village, rather than a facility, that calls upon the comforts of home in a neighborhood setting. Within the village, residents are free to engage, explore, and take part in activities as self-sufficient human beings. Located in Frederick, Maryland, my objective is to design a small-town community that enables both on and off-site engagement. I analyzed architectural design methods that mitigate the struggles of daily activities while maintaining privacy and independence, and also researched a largely overlooked aspect of assisted living facilities: site development. This enabled me to curate a space where residents are free to explore and take part in various activities throughout the site. A monotonous routine leads to a stagnant mind. My thesis aims to create a space where exploration and independence are not only permitted but encouraged. Rather than aging in place, the goal is to live in place while the mind and body are in motion, making new memories and discoveries every day. / Master of Architecture / My aunt faced the challenge of her elderly mother experiencing white coat hypertension: an increase in blood pressure due to anxiety and stress during doctor visits. But it made a remarkable difference after she switched to a specialized geriatric office that emphasized a welcoming, homelike design. The warm ambiance, comforting decor, and personalized care reduced her anxiety, alleviating her white coat hypertension and resulting in regular blood pressure readings. This experience inspired me to emphasize the importance of geriatric-friendly design in assisted living and memory care facilities. In response to this issue, my thesis proposes the creation of an assisted living and memory care village instead of a traditional facility. The village aims to provide a homelike setting where residents can experience a sense of comfort and freedom. I have analyzed architectural design methods that address the struggles of daily activities while maintaining privacy and independence. Additionally, I have explored the often overlooked aspect of site development in assisted living facilities to curate the space thoughtfully where residents are encouraged to explore and engage in various activities throughout the village and evoke feelings of home, community, and comfort.

In Sweden and around the world, there has been a pandemic during the years 2020 and 2021. People who have been working in offices have, to a large extent, been encouraged to work from their homes and as a result, it has been noticed that working from home has a possibility to continue after thepandemic is over. With this in mind, the question how housing and working conditions should bedeveloped for this to be achievable in the long run is raised. The project has been carried out with the aim of investigating how housing can be designed to enable working from home and be a valid option even after the pandemic. The study has been carried out in four steps: • A literary study of working from home, different types of offices and housing development has been carried out. This was to get a clear picture of what is required of a workplace to be able to get good work result and how homes can be designed so working from home does not disturb the home life. • A survey to find out how working from home has been perceived by people during the pandemic and what would enable them to work from home in the future. • A site analysis, the site that is projected is located in Stockholm and will function as an interaction with the rest of the area. The area that has been chosen is Värtahamnen, which with an already planned block, is the basis for the location and design of the apartment building. • A design phase. Research by design shows what an apartment building adapted for home based work can look like. Three target groups were selected: singles, cohabitants and families The results of the study show that a majority of people are willing to have their working situation as a combination of working from home and going to an office. As the social part of pandemic and working from home has made people feel too isolated, they want to be able to get social interaction during the work week. After collecting information about, different types offices, housing design and Värtahamnens planned conditions, a program for an apartment building has been developed. Four apartments with different living spaces were chosen to show different conditions people have had when working from home. - 30 sqm Singel- 25 sqm Singel- 56 sqm Cohabitant- 83 sqm Family The building was developed with the aim that working from home should be a possible alternative for the residents. The neighborhood and the area should also be able to provide for the needs that theresidents have, within a reasonable distance. As the information from the questionnaire and the literature study can be interpreted differently depending on who is studying it, the way the building and apartments are developed will not be definitive but will work as a proposal from those who conducted the study, this makes the answers to the report one of several possibilities. / I Sverige och i världen har det under åren 2020 och 2021 pågått en pandemi. Personer som jobbat på kontor har i stort utsträckning blivit uppmuntrade att jobba hemifrån och som effekt ser man möjligheten med hemarbete även efter pandemin. Med detta i åtanke uppstår frågan hur bostäder och arbetsförhållanden ska utvecklas för att det ska vara görbart i längden.Examensarbetet har utförts i syfte att undersöka hur bostäder kan utformas för att underlätta hemarbete och vara en möjlighet även efter pandemin. Studien har utformats i fyra olika steg: En litteraturstudie, där en fördjupning kring hemarbete, kontor och bostadsutveckling har utförts. Detta för att få en tydlig bild över vad som krävs av en arbetsplats för att få ett bra arbetsresultat och hur bostäder kan utformas för att få en bra samvaro tillsammans med arbete. • En enkätundersökning för att få reda på hur hemarbetet har uppfattats av människor under pandemin och vad som skulle underlätta deras hemarbete i fortsättningen. • En platsanalys. Områdets som är valt är placerat i Värtahamnen, Stockholm. Området har redan ett planerat kvarter och står som grund för placeringen samt utformning av flerbostadshuset. • En gestaltning. Genom research by design visas det hur ett flerbostadshus anpassat för hemarbete kan se ut. Tre målgrupper valdes ut: ensamstående, sambo och familj. Resultatet av förundersökningen visar att en majoritet kan tänka sig att jobba med en kombination av hemarbete och kontor. Då den sociala delen i hemarbetet har gjort att människor känner sig för isolerade vill man ha en möjlighet att få socialt utbyte under arbetsveckan. Efter insamlad information om hemarbete, kontorsformer, bostadsutformning och Värtahamnens förutsättningar har förslagshandlingar till ett flerbostadshus för hemarbete tagits fram. Resultatet blev fyra lägenheter. - 30 kvm Singellägenhet- 35 kvm Singellägenhet- 56 kvm Sambo- 83 kvm Familj Byggnaden är framtagen i det syfte att hemarbete ska vara ett möjligt alternativ för de boende.Utformningen av lägenheterna är gjord så att hemarbete och samvaron i hemmet inte ska påverka varandra negativ. Som komplement till lägenheterna utformades också två kontorsvarianter, en privat för de boende och allmän. Detta gör att de boende kan arbete på tre sociala nivåer. Kvarteret och området ska erbjuda de vardagliga behov som de boende har inom rimliga avstånd. Då informationen från enkäten och litteraturstudien kan tolkas olika beroende på vem det är som tar del av den blir svaret på undersökningen inte definitiv utan ett förslag från dem som har genomfört undersökningen, detta gör att svaren på rapporten blir en av flera möjligheter.

Call number: LD2668 .T4 1965 R225 / Master of Science

This study examined the relationship between five neurocognitive domains, including memory, visual-spatial skills, executive functioning, language, and attention, and three instrumental activities of daily living (IADLs), (financial management, medication management, and driving), as well as three basic activities of daily living (ADLs), including dressing, feeding, and grooming. Subjects were community dwelling older adults diagnosed with Alzheimer's Disease (AD) ranging in severity from mild to severe. Correlation and regression models were used to analyze the relationship between neurocognitive domains and self-care activities. All of the neurocognitive domains were significantly but mildly correlated with declines in IADLs, and all of the neurocognitive domains, except memory, were significantly but mildly correlated with ADL decline. None of the regression models, except driving, produced significant results. The hypotheses were based on the belief that overlap occurs between declines in cognitive domains and self-care skills. The results of this study support the assertion that global cognitive decline occurs followed by declines in IADLs and later declines in ADLs. Thus, instead of specific neurocognitive domains predicting decline in individual self-care skills, this research indicates that the degree of severity of cognitive decline is predictive of impairments in IADLs or ADLs with milder global impairment predicting IADLs and more pronounced decline predicting declines in ADLs. Degree of severity may have been more predictive because while individuals vary in cognitive symptom presentation, the course of AD always progresses from mild to more severe. The role of over-learning also potentially impacted the results of the study. Individuals learn and daily practice ADLs at a young age causing them to require less higher level cognitive skills (over-learned). Since over-learned IADLs require less higher level cognition, they were preserved longer in AD course, thus declining after global cognitive impairment. Clinicians need to thoroughly assess the degree to which an individual has over-learned a task in order to make the most accurate recommendations. If an individual has milder global decline, IADLs are likely to be impaired, and if an individual has moderate global decline with memory reaching a floor, ADLs are likely to be impaired.

published_or_final_version / Urban Studies / Master / Master of Social Sciences

Statics, dynamics, rheology and scission-recombination kinetics of self-assembling linear micelles are investigated at equlibrium state and under shear flow by computer simulations using a newly proposed mesoscopic model. We model the micelles as linear sequences of Brownian beads whose space-time evolution is governed by Langevin dynamics. A Monte Carlo algorithm controls the opening of a bond or the chain-end fusion. A kinetic parameter omega modelling the effect of a potential barrier along a kinetic path, is introduced in our model. For equilibrium state we focus on the analysis of short and long time behaviors of the scission and recombination mechanisms. Our results show that at time scales larger than the life time of the average chain length, the kinetics is in agreement with the mean-field kinetics model of Cates. By studying macroscopic relaxation phenomena such as the average micelle length evolution after a T-jump, the monomer diffusion, and the zero shear relaxation function, we confirm that the effective kinetic constants found are indeed the relevant parameters when macroscopic relaxation is coupled to the kinetics of micelles. For the non-equilibrium situation, we study the coupled effects of the shear flow and the scission-recombination kinetics, on the structural and rheological properties of this micellar system. Our study is performed in semi-dilute and dynamically unentangled regime conditions. The explored parameter omega range is chosen in order for the life time of the average size chain to remain shorter than its intrinsic (Rouse) longest relaxation time. Central to our analysis is the concept of dynamical unit of size Lambda, the chain fragment for which the life time tau_Lambda and the Rouse time are equal. Shear thinning, chain gyration tensor anisotropy, chain orientation and bond stretching are found to depend upon the reduced shear rate Beta_Lambda=gamma dot*tau_Lambda while the average micelle size is found to decrease with increasing shear rate, independently of the height of the barrier of the scission-recombination process.

The overarching theme of this thesis is the prevention of progressive-type disability. Unlike catastrophic disability, progressive disability is gradual and more common in older adults. Because progressive disability can take years to develop, it is often conceptualized as a continuum, from less to more disabled. Disability prevention, by definition, is designed to identify people who are as yet nondisabled but at high risk for future functional decline by identifying an early functional state associated with increased risk of subsequent disability (Fried & Guralnik, 1997). This thesis sought to address two challenges associated with identifying an early functional state of disability. The first challenge relates to instrument calibration. Traditional instruments (based on self-report) used for assessing disability, scales of activities of daily living (ADL) and instrumental activities of daily living (IADL), were originally developed to describe levels of functional status in institutionalized older adults. Thus, these instruments poorly discriminate, as well as underestimate disability in the early stages of development. Poor discrimination refers to tasks or activities (i.e., scale items) that prove unresponsive to changes in a particular person’s ability level. Performance measures on the other hand, such as walk time or grip strength, have proven to be quite responsive to early declines in functional status. Despite the popularity of performance measures used to assess health status in epidemiology or gerontological research, evidence suggests that they measure a somewhat different construct than self-reported activities of daily living. ADLs have a long history of use in the medical community, yet it has been proposed that the relative standing of ADLs, in relation to communitydwelling older adults, could be enhanced by improving construct validities that are at least equivalent to those of physical performance measures. Item response theory (IRT) methodology can be used to improve the structure of ADL scales so that they are more sensitive in detecting the early stages of functional decline within relatively high functioning older adults; a stage that has been shown to be more responsive to clinical interventions aimed at prevention of overt disability or frailty. IRT can improve ADL scales in multiple ways: by confirming an underlying uni-dimensional continuum of disability, establishing interval level measurement or item hierarchies, and increasing scale precision. As part of this thesis I conducted a systematic review of functional status scales, applied to community-dwelling older adults, which employed IRT procedures. The review was useful in that it draws attention to areas of functional assessment that can be improved upon, most notably, the topic of establishing interval level data and construct under-representation. Using data from the Cardiovascular Health Study, I was able to show that a common hierarchy of functional decline was observed for a diverse set of conditions and diseases that are prevalent among community-dwelling older adults. Such an indicator could be used to identify hierarchical declines relating to severity in diverse patient populations. Improvements in validity of functional status scales can also lead to the use of ADL-IADLs as potential determinates of disability, rather than simply acting as outcome measures of disability. Again using data from the Cardiovascular Health Study, I examined the predictive power of IADL (mobility-type) items on later disability. Self reported difficulty in 2 or 3 of the most difficult IADL items increased the odds of being disabled eight years later by a factor of 3.5. The odds of being disabled fell to 1.9 for those reporting difficulty with one item. The second challenge of this thesis relates to defining determinants of functional decline that manifest themselves at the earliest stages of the disablement process. As previously stated physical performance measures have been shown to be sensitive to early stages of functional decline. However, can other measures, potentially spanning multiple domains, be used to identify those at high risk for future disability? In particular I was interested in whether psychosocial and cognitive variables could be used to detect changes in functional status at the preclinical stages of the disablement process. With regard to the Cardiovascular Health Study, I was able to show that, for subjects within the normal range of cognitive functioning, performance in the lowest quartile of the Digit Symbol Substitution Test resulted in a 2.2 increase in the odds of being disabled. Performance on this measure, as well as selfreported mobility noted above, could detect decrements in functional status as much as 8 years prior. With the use of the Lothian Birth Cohort sample I explicitly investigated the psychosocial domain. I found that the level of depressive symptoms increased the odds of being disabled by 56%. Again, these symptoms were assessed as much as eight years prior to self-reported disability. The general findings of this thesis indicate that refinements in ADL-IADL measures can aid in the detection of disability at the pre-clinical level, and that cognitive function and intra-individual factors play a pivotal role in speeding up or slowing down the disablement process.

INTRODUCTION: The rate of smoking is significantly higher among people living with HIV (PLWH) in comparison to the general population (CDC, 2017b; Humfleet et al., 2009). Tobacco use among PLWH heightens the risk for HIV-related symptoms and is a pertinent public health issue. Smokers living with HIV are also more likely to develop non-AIDS-related illness in comparison to non-smokers living with HIV. Smoking cessation interventions are desperately needed to cater towards PLWH. This warrants the need for patient-provider interactions in healthcare facilities regarding smoking cessation. AIM: To document rates of smoking and visitations to healthcare facilities among persons living with and without HIV in higher vs. lower-risk areas and to examine associations among healthcare visitations, stressors, and smoking in these sub-samples (i.e., PLWH in higher-risk areas, PLWH in lower-risk areas, people without HIV in higher-risk areas, people without HIV in lower-risk areas). METHODS: Secondary analyses were conducted using data from a network-based, HIV endemic study that was conducted in Metro Atlanta (Rothenberg, Dai, Adams & Heath, 2017). The study included 927 participants from 10 Atlanta zip codes (5 lower-risk and 5 higher-risk based on reported HIV cases). Participants provided information on their smoking status and healthcare visitations, as well as whether they had experienced several stressors (e.g., violence, homelessness, being threatened with a weapon, lack of transportation). Descriptive analyses and frequency distributions were conducted and presented on key variables. Logistic regression analyses were conducted to examine associations between key variables and smoking. RESULTS: Overall, the rate of smoking was quite high in this study. Seventy-four percent of the sample smoked, which is almost five times the smoking rate among the general adult U.S. population (CDC, 2016a). The smoking rate was strikingly high among PLWH in the higher-risk areas (95%). In unadjusted analyses, participants who were older, male, homeless, and do not drive their own car were more likely to smoke. In the adjusted analyses age, gender, and lack of transportation remained significant predictors of smoking. Visitations to healthcare facilities were not significantly associated with smoking or other variables in this study. DISCUSSION: Smoking appears quite common among PLWH, especially those living in higher-risk areas. This study provided important information on the extent to which persons living with and without HIV in higher and lower-risk areas of Atlanta are receiving healthcare services, as well as how demographic factors and stress relate to smoking in these sub-samples. Future research is needed to develop and disseminate effective smoking cessation programs among smokers living with HIV.

Background: Diabetes is a chronic metabolic disease and an increasing public health problem. Treatment of type 1 diabetes requires daily insulin injections. Young people living with diabetes may feel that they do not fit in among others of the same age. Aim: Illustrate young people's experiences of living with diabetes type 1. Method: This study was a qualitative literature-based study with an inductive approach. The result was based on 10 qualitative scientific articles. Result: The analysis resulted in three main themes and seven subthemes. The main themes were: To live in a process of adaptation, A buffet of challenges and How the social surroundings impact the life. Conclusion: The results showed that young people who lived with type 1 diabetes felt that they had to adapt their lives to the disease. For young people it was also important to become independent in their illness. It was obvious that living with type 1 diabetes was an experience of both physical and mental challenge, and the people in the studies expressed a desire to be normal and to be able to compare themselves with others. The social surroundings had a clear impact in many ways, though the support from the environment was perceived as valuable. / Diabetes typ 1 är en ständigt ökande folksjukdom som ofta drabbar unga människor. Diabetes typ 1 är en kronisk ämnesomsättningssjukdom som ställer krav på den unga individen och skapar utmaningar i vardagen. Unga som lever med diabetes påverkas av sin omgivning och är i behov av stöd på olika sätt. Diabetes innebär att individen ständigt har förhöjda blodsockernivåer, till följd av brist på insulin. Unga människor lever i en turbulent period av livet, och att leva med en kronisk sjukdom kan förhindra en utveckling av den egna identiteten. Egenvården upplevs som en viktig del på vägen mot självständighet hos de unga, och sjuksköterskan har en central del i att hjälpa den unga individen att främja hälsa. Syftet är att belysa unga människors upplevelse av att leva med diabetes typ 1. Tio kvalitativa vetenskapliga artiklar har använts som material i resultatet. Resultatet visar att sjukdomen kräver en anpassning av livet. Det är en dragkamp om ansvaret för sjukdomen mellan de unga och deras föräldrar, då självständighet anses viktigt av unga människor för att uppnå frihet, vilket relateras till begreppen livsvärld och hälsa. De unga upplevde både känslomässiga och praktiska utmaningar i livet med diabetes, vilket diskuteras i relation till livskvalitet. En önskan om att få vara normal och kunna jämföra sig med andra i samma ålder finns, eftersom det är en betydande del i de ungas sökande efter en egen identitet. De unga anser att omgivningen påverkar dem på olika sätt, stödet från vänner och familj upplevs som betydelsefullt.

I–HOPE is an instrument that can be used to examine person–environment fit in the home. The instrument is developed in the United States and involves forty-four activity cards that are to be sorted by the client to address the activities that are problematic in his/her everyday life. The purpose of this study was to examine if the activity cards would fit in a Swedish context, and if other activities needed to be added, to match every day activities of people, 65 years and older, living in ordinary homes in Sweden. A survey was distributed to twenty-one participants age 65 and older. This survey was conducted in a project with Luleå University of Technology and the University of Gothenburg, that aims to adapt I-HOPE to be applicable in Sweden. Results show that nineteen of the forty-four activity cards were identified by all the participants. Further, eighteen more cards were identified by the majority of the participants. The seven activity cards that were not identified, or were done in a different way than what the picture showed, contained multiple activities that were categorized into one, compared to the ones that were identified. Additionally, the participants identified two more activities, that they felt, the instrument lacked. These results conclude that I-HOPE contains some valid activities, but needs to be adapted further, to fit a Swedish context, and to work as an occupational instrument for elders, ageing in place.