Introdução - A dinâmica do arranjo domiciliar (unipessoal ou acompanhado) e outros condicionantes podem influenciar o estado nutricional de idosos. Objetivo - Verificar a associação entre estado nutricional e variáveis referidas: arranjo domiciliar, alimentação, demográficas, socioeconômicas e clínicas, em coorte de idosos, domiciliados no município de São Paulo, em 2000 e 2006. Métodos - A população de estudo foi composta por idosos ( 60 anos), de ambos os sexos, participantes do Estudo SABE, em 2000 e 2006. As variáveis de estudo foram: estado nutricional, adequado (massa muscular, segundo área muscular do braço, percentil 25) e inadequado (massa muscular < percentil 25), dinâmica do arranjo domiciliar (mudança de unipessoal ou acompanhado, de 2000 para 2006); grupos etários (60-74 e 75); sexo; escolaridade ( 8 ou > 8 anos); renda mensal per capita, em quartis; alimentação, segundo número de refeições/dia (< 3 ou 3), e frequência de ingestão de alimentos, com resposta dicotômica (sim ou não): laticínios - 1 vez/dia, ovos ou leguminosas - 1 vez/semana; carnes - 3 vezes/semana; frutas, verduras ou legumes - 2 vezes/dia; sintomas depressivos, segundo Escala de Depressão Geriátrica (ausência: escore < 6, leves: 6 e < 11, e graves - 11). Para verificar a associação entre as variáveis, utilizou-se teste de Rao & Scott, razão de prevalência (RP) e regressão logística múltipla (p<0,05); e o programa Stata/SE® 10.1 for Windows. Resultados - Verificou-se associação positiva, com maior chance, para estado nutricional inadequado com grupo etário 75 anos (OR=1,53; IC=1,191,95; p=0,001); com sintomas depressivos graves (OR=2,07; IC=1,133,80; p=0,020); com dinâmica do arranjo domiciliar: acompanhado2000 e sozinho-2006 (OR=1,80; IC=0,98-3,31; p=0,056), e associação negativa, com menor chance, para ingestão referida de laticínios (OR= 0,60; IC= 0,38 0,96; p=0,034). Identificou-se prevalência de estado nutricional inadequado em 32 por cento dos idosos que apresentaram mudança do arranjo domiciliar (acompanhado-2000 e unipessoal-2006), assim como do grupo etário 75; e em 24 por cento , daqueles que referiram ingestão de laticínios, e, ainda, em 35 por cento , daqueles, com sintomas depressivos graves. Conclusão - Constatou-se associação positiva, de estado nutricional inadequado, com grupo etário 75, sintomas depressivos graves, mudança da dinâmica do arranjo domiciliar (acompanhado unipessoal), e negativa, para ingestão referida de laticínios / Introduction - The dynamic of living arrangement (alone or accompanied) and other conditions may influence the nutritional status of elderly. Objective - To study the association between nutritional status and such variables: living arrangement, food, demographic, socioeconomic and clinical, in a cohort of elderly people, living in São Paulo in 2000 and 2006. Methods - The study population consisted of elderly ( 60 years) of both genders, participants in the SABE Study, in 2000 and 2006. The variables were: nutritional status, adequate (muscle mass, the second arm muscle area, 25th percentile) and inadequate (muscle mass < 25th percentile), the dynamic of living arrangement (change of living alone or accompanied, from 2000 to 2006); age groups (60-74 and 75), gender, education ( 8 or > 8 years), monthly income per capita in quartiles, food, according to the number of meals/day (< 3 or 3), and frequency food intake, with dichotomous response (yes or no): dairy - 1 time/day, eggs or legume - 1 time/week; meat - 3 times/week, fruits, greenery or vegetables - 2 times/days, depressive symptoms, according to the Geriatric Depression Scale (absence: a score < 6, mild: 6 and < 11, and severe - 11). To investigate the association between variables, it was used test Rao & Scott, prevalence ratio (PR) and multiple logistic regression (p < 0.05) and Stata/SE 10.1 for Windows®. Results - There was a positive association, with a greatest chance for inadequate nutritional status with age group 75 years (OR = 1.53, CI = 1.19 to 1.95, p = 0.001), with severe depressive symptoms (OR = 2.07, CI = 1.13 to 3.80, p = 0.020), with the dynamic of living arrangement, accompanied-2000 and alone-2006 (OR = 1.80, CI = 0.98 to 3.31; p = 0.056) and negatively associated with less chance for the intake of dairy products (OR = 0.60, CI = 0.38 to 0.96, p = 0.034). It was identified a prevalence of inadequate nutritional status in 32 per cent of the elderly, showing change of living arrangement (accompanied-alone-2000 and 2006), as well as the age group 75, and 24 per cent of those who reported intake of dairy products, and also in 35 per cent of those with severe depressive symptoms. Conclusion - It was found a positive association of inadequate nutritional status, with age group 75, severe depressive symptoms, dynamic of living arrangement (together - alone) change, and negative, for the intake of dairy products

The overall aim of this thesis was to describe how people with very severe obstructive pulmonary disease (COPD) experienced their every day lives and created meaning, with focus on end-of-life. A second aim was to describe how death and dying can be viewed from the perspective of relatives to people with COPD. In study I, eight patients were interviewed about how COPD affected their everyday lives. A phenomenological method was used. In study II, four people with COPD who lived alone were interviewed over time, to illuminate how the illness influenced their everyday life and their existential thoughts about life and death. In study III, four couples of whom one partner in each couple had COPD were interviewed several times to illuminate the affect the illness had on the spousal relationship, their self-expressed needs, and their existential thoughts, from the perspective of two people living together. A phenomenological-hermeneutic method was used for the analyses in studies IIand III. Study IV aimed at studying patients’ last six months of life with focuson dying and death, and in this study content analysis was used.The studies (I-IV) revealed that suffering from very severe COPD can be a daily struggle to survive as well as to maintain the self-image. The studies also explicate experiences of a shrinking life space, and questions of meaning were being challenged (I). Study II showed that living alone provided feelings of independency. However the bodily losses reminded the patients’ about death and raised fears about death of being painful, as they did not want to face death alone. For the couples in study III living with COPD meant living in a changed pace with uncertainty, changed intimate relationship and finding new ways of living together. Study IV outlined the trajectory of illness to be irregular and characterized by periods of sudden deterioration, making it difficult to plan for the future. Death was experienced as an unexpected experience and was described by all as peaceful. The results in this thesis have outlined important insight into the existential challenges of living with COPD as experienced by the ill persons themselves and their next of relatives. / Birgitta Andershed is also affiliated to Enheten för forskning i palliativ vård, Ersta Sköndal Högskola, Stockholm och Institutionen för omvårdnad, Gjøvik universitet, Norge.Eva Sahlberg-Blom is also affiliated to Enheten för forskning i palliativ vård, Ersta Sköndal Högskola, Stockholm

有鑑於過去人口結構的變化，台灣已成為人口老化速度最快的國家，人口老 齡化已成為一個重大議題。而老年人比例最高的日本，卻出現廣泛的老年貧窮 （下流老人）現象。因此，本研究以日本的情況為依據，對台灣老年貧窮的整體 概況和未來趨勢的發展進行資料整合與分析。主要探討台灣“老年貧窮”問題的 出現，並找出其影響的程度及其未來的發展，後續並深入分析其造成台灣“老年 貧窮”問題之關鍵指標因素，以及政府解決老年貧窮問題的政策與措施。研究發 現，超過五成老年人口落在最低收入、最貧窮層級的家戶中，顯示台灣社會的“老 年貧窮”現象有所增加。而造成台灣老年貧窮的原因為：一、退休養老金不足（低 於基本生活開銷）; 二、就業（低薪的工作環境）; 三、家庭養老功能下降（老 人獨居比率不斷上升）; 四、太早離開勞動力市場（儲蓄不足）。研究結果顯示，弱化的社會保障制度是老年貧窮比率升高的主要原因，而老年貧窮的現象亦廣泛存在於台灣社會，因此建議需提升公眾意識，提早準備充足的退休養老金、並加 強社區老人關懷功能、以及持續關注老年貧窮的問題。本研究結果可提供未來探 討台灣老年貧窮議題之參考，相關研究值得後續做進一步的探討分析。 / In view of the change in demographic structure in the past few years, Taiwan has become the country with the fastest speed of population aging. The aging population has become a major issue. Japan has the highest ratio of aged citizens, and the widely discussed phenomena of elderly poverty (The low-living elderly). Thus, this study based on Japan's case, has systematically reviewed, analyzed, and secondary data, in order to provide the overall and future trends of elderly poverty situation in Taiwan. The study probes into the emergence of the “elderly poverty” problem and try to find out the extent of this problem and its future outlook, to explore the causes of the “elderly poverty” problem in Taiwan and the official measures for alleviating elderly poverty. The research found that more than 50% of the elderly was the poorest households with the lowest income, nearly half of the elderly population falls to the lowest and poorest level, shows “the low-living elderly” phenomenon has increasing in Taiwan’s society. The causes of the elderly poverty in Taiwan: 1. the labor pension is too low (less than the necessary living expenses); 2. unstable employment (low income work); 3. family care function are decline (the elders living alone has keep rising); 4. early to exit from the labor market (lack of deposits). The weakened social security system are the main causes for the rising old-age poverty. The elderly poverty exists widely and need to promote public awareness for prepare adequate deposit in retirement, strengthen care function of community and focus on the elderly poor issues. For overall pictures of elderly poverty in Taiwan is worthy of further investigation and discussion.

The purpose of this study was to conduct a descriptive and exploratory analysis of Riverside County's Independent Living Skills Program (ILSP) and its ability to prepare foster youth for successful adult transition. A vital component of this study was the exploration of perceived preparedness through the eyes of the participants enrolled in this program.