Introdução: No acompanhamento diário de pacientes que realizam troca de sonda de gastrostomia endoscópica percutânea (GEP), observa-se a preco- cidade com que ocorrem essas trocas devido à curta durabilidade da sonda, especialmente decorrente da ruptura do balão interno da sonda. Objetivo: Este estudo prospectivo visou à avaliação da durabilidade de cinco diferen- tes marcas de sondas de troca de GEP. Método: Cem procedimentos con- secutivos de troca de sonda de GEP (realizados em 65 pacientes) foram dis- tribuídos, a cada grupo de 20 procedimentos, em cinco grupos determinados pelas marcas de sondas avaliadas (Kangaroo®, Wilson Cook®, Silmag®, Fre- ka® e Bard®). Conforme o protocolo proposto, após a troca, os pacientes fo- ram seguidos ao longo de seis meses, e, nesse período, foram realizadas três avaliações para verificação de eventuais intercorrências. Para avaliação da durabilidade das sondas, foi considerado o período de permanência dos pacientes no protocolo, determinada pelo término do período de estudo ou pela necessidade de troca da sonda por ruptura do balão ou desgaste do tubo ou da tampa. As curvas de durabilidade das sondas foram determina- das pelo Método de Kaplan Meier e pelo Modelo de Regressão de Cox. Resultados: Houve variações importantes na durabilidade das sondas quando considerados os três motivos de troca da sonda associados. Essa diferença não foi observada quando se considerou apenas a ruptura do balão, cujas ocorrências se mostraram associadas com pacientes em uso de GEP por distúrbios neurológicos sem diagnóstico. A durabilidade das sondas foi tanto menor, quanto maior o número de trocas anteriores. Conclusões: A marca da sonda de troca de GEP não influenciou a sua durabilidade quando deter- minada pela ruptura do balão, mas, quando determinada também por des- gaste em tubo e tampa, as sondas Wilson Cook® apresentaram durabilidade significativamente maior do que as sondas Silmag® e Bard®. O número de trocas anteriores se mostrou fator determinante de menor durabilidade das sondas / Introduction: During the follow-up of patients after replacement of percuta- neous endoscopic gastrostomy (PEG) tubes, the early need of new replace- ments seems to be consequence of the short durability of the tubes, espe- cially due to the rupture of their internal balloon. Objectives: In this prospec- tive study, the durability of five different PEG tubes was estimated. Methods: One hundred consecutive procedures (in 65 patients) for replacing PEG tubes were divided into five groups determined by the tubes model: Kanga- roo®, Wilson Cook®, Silmag®, Freka® and Bard®. According to the protocol developed for the study, patients were followed up along six months, and three evaluations for verifying eventual outcomes were carried out during this period. Estimation of the tubes durability considered the time patients re- mained in the protocol, which was determined by the termination of the follow up period or by the need for replacing the tubes due to the balloon rupture or to the loss of use of tube or cover. Curves of tubes durability were estab- lished by applying the Kaplan-Meier Method and the Cox Regression Model. Results: Important variations of the tubes durability were observed when the three causes for replacement were considered all together. Differences were not observed when considered only the balloon rupture, which was associated with patients using PEG in virtue of not specified neurologic disorders. Shorter tubes durability was associated with more previous replacements. Spontaneous opening of the cover and slipping of the external protection were significantly less frequent in the Freka® tubes, although such outcomes did not determined the tubes durability. Conclusion: The model of PEG re- placement tubes did not influence their durability regarding the balloon rup- ture alone. Considering such occurrence associated with problems in tubes or covers, the longest durability was observed in Wilson Cook®, followed by Freka, ® Kangaroo®, Silmag® and Bard® tubes. The number of previous re- placements showed to be determining factor for the tubes durability

Abstract The aim of the study was to investigate the amount and focus of rehabilitation nursing care practices and the association of these practices to quality outcomes. Additionally, the aim of the study was to describe the characteristics and leadership models of the functional level in long-term care units providing rehabilitation nursing care. The study consists of four articles. The data for the first three articles were derived from the National Institute for Health and Welfare Resident Assessment Instrument (RAI) database. The data for the first article (n = 5312) were collected using resident level data. The second article is based on unit level information (n = 256) and data from a questionnaire sent to the nursing leaders of the functional level (n = 189) in facilities which adopted RAI. For the third article the resident level data (n = 2037) were used from the study of Laine (2005). The statistical analyses were performed by SAS statistical software for Windows. The data were presented as mean scores and confidence intervals. Regression models were used to present the associations between variables. The qualitative data for the fourth article was collected by interviews with the nursing leaders at the functional level (n = 14). The data were analysed by content analysis. The results show that residents receiving rehabilitation nursing had more impaired cognitive and physical function. The amount of rehabilitation nursing practice was associated to the nurses' assessment of residents' rehabilitation potential. Daily provision of rehabilitation nursing activity was associated to better care quality. It decreased the prevalence of bedridden residents and residents with little or no activity. It increased the amount of nursing time spent on residents. The leadership of the rehabilitation units consisted of recognizing options, promoting guidelines, reminding nurses, upholding open communication, supporting the learning process and respecting. The characteristics of rehabilitation units involved characteristics of Magnet Hospitals. The measure of rehabilitation nursing that measured the amount of rehabilitation nursing activity was usable and distinctive. In this study, measurable information about the amount of rehabilitation nursing practice was acquired. Findings of this study are usable for evaluation of nursing care outcomes and for developing nursing management. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida kuntoutumista edistävän hoitajan toiminnan määrää, kohdentumista ja sen yhteyttä hoidon laadun tuloksiin. Lisäksi tarkoituksena oli kuvata kuntoutumista edistävien osastojen tunnuspiirteitä ja lähijohtamisen menetelmiä pitkäaikaisessa laitoshoidossa. Tutkimus koostuu neljästä osajulkaisusta, josta kolmessa on käytetty valmiita tutkimusaineistoja. Ensimmäisen (n = 5312) osajulkaisun asiakastason aineisto on kerätty tekemällä poimintoja Terveyden ja hyvinvoinnin laitoksen Resident Assement Instrument (RAI) -tutkimustietokannasta. Toisessa osajulkaisussa tutkimustietokannasta on kerätty osastotason aineisto (n = 256) ja tehty poimintoja RAI-järjestelmää käyttävien osastonhoitajien toimintatietokyselystä (n = 189). Kolmannessa osajulkaisussa on hyödynnetty asiakastason aikamittaus- ja RAI-arviointiaineistoa (n = 2037), jota Laine (2005) käytti väitöskirjassaan. Analyyseissä on käytetty SAS-tilasto-ohjelmistoa. Aineisto on kuvattu keskiarvoin ja luottamusvälein. Muuttujien yhteyksiä on kuvattu käyttämällä regressiomalleja. Neljättä osajulkaisua varten on koottu laadullinen aineisto osastonhoitajien teemahaastatteluista (n = 14), joka on analysoitu sisällön analyysillä. Tulosten mukaan hoitajan kuntoutumista edistävä toiminta kohdistui niihin asiakkaisiin, joilla oli keskivaikeasti alentunut fyysinen toimintakyky ja kognitio. Hoitajan toiminta oli yhteydessä hoitajan uskoon asiakkaan kuntoutumisen mahdollisuudesta. Osastotason tarkastelussa päivittäinen kuntoutumista edistävä toiminta oli yhteydessä hoidon laadun tuloksiin, sillä se vähensi vuodepotilaiden määrää ja lisäsi asiakkaiden sosiaalista osallistumista. Se lisäsi myös asiakaskohtaista välitöntä hoitoaikaa. Lähijohtamisen menetelminä korostuivat mahdollisuuksien näkeminen, linjassa pitäminen, mieleen palauttaminen, avoin kommunikointi sekä hoitajien osaamisen tukeminen ja arvostaminen. Kuntoutumista edistävien osastojen tunnuspiirteinä korostuivat magneettisairaaloiden vetovoimatekijät. Tutkimuksessa kehitetty kuntoutumista edistävän hoitajan toiminnan määrän mittaamiseen tarkoitettu mittari osoittautui käyttökelpoiseksi ja erottelevaksi mittariksi. Tutkimuksessa saatu tieto on hyödynnettävissä kuntoutumista edistävän hoitajan toiminnan mittaamisessa kuten myös hoidon tulosten arvioinnissa. Tutkimustuloksista on hyötyä hoitotyön johtamisessa. / Sammanfattning Syftet med undersökningen var att analysera mängden av rehabiliteringsfrämjande vårdinsatser, vem de riktades till och hur de relaterar till vårdkvalitet. Dessutom var avsikten att beskriva vad som kännetecknar rehabiliteringsfrämjande avdelningar och ledarskapsmodeller inom institutionsvården. Undersökningen består av fyra delpublikationer: i tre av dem användes existerande forskningsmaterial. Materialet på klientnivå (n = 5312) som användes i den första delpublikationen samlades in genom axplock ur forskningsdatabasen Resident Assessment Instrument (RAI) på Institutet för hälsa och välfärd (THL). Den andra delpublikationen består av material på avdelningsnivå (n = 256) och material ur en enkät om verksamhetsuppgifter (n = 189) riktad till de avdelningsskötare som använder RAI-systemet. Den tredje delpublikationen omfattar tidmätnings- och RAI-bedömningsmaterial (n = 2037) på klientnivå som Laine (2005) använde i sin doktorsavhandling. I analyserna har SAS-dataprogramvara använts. Materialet har beskrivits med medelvärden och konfidensintervaller. Variablernas förhållanden till varandra har illustrerats med regressionsmodeller. För den fjärde delpublikationen har ett kvalitativt material insamlats från temaintervjuer med avdelningsskötare (n = 14) och analyserats med innehållsanalys. Resultaten visar att vårdarens rehabiliteringsfrämjande vårdinsatser riktade sig på de klienter som hade medelsvårt nedsatt fysisk funktionsförmåga och kognition. Vårdinsatserna var sammankopplade med vårdarens uppfattning om klientens rehabiliteringsmöjligheter. I studien på avdelningsnivå relaterade den dagliga rehabiliteringsfrämjande vårdinsatsen till vårdkvalitet. Antalet sängliggande klienter minskade och det sociala deltagandet hos klienterna ökade, även den direkta vårdtiden per klient ökade. Bland de metoder som avdelningsskötarna använde för ledarskap framhävdes upptäckandet av möjligheter, linjehållning, påminnelser, öppen kommunikation samt stödandet och värdesättandet av vårdarnas kompetens. Särskilt kännetecknande för de rehabiliteringsfrämjande avdelningarna visade sig vara magnetsjukhusens dragningskraft. För att mäta mängden rehabiliteringsfrämjande vård som gavs, utvecklades en mätare, vilken visade sig vara användbar och urskiljande. De resultat som denna forskning gett kan tillämpas för att lyfta fram mätbarheten av rehabiliteringsfrämjande vårdinsatser såsom även till att utvärdera vårdresultaten. Forskningsresultaten kan också utnyttjas till att utveckla ledarskapet inom vårdarbetet.

Dans cette thèse, j'utilise différents outils de l'analyse dynamique pour répondre à des questions liés aux comportements à la retraite et/ou aux marches immobiliers. Dans le premier chapitre, qui s'intitule en anglais "Long-Term Care Insurance, Housing Demand, and Decumulation", j'étudie l'influence de l'immobilier sur la demande d'assurance dépendance en comparant un modèle structurel à des données américaines issues du Health and Retirement Study (HRS). Dans le second, qui a pour titre "Disability in Retirement, Home Production, and Informai Insurance Between Spouses" j'étudie comment l'assurance informelle entre conjoints affecte les comportements de desépargne. Le modèle reproduit certains faits stylisés observés dans les données HRS et dans une enquête qui est liée : le Consumption and Activities Mail Survey ou CAMS. Le troisième chapitre, qui s'intitule "Sectoral Productivity, Collateral Constraints, and Housing Markets" est un travail joint avec Hippolyte d' Albis et Eleni Iliopulos. Nous y étudions les implications de l'introduction d'un marché locatif dans un modèle standard de marchés immobiliers avec contraintes de collatéral. / This thesis applies tools from dynamic analysis to answer questions related to retirement behaviours and/or housing markets. In the first chapter entitled "Long-Term Care Insurance, Housing Demand, and Decumulation", I study the influence of housing on the demand for long-term care insurance comparing a structural mode! with US data from the Health and Retirement Study (HRS). In the second one ("Disability in Retirement, Home Production, and Informai Insurance Between Spouses"), I study how the informai insurance fom a spouse affects dissavings behaviours. The model reproduces some key patterns observed in the HRS and a companion survey the Consumption and Activities Mail Survey (CAMS). The third one entitled "Sectoral Productivity, Collateral Constraints, and Housing Markets" is a joint work with Hippolyte d'Albis and Eleni Iliopulos. We study the influence of introducing a rentai market in an otherwise standard model of the housing market with collateral constraints.

Not only productive age population uses life insurance as an instrument serving to cover the risks, but we should more consider using this product in pre-retirement and retirement age. With respect to demographics of the population, we can expect an increase in the number of our elderly population that will be interested in the use of life insurance products. In the introduction, we present a questionnaire survey of potential candidates for insurance product, that provides information about the preferences of the individual types of insurance. Further work focuses on two significant risks for people of working age, the risk of total disability and critical diseases. In the next part we analyze Czech, European and American insurance market with regard to the category of people approaching retirement age. In conclusion, the author makes recommendations for product innovation on the Czech insurance market.

This two-part study evaluates a government sponsored Long Term Care Aide/ESL Program taken by a group of immigrant women. The purpose of the first part of the study was to assess how effective a B.C. government sponsored Long Term Care Aide/ESL program was in preparing a group of immigrant women for the workplace. A questionnaire was used to determine demographics and employment status. Also, it obtained perceptions on the strengths and weaknesses of the program. The purpose of the second part of this study was to hear the women's personal insights and voices about their experiences while taking the program and after the program. Semi-structured interviews were used to obtain these stories. Results from the quantitative questionnaire indicated that 94% of the immigrant women who had taken this course were employed as care aides. Three years after the completion this program, the women felt that the course had provided them with both a vocational skill and more English language skills. Results from the qualitative portion of this paper focused on how the women felt about their experiences in this Long Term Care Aide/ESL program in their own words. The data were analyzed and put into themes. Theme 1 was "The pain of renewal". It presented their collective stories of being an immigrant and struggling to begin again. Theme 2 was "The costs and the benefits". This theme presented the women's insights on working as care aides. Most of the women liked their jobs but found trying to secure a full time job difficult. Theme 3 was "The need to learn the language of care". All the women interviewed wanted to have more "caring" language, the "everyday" language to relate to their clients. Theme 4 was "Advice to other immigrant women". This theme revealed how some women felt about the work they did. The last theme, Theme 5, was "Hopes and dreams". Half of the women interviewed had aspirations to continue their education and these women were already enrolled in other health care courses. The results of the study are discussed and implications are drawn for research and pedagogy. / Education, Faculty of / Language and Literacy Education (LLED), Department of / Graduate

Background: Statins have questionable benefits among older adults with life-limiting illness. Statin use is widespread among U.S. older adults, but little is known about use in nursing homes. This dissertation was designed to identify the prevalence and predictors of statin pharmacotherapy use and discontinuation in U.S. nursing homes. Methods: Data sources (2011-2016) included: Minimum Data Set 3.0, Medicare administrative claims data, Provider of Service files, and Dartmouth Atlas files. Analyses included: descriptive statistics, multilevel modeling, and proportional change in cluster variations with adjustments to reduce confounding and model misspecification. Results: Approximately 36% of older adults admitted to U.S. nursing homes between 2015 – 2016 were actively using statins at the time of admission. Among long-stay residents with life-limiting illness, 34% were on statins at one time (2016; aged 65-75 years: 44%, >75 years: 31%). Statin use varied significantly by hospital referral regions, with most variation in the >75 age group. Limiting the sample to statin users, 20% discontinued statins within 30 days of nursing home admission. While discontinuation was positively associated with severity of life-limiting condition, the majority of residents remained on statins 30 days post-admission, including those with a < 6-month prognosis. Conclusion: Statin use is pervasive across US nursing homes and persists with life-limiting illness. Geographic variation appeared to coincide with clinical uncertainty, especially among adults >75 with few national guidelines. More needs to be done to prioritize statin deprescribing in nursing homes with research that identifies ways to facilitate improved patient-provider awareness and engagement in the discontinuation process.

Person-centered care is important to the quality of life of nursing home residents with dementia. Preference assessments enable person-centered care by documenting residents’ preferred activities. Residents with severe dementia are less likely to have a role in preference assessment due to communication challenges associated with the disease. External supports (visual and text cues) are effective in improving the communication of residents with dementia, but these cues are often not used in practice. Standard assessment (verbal questioning) places greater demands on short-term memory and attention, which are known deficits in dementia. Applying a within-subjects design, this study evaluated two conditions (standard and supported) for assessing preferences of residents with severe dementia (N=21). This study examined the effect of these conditions on residents’ consistency over time (1-week) and utterance types in response to preference questions. Naïve judges (N=10) listened to the interviews and rated residents’ communication clarity and their confidence with understanding residents’ preferences. Results show that residents with severe dementia can report preferences with similar consistency in both assessment conditions; however, residents may comprehend the assessment better when provided in a supported format. In addition, residents successfully engaged in preference interviews without proxy participation. Anecdotally, many residents demonstrated an accurate understanding of their environment and how they would prefer to spend their days. Future studies will optimize visual stimuli, choice options, staff training components, efficiency measures, and examine acceptability by nursing home staff.

Diploma thesis "Educational and activating activities of seniors in long-term care facilities in the Pilsen Region" in the theoretical part is devoted to the definition of old age and related aspects from the biological, psychological and social point of view. The thesis also deals with education and activation of seniors in the context of applied science discipline and organization in the Czech Republic within the framework of lifelong learning. Aspects of educational activities of seniors and specifics of their education and activation are also identified. The thesis also describes the best-known methods and techniques of seniors activation in long-term care facilities. In the empirical part, a questionnaire survey was carried out, in which the respondents were clients of retirement homes and patients of specialized hospital wards providing care to geriatric patients. At the same time, standardized interviews were conducted with workers who organize, secure or participate in activities focused on education and activation of their clients or patients. The aim of the thesis is to characterize aspects of the educational activities of seniors and to identify the specifics of education and activation of seniors in long-term care facilities. Based on an analysis of existing educational activities in...

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Policies at assisted living facilities should be designed to develop high quality social relationships among older persons that could increase the contentment of the residents. Despite the broad consensus on this mission, the role of social support in the perceived contentment of assisted living facility residents has not been adequately explored. Using social network theory as the framework for this study, the purpose of this quantitative study was to determine whether (a) perceived level of social support was related to perceived level of contentment with life among assisted living facility residents, (b) the length of time spent in the facility was related to perceived levels of contentment, and (c) perceived social support moderated the relationship between the length of time in the facility and perceived levels of contentment with life. The sample included 100 residents from 2 assisted living facilities in North Carolina. The Multidimensional Scale of Perceived Social Support and the Generalized Contentment Scale were used in this study. Linear regression analyses were employed to answer the research questions. Participants with higher levels of perceived social support tended to have higher levels of perceived contentment with life, and the length of time residents had spent in the facility was not related to their perceived contentment with life. In addition, levels of social support did not moderate the relationship between the length of time respondents had been in the facility and contentment; age, gender, ethnicity, and marital status were not related to perceived contentment with life. This study leads to positive social change by providing long-term care providers with information on social support systems and how staff can create conditions for them to enjoy better social relationships and experience greater support, thereby facilitating their contentment with life.