For older adults, functional independent mobility is essential to well-being. Many care home residents have physical and cognitive impairments and use wheelchairs. Residents with difficulty self-propelling manual wheelchairs may benefit from power mobility; however, those with cognitive impairments may be precluded because of the potential for injury. My research goals were to apply novel power wheelchair technology to enable safe, independent mobility. Technology was developed to examine the value and implications of power mobility for residents with restricted mobility and mild or moderate cognitive impairments. The first study tested a prototype anti-collision wheelchair with a contact sensor skirt. Six single subject studies were completed. Distances travelled in manual and anti-collision wheelchairs were compared. Observational and interview data were collected. Focus groups (37 staff) and interviews (18 staff, six other residents, one spouse) were performed. Three of six residents were able or had potential to operate the prototype. One resident chose to use it beyond the study, and his mobility and well-being improved. Case analyses showed factors limiting prototype acceptance. Residents were unsatisfied with the appearance and slow speed, and found the interface frustrating to operate because of inadequate feedback. Social isolation and reduced autonomy restricted independence achievable with technology. Socialization and affective benefits of mobility were demonstrated in one case where prototype use was continually assisted. Residents and staff supported the anti-collision concept. On observation, the prototype compensated for absent or delayed responses of residents to obstacles below sensors and decreased injury risk. However, full sensor coverage of the environment was needed. The second study addressed acceptance and interface usability issues. A simulated collision-avoidance wheelchair with a multimodal feedback interface was evaluated. The interface provided audio, visual and haptic feedback to guide navigation away from obstacles. Through observations, interviews and questionnaires, five residents evaluated the device. High device acceptance and usability were found. The device was easy to use and assisted with performance of indoor mobility goals. Further research is necessary before power wheelchairs with new features are available for users; however, these results could play a fundamental role in shaping technology development and mobility interventions for this neglected population.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

For older adults, functional independent mobility is essential to well-being. Many care home residents have physical and cognitive impairments and use wheelchairs. Residents with difficulty self-propelling manual wheelchairs may benefit from power mobility; however, those with cognitive impairments may be precluded because of the potential for injury. My research goals were to apply novel power wheelchair technology to enable safe, independent mobility. Technology was developed to examine the value and implications of power mobility for residents with restricted mobility and mild or moderate cognitive impairments. The first study tested a prototype anti-collision wheelchair with a contact sensor skirt. Six single subject studies were completed. Distances travelled in manual and anti-collision wheelchairs were compared. Observational and interview data were collected. Focus groups (37 staff) and interviews (18 staff, six other residents, one spouse) were performed. Three of six residents were able or had potential to operate the prototype. One resident chose to use it beyond the study, and his mobility and well-being improved. Case analyses showed factors limiting prototype acceptance. Residents were unsatisfied with the appearance and slow speed, and found the interface frustrating to operate because of inadequate feedback. Social isolation and reduced autonomy restricted independence achievable with technology. Socialization and affective benefits of mobility were demonstrated in one case where prototype use was continually assisted. Residents and staff supported the anti-collision concept. On observation, the prototype compensated for absent or delayed responses of residents to obstacles below sensors and decreased injury risk. However, full sensor coverage of the environment was needed. The second study addressed acceptance and interface usability issues. A simulated collision-avoidance wheelchair with a multimodal feedback interface was evaluated. The interface provided audio, visual and haptic feedback to guide navigation away from obstacles. Through observations, interviews and questionnaires, five residents evaluated the device. High device acceptance and usability were found. The device was easy to use and assisted with performance of indoor mobility goals. Further research is necessary before power wheelchairs with new features are available for users; however, these results could play a fundamental role in shaping technology development and mobility interventions for this neglected population.

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.

The Best PhD Thesis in the Faculties of Architecture, Arts, Business & Economics, Education, Law and Social Sciences (University of Hong Kong), Li Ka Shing Prize, 2003-2005. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Mental Health / Master / Master of Social Sciences

Tyrimo tikslas - nustatyti hospitalinių infekcijų ir jų rizikos veiksnių paplitimo ir struktūros ypatumus Lietuvos slaugos ligoninėse. Tyrimo uždaviniai: 1. Aprašyti hospitalinių infekcijų paplitimą ir struktūrą slaugos ligoninėse. 2. Nustatyti hospitalinių infekcijų rizikos veiksnių paplitimą. 3. Aprašyti skirtų antibakterinių vaistų paplitimą spektrą slaugos ligoninėse. 4. Įvertinti ryšį tarp rizikos veiksnių ir hospitalinės infekcijos. Tyrimo metodai ir apimtis. Atliktas aprašomasis vienmomentinis paplitimo tyrimas. Tyrime dalyvavo dvidešimt viena slaugos ir palaikomojo gydymo ligoninė, ištirti 1380 pacientų. Tyrimas buvo atliktas pagal vienmomentinio paplitimo tyrimo metodiką, infekcijos buvo nustatomos ir diferencijuojamos į hospitalines ir visuomenėje įgytas, pagal hospitalinių infekcijų registravimo kriterijus. Duomenų tvarkymui ir analizei naudoti SPSS bei Winpepi statistiniai paketai. Rezultatai. Nustatytas 6,1% hospitalinių infekcijų paplitimas. Didžiausią dalį visų HI sudarė apatinių kvėpavimo takų (62,5%) bei odos ir minkštųjų audinių infekcijos (21,7%). HI paplitimas ligoninėse esančiose apskričių centruose (7,6%) buvo didesnis nei rajonų ligoninėse (3,3%) (p<0,001). Didžiausias hospitalinių infekcijų paplitimas (20,0%) nustatytas 20-40 metų pacientų amžiaus grupėje. 61 - 80 m. ir 81-100 m. amžiaus grupėse didžiausią dalį HI struktūroje sudarė apatinių kvėpavimo takų infekcijos (atitinkamai 70,0% ir 62,0%). Diagnozuojant hospitalines infekcijas, nebuvo atliktas... [toliau žr. visą tekstą] / Prevalence of hospital infections and risk factors in Lithuanian long-term care hospitals The aim of this study was to set out the prevalence and structure of hospital infections and risk factors in Lithuanian long-term care hospitals. The tasks of the investigation: 1.To describe the prevalence and structure specificity of hospital infections. 2. To define the prevalence of risk factors of hospital infections. 3. To define the prevalence and structure of prescribed antibiotics in long-term care hospitals. 4. To rate the relation between risk factors and hospital infections. Methods of the ivestigation. The point-prevalence study was carried. All (43) Lithuanian long-term care hospitals were invited to take part in this study, the participation was voluntary. The study was carried in 21 hospitals, all patients admitted before the survey day were included, 1380 patients were examined. The following data was recorded: infections, medical condition, chronic disease, the use of antibiotics. Data was processed and analysed using SPSS and Winpepi statistical programmes. Results. The 6,1% prevalence of hospital infections was defined. Lower respiratory tract (62,5%) and skin and soft tissues infections (21,7%) were the most common. The prevalence of hospital infections was higher in the town hospitals (7,6%) than in the district hospitals (3,3%) (p<0,001). The highest prevalence of hospital infections (20,0%) was in group of 20-40 years old patients. In group of 61-80 and 81-100... [to full text]

There is limited knowledge on provisions used to ensure swallowing safety, nutritional adequacy and sensory acceptability of pureed foods in long-term care homes (LTCHs). The overall aim for this research was to expand knowledge of pureed food production in LTCHs, to study the impact of varying ingredients and preparation on sensory and nutrition and to model perceived oral textures in pureed food. Qualitative interviews with dietary staff (n=53) in 25 LTCHs showed a variety of challenges and practices in production, affecting overall quality. Pureed turkey varying in added liquid, meat muscle and seasoning method and pureed carrots varying in thickener type were evaluated by a descriptive sensory panel (n=10). Results indicate that small formulation changes can have a significant impact on the nutrition and sensory properties of pureed food. Instrumental tests using a viscometer, line-spread test and texture analyzer showed different strengths in predicting variation in orally-perceived textures. / Funding for this project has been provided by Agriculture and Agri-Food Canada through the Canadian Agricultural Adaptation Program (CAAP). In Ontario, this program is delivered by the Agricultural Adaptation Council (AAC).

Darbe nagrinėjama socialinio darbo kokybė ir jos vertinimas institucinės socialinės globos įstaigose senyvo amžiaus asmenims. Darbo tikslas - vadovaujantis socialinių darbuotojų vertinimais, išryškinti socialinių paslaugų kokybės charakteristikas institucinės socialinės globos įstaigose senyvo amžiaus žmonėms. Siekiant atskleisti socialinių darbuotojų paslaugų kokybės sampratos charakteristikas ir užtikrinimo praktikoje bruožus, atliktas kokybinis tyrimas. Duomenys surinkti interviu metodu. Jame dalyvavo 5 institucinės socialinės globos įstaigose senyvo amžiaus dirbantys socialiniai darbuotojai. Tyrimu atskleista, kad socialinių paslaugų kokybė (įstaigos perspektyva) yra suprantama kaip subjektyvus, pasitenkinimą keliantis, kūrybiškas, pagrįstas kvalifikacija ir profesine patirtimi, socialinis darbas. Formalusis išorinis paslaugų kokybės vertinimas suprantamas kaip privalomas, neformalusis – kaip naudingas dėl galimybės vertinti kitų darbą ir įsivertinti save. Kokybės vertinimas laikomas probleminiu veiklos aspektu, nes atlikti trūksta laiko, vertinimo įrankių, vienodo vertinimo prasmės suvokimo. Socialinių darbuotojų veiklos suvokime profesiniu lygmeniu išryškėjo atliekamo vaidmens sudėtingumas, neapibrėžtumas, plačios atsakomybės sritys, vaidmens nuvertinimas ar neįvertinimas sąveikoje su kitų sričių specialistais, neigiamos patirtys dirbant kompetencijos neatitinkantį darbą. Atskleidžiant socialinių darbuotojų ir jų klientų sąveikos bruožus, reikšmingus kliento gyvenimo... [toliau žr. visą tekstą] / The paper examines the quality of social work and its assessment in the residential care homes for the elderly. The goal of the paper is to stress the main aspects of quality social services in the residential care homes for the elderly from social workers point of view. Qualitative study was conducted in order to reveal the social worker service quality concept, its characteristics and features of the assurance. Data collected using the interview method. Five individual interviews were carried out with social workers, working at residential care homes for the elderly. The results of the study revealed that the quality of social services is understood as a social work: subjective, gratifying, creative, based on qualifications and professional experience. Social workers understand that formal external assessment of quality of social services is mandatory. Nonformal they perceive as useful. The key challenge of the quality assurance is the lack of time, quality assessment tools and equal understanding. Social workers are aware of their professional role as a complex, uncertain, covering broad areas of responsibility, impaired or lost, when there are interactions with other specialists. Social workers feel frustrated when working on an inappropriate job. From social workers point of view, the client's quality of life associated with long-term and professional contact with an experienced social worker. Customer confidence in the quality of services when faced with a social worker... [to full text]