Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction. Aging favors the appearance of propitious clinical conditions to a high use of medicines, a reality in the elderly over 65 years of age. However, the number of medicines used should not be the only predictor of a medication regimen complexity, other factors may increase the complexity of pharmacotherapy leading to possible problems related to pharmacotherapy. In this perspective, there are few national studies that evaluate the medication regimen complexity in the elderly, especially those that evaluate outcomes influenced by this complexity, so as to allow interventions for its optimization. Thus, the objective of this dissertation was to evaluate the pharmacotherapeutic profile and the health outcomes associated with the medication regimen complexity. Methods. This study was carried out in two stages. In the first stage, a descriptive cross-sectional study was performed to evaluate the medication regimen complexity of elderly patients in three long-term care facilities using the Medication Regimen Complexity Index (MRCI). This study was conducted for 12 months in three long-term care facilities in the state of Sergipe. In the second stage, a systematic review was performed to identify in the literature which outcomes were influenced by the medication regimen complexity, using the MRCI. We analyzed all study designs published until February 2017 who met the following eligibility criteria: using the MRCI instrument to measure the medication regimen complexity, assessing the medication regimen complexity for global regimens, related the medication regimen complexity with clinical and/or humanistic and/or economic outcome, was written in English, Spanish or Portuguese. Results. In the first stage, the evaluation of the medication regimen complexity obtained an average of 15.1 points (± 9.8), with a minimum of two and a maximum of 59 points. The highest levels of complexity were associated with the dose frequency, with a mean of 5.5 (± 3.6) points. A significant relationship between the medication regimen complexity and the variables polypharmacy, drug interaction, drug potentially inappropriate for the elderly and therapeutic duplicity was found (p <0.001). In the second stage, of the 610 studies evaluated, 20 met the eligibility criteria. The health outcomes most influenced by the medication regimen complexity were the clinical outcomes: hospitalization, hospital readmission and adherence to pharmacotherapy, most of the studies presented satisfactory results to association the outcomes with the complexity and obtained good methodological quality. Conclusion. This dissertation made it possible to evaluate the pharmacotherapeutic profile of elderly patients, showed that besides polypharmacy, potential drug interaction, therapeutic duplicity and potentially inappropriate medicines for the elderly are risk factors for the increased medication regimen complexity in these patients. Furthermore, identified that the health outcomes most influenced by the medication regimen complexity were ones clinical: hospitalization, hospital readmission and adherence to the pharmacotherapy. / Introdução. O envelhecimento favorece o aparecimento de condições clínicas propícias para o elevado uso de medicamentos, observado principalmente em pacientes acima de 65 anos de idade. Entretanto, o número de medicamentos utilizados não deve ser o único preditor de uma farmacoterapia complexa, pois outros fatores podem elevar a complexidade, conduzindo a possíveis problemas relacionados à farmacoterapia. Nesta perspectiva, são escassos os estudos nacionais que avaliam a complexidade da farmacoterapia em idosos, principalmente os que analisam desfechos influenciados por essa complexidade, de modo a permitir intervenções para sua otimização. Assim, o objetivo desta dissertação foi avaliar o perfil farmacoterapêutico e os desfechos em saúde associados à complexidade da farmacoterapia. Metodologia. Este estudo foi realizado em duas etapas. Na primeira, foi realizado um estudo transversal descritivo para avaliar a complexidade da farmacoterapia de idosos atendidos em três instituições de longa permanência para idosos (ILPIs), por meio do instrumento Medication Regimen Complexity Index (MRCI). Este estudo foi conduzido por 12 meses em três instituições no Estado de Sergipe. Na segunda etapa, foi realizada uma revisão sistemática, a fim de identificar, na literatura, quais desfechos estão associados à complexidade da farmacoterapia, medida pelo instrumento MRCI. Foram analisados todos os delineamentos de estudos publicados até fevereiro de 2017 que atenderam aos seguintes critérios de elegibilidade: usar o instrumento MRCI para medir a complexidade da farmacoterapia; avaliar a complexidade da farmacoterapia para os regimes globais dos pacientes; e relacionar a complexidade da farmacoterapia com desfechos clínicos e/ou humanísticos e/ou econômicos, publicados em inglês, espanhol ou português. Resultados. Na primeira etapa, a avaliação da complexidade da farmacoterapia obteve média de 15,1 pontos (± 9,8), com mínimo de dois e máximo de 59 pontos. Os níveis mais altos de complexidade foram associados à frequência de dose, com uma média de 5,5 (± 3,6). Além disso, foi identificada relação significativa entre a complexidade da farmacoterapia e as variáveis polifarmácia, interação medicamentosa, medicamento potencialmente inapropriado para idosos e duplicidade terapêutica (p< 0,001). Na segunda etapa, dos 610 estudos avaliados, 20 preencheram os critérios de elegibilidade. Os desfechos em saúde mais influenciados pela complexidade da farmacoterapia foram os desfechos clínicos: hospitalização, readmissão hospitalar e adesão à farmacoterapia. A maioria dos estudos apresentou resultados satisfatórios para associação dos desfechos com a complexidade e obtiveram boa qualidade metodológica. Conclusão. Esta dissertação possibilitou avaliar o perfil farmacoterapêutico de pacientes idosos e identificar que, além da polifarmácia, interação medicamentosa potencial, duplicidade terapêutica e medicamentos potencialmente inapropriados para idosos são fatores de risco para o aumento da complexidade da farmacoterapia nestes pacientes. Além disso, identificou-se que os desfechos em saúde mais influenciados pela complexidade da farmacoterapia foram os clínicos: hospitalização, readmissão hospitalar e adesão a farmacoterapia. / Aracaju, SE

Quality of life is one of the main concerns in long-term care amongst ageing populations in many countries. This problem is historically unique and increases the demand for research material. This thesis looks at how different societies promote or fail to promote successful ageing of long-term care of older people, and considers how countries may learn from one another in their search for solutions. The three countries studied (England, the Netherlands and Taiwan) correspond to Esping-Anderson's three types of welfare system (Esping-Anderson, 1990). In addition, the Asian-European dimension has been employed as it is a neglected one. Data sources included conceptual, empirical and statistical documents on long-term care of older people. Moreover, this research used identical qualitative cross-national research methods on three levels in each country: national, county and municipal. A total of 142 interviews were carried out in 2004. This aim of this study was broadly to rank the three welfare systems where there were clear differences but to qualify this by pointing out the complexities and difficulties of mixed economy comparisons. The overall conclusion is that the Netherlands provides higher quality care to older people, thus confirming Esping-Andersen's finding about the superiority of social democratic systems. In reviewing current policies and research in needs and successful ageing, this qualitative comparative study has focused on needs, social inclusion, power and autonomy, care resources as well as partnership as crucial concepts in care systems and discovered good practice in each and lessons to be learnt.

The purpose of this study was to examine Residential Care Aides’ (RCAs) experiences of good quality dementia care provision. Informed by a political economy perspective, I sought to understand how RCAs conceptualize quality dementia care, whether such conceptualizations are reflected in their daily care practice and how the organizational care context impedes or facilitates such care provision. Drawing on a focused ethnographic approach, I utilized in-depth interviews, participant observation and the review of selected documents to contextualize RCAs’ experiences within the organizational care environment. Over a 12-month period, in-depth interviews with 29 staff (21 RCAs, 3 LPNs and 5 managers) and 239 hours of participant observation were conducted in four small-scale dementia units in two nursing homes in British Columbia, Canada. In-depth interviews yielded information-rich data about RCAs’ care experiences and their relationships with residents, while participant observation afforded the opportunity to strategically link RCAs’ actions and interactions with what was said, a feature missing from much of the previous research examining staff perceptions of quality dementia care. A select review of facility documents and provincial licensing regulations provided additional insight regarding the relevance of the larger structural context for RCAs’ care experiences. In general, RCAs conceptualized, and exhibited in their daily physical care provision, quality dementia care as that which focused on tangible care outcomes (i.e., keeping residents clean, comfortable, calm and happy), on their care approach (i.e., delivering care in a compassionate, patient and affectionate manner) and was guided by family ideology (i.e., invoking of family metaphors). Inherent in their care provision was a sense of role tension, as they sought to incorporate social interaction with task completion and their co-workers’ conflicting expectations. Study findings also illustrated how, in the face of continued disempowerment and organizational constraints, RCAs sought to provide quality dementia care by negotiating their peer and supervisory relationships and selectively breaking formal and informal policies/procedures. Salient to RCAs’ experiences of personhood was the limited recognition and appreciation they received from management and the manner in which work-life balance, staffing coverage, human resource management practices and limited information sharing further devalued them and their work. Study findings draw attention to the importance of: acknowledging the role of structural constraints in the pervasiveness of a task-oriented work culture; attending to (and facilitating) staff personhood; facilitating supportive peer and supervisory relationships and; fostering effective management practices as a means of potentially improving care quality. As such, the study sheds important light on what RCAs require within their work environments to help facilitate resident well-being, reinforcing the assertion that residents’ care conditions are inextricably linked to RCAs’ care work conditions. / Graduate / 0351

The aim of the diploma thesis is to map out the subjective view of volunteers on the psychosocial needs of patients at the Long-term care department in the Královské Vinohrady Faculty Hospital. The work first focuses on the characteristics of patients in a long-term treatment. It also provides the overview of their psychological and social needs and about those who play a role in meeting these needs. The reconnaissance survey identifies areas where volunteers complement the work of social workers and care staff. In the evaluation, the results of the interviews with volunteers are compared with the opinions of the patients themselves

This descriptive correlational study was designed to examine the relationship between situational control, and both psychological and physical well-being, in the institutionalized elderly. A convenience sample of 52 elderly institutionalized subjects was selected from two intermediate care facilities. The subjects completed the Perceived Weil-Being Scale, the Situational Control Of Daily Activities Scale, and the Subject Information Sheet. All residents were found to have an overall perception of situational control. However, residents perceived a lack of control for the daily activities of eating and grooming. The majority of residents obtained a moderately high score on the psychological well-being and physical well-being scales. No significant relationship was found between situational control and psychological well-being, or situational control and physical well-being. A significant positive relationship was found between psychological well-being and physical well-being. / Applied Science, Faculty of / Nursing, School of / Graduate

A society's moral heart can be judged by how well it provides for its weakest and most vulnerable citizens. In recent years significant strides have been made to improve the quality of institutionalized persons' lives. However, because we have not yet fully developed a moral vision of long-term care living, residents do not always receive the basic care that they should. Particularly ignored and inadequately addressed is the complex moral and social issue of residents' sexual lives. Currently there is little support for sexual activity or sexual care in long-term care settings. Society's moral rules are designed for independent people living in their own homes. Professional governance bodies have created moral rules regulating short-term professional interactions and responsibilities but rarely have ones that pertain to longterm care settings. The aim of the present research is to contribute to the development of a moral vision of how long-term care institutions should manage sexual activity and sexual care. A qualitative study was designed to identify the factors that negatively influence sexual activity and sexual care, and the supports that residents and staff respectively need in order to have sexual lives and provide sexual care. Using an exploratory design the investigator conducted in-depth interviews with twenty-four residents and staff and carried out twenty hours of participant observation with two community residents. Six negative influences on residents' sexual lives and nine negative influences on staffs provision of sexual care were identified. The work also explores ethical and legal issues pertaining to the provision o f sexual care. It is argued that residents have moral rights to sexual care which impose duties on institutions to provide that care. Legal barriers to providing such care are then considered, and found not to be insurmountable. The above research and explorations led to three conclusions. First, unless sexual care is available residents cannot have sexual lives. Second, for sexual care to be available institutions must accept that it is their moral responsibility to provide it and ensure that staff are adequately supported. Third, institutions should develop a framework for the delivery of sexual care. / Arts, Faculty of / Graduate and Postdoctoral Studies / English, Department of / Graduate

Cette thèse étudie les politiques d’aide aux personnes âgées dépendantes à domicile menées au Japon, afin d’en tirer des enseignements pour la France. Nous développons notre étude à travers trois axes : i) l’analyse des différences entre le systèmes japonais et français dans l’organisation de l’aide publique et dans l’aide réellement perçue par les personnes en perte d’autonomie, ii) l’examen des barrières potentielles à l’accès aux aides publiques au Japon, iii) l’étude des conséquences de l’aide informelle sur l’emploi des femmes seniors au Japon. Dans cette perspective, nous avons effectué deux études qualitatives comparant les politiques japonaises et françaises, puis deux études micro-économétriques des comportements individuels et familiaux de prise en charge dans le contexte japonais. Ce travail met ainsi en exergue les spécificités des politiques menées dans les deux pays, et souligne les avantages et les faiblesses du modèle japonais. / This thesis focuses on the long term home care policies conducted in Japan, in order to draw lessons for France. Our analysis is developped through three topics : i) the analysis of the differences between the Japanese and the French systems in the public care organisation and in the care received by the elderly, ii) the examination of potential barriers to access to public elderly care in Japan; iii) the study of the impact of informal care on the labor participation of Japanese middle-aged women. In this regard, we carried two qualitatives studies comparing Japanese and French policies, and two microeconometrics studies of individual and family behaviour of caring in Japan. This study outlines the specificities of the policies conducted in both countries, and highlights the strenghts and weakness of the Japanese model.

The aim of this thesis is to analyze Long-Term Care in the Czech Republic, to design a Quality Management System for Long-Term Care, and to demonstrate its practical application in Gerontological Centre. A Quality Management Handbook for Long-Term Care represents an additional aim of this thesis; it is designed for Health and Social organizations having a similar spectrum of activities. This work relies on document analysis - available scientific studies on long-term care, and literature focused on quality management. A significant part of the text is supported by our own practical experience and is reinforced by consultations with experts in senior care. ISO systems, TQM approaches, Standards of social services, and National accreditation standards for subsequent and long-term care SAK ČR (United Accreditation Commission of Czech Republic) have been used as a starting point for the proposed Quality Management System. The proposed system has a broad scope, including resources, processes and outputs. The systems used in practice have some common parts; therefore the proposed model may be easily modified to accommodate the specific requirements of individual certification authorities.

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