No description available.

Bakgrund: Omvårdnaden av en människa med demenssjukdom på särskilt boende kräver resurser i form av personal, ändamålsenliga lokaler samt läkemedel. Det behövs adekvat utbildad personal med lämpliga personliga egenskaper för att skapa långvariga relationer med närstående och boende. Syfte: Syftet med den här studien är att undersöka upplevelsen av att vara närstående till en människa med demenssjukdom boende på särskilt boende. Metod: En litteraturstudie genomfördes där tio vetenskapliga artiklar granskades och analyserades efter en modell framtagen av Friberg (2006). Resultat: Fem teman framkom genom analysen; de närståendes upplevelser av omvårdnaden på särskilt boende, upplevelsen av att besöka sin familjemedlem, upplevelsen av aktiviteter, upplevelser av den fysiska miljön och integritet samt upplevelsen av att hantera sin situation. Slutsats: Personliga relationer är av största vikt för upplevelsen av att vara närstående till en människa med demenssjukdom boende på särskilt boende. Utbildning och handledning av personal och närstående kan förhindra missförstånd och hjälpa till att undvika konflikter. / Background: Caring for a person with dementia in special care facilities requires resources like personnel, facilities and medicine. It takes adequate educated staff with personal qualities to create a long-lasting relationship with relatives and residents. Aim: The aim of this study was to examine the experience of being a relative to a person with dementia living in a nursing home. Method: A literature review was conducted in which ten scientific studies were examined and analyzed according to Friberg (2006). Results: Five themes emerged from the analyses describing relatives’ experiences of nursing home care, activities, surroundings and integrity as well as coping strategies. Conclusions: Personal relations are of outmost importance for the experience of being a relative to a person with dementia living in a nursing home. Education and guiding of staff and relatives might prohibit misunderstandings and may help to avoid conflicts.

Objectives: To develop and validate a survey that can be used to measure key infection prevention and control (IP&C) structures and processes in LTC facilities. Methods: This study was designed using a three-phase methodology. In Phase I, six structural and process composite indices were developed based on the 2004 PHAC recommendations for IP&C in LTC and other literature. During the second phase of the study, a group of 7 experts in LTC IP&C used the Delphi methodology to validate and further develop the survey based on group consensus. Five Safety Principles published by the Institute of Medicine were also provided to the experts so they could be used to complement and further develop the concepts covered by the survey. The Delphi phase began in April and ended in October 2007; 114 worksheets were sent to experts to support the consensus-reaching process. Once the validity of a survey draft had been established based on expert-group consensus, it was pilot-tested in Phase III using 20 randomly selected LTC facilities in Fraser Health. Findings: The three-phase methodology used in this study was very useful and innovative way to further develop and validate the literature-based survey developed in Phase I for IP&C in long term care. In addition, by merging two bodies of knowledge and thought into the process, concepts and components that are not explicitly described in IP&C literature yet were felt to be key in program success, were incorporated into the measurement tool. Using Delphi, the experts expressed a need for IP&C professionals working in LTC to increase their knowledge, understanding and use of safety theory and strategies. They also felt that interdisciplinary work, the development of a culture of safety, and the development clear and simple IP&C systems are key ways in which infections can be prevented and outbreaks quickly controlled. In Phase III, the pilot-study analysis demonstrated the utility, validity and reliability of the survey. In addition, the analysis showed that there is a tendency for facilities to have lower levels of components within the Leadership Index and the ICP Index.

The presence of human pharmaceuticals in the aquatic environment is now becoming a well-established fact. The identified problems associated with their presence include the fact that these compounds are biologically active, some of them are toxic in nature, and a number of compounds have potential to foster and maintain drug resistant microorganisms. They are discharged into the aquatic environment from a variety of sources, but mainly by the excretion of incompletely metabolized pharmaceuticals by individuals into the wastewater. This situation makes finding a source-control strategy difficult. However, healthcare facility (hospitals and long-term-care homes) effluents are suspected to have relatively higher concentrations of these compounds, as such facilities use pharmaceuticals in large amounts for diagnostic, cure and research purposes. It is expected that controlling discharges from these facilities may provide a cost-effective solution to reduce the pharmaceutical loads entering the aquatic environment.

This study examined the influence of personal and workplace factors on direct care workers¡¯ retention in Assisted Living Facilities (ALFs). The sample includes 11 ALFs in urban areas in Atlanta, Georgia and 13 participants from the sample facilities. The findings show that personal and workplace factors interact with each other to influence retention in the long-term care field and retention in a particular facility. The findings of this study may have implications for facility policy and practice to retain workers.

While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

The aim of this study was to investigate fall risk and predisposing factors for fall among the residents in long-term care institutions. Methods. Elderly care homes residents 48 men (mean ± SD, 78,6±7,0) and 101 women (mean ± SD, 81,6±6,4), all 149 residents, participated in the study. For investigation a questionnaire was used, which was made according literature and including following instruments: Environmental Falls Audit Tool – Individual, Falls Risk Assessment Tool and Risk Factor Checklist, Mini Mental State Examination. Results. The most frequently diseases among men and women were heart and vascular (89,6 % and 92,1 %) and eyes diseases (70,8 % and 75,2 %). Ambulatory aid was needed for a half of all residents (54,4 %); ambulatory aid, which respondents didn’t want to used were three times common for women than men (p=0,007). Most residents had low fall risk (72,5 %), but high fall risk was more common in women (14,9 %) than men group (4,2 %); there were no significant difference between groups. High fall risk significantly dominated among the residents older than 85 year in comparison with 65-74 and 75-84 year age groups. Residents who had lower education (p<0,001), were older (p=0,005) and took more medications (p=0,002) had higher fall risk scores evaluated by Fall Risk Assessment Tool. Residents who had such risk factors as unsafe mobility, over-reaches transfer, forgot gait aids, observed behavioural agitation, disorientation had more medium-high fall risk... [to full text]

This study is a secondary analysis of data collected from a six-year longitudinal qualitative study called Eating Together (ET), which sought to better understand the mealtime experience of community dwelling persons with dementia and their primary partners in care. Findings from the primary study highlighted the importance of mealtimes for these families, and as persons with dementia moved into long-term care homes it was noted that the meaning of the mealtime experience was challenged. Data from select dyads in the primary study was thematically analyzed, to understand the mealtime experience of persons with dementia and their primary partners in care, when persons with dementia relocated to a “new place”; a long-term care home. Findings revealed five themes related to the new mealtime experience in the long-term care home, including: systemizing the meal, adjusting to dining with others, holding on to “home”, evolving roles, and becoming “at home”. / Social Sciences and Humanities Research Council of Canada

This study involved 58 persons with dementia living in three rural Canadian long-term care (LTC) facilities. In an attempt to find the relationship between these person's possible pain and levels of agitation, data on five proxy indicators of pain were collected and correlated with scores from the Pittsburgh Agitation Scale (PAS). Results indicated that three of the resident pain measures were significantly correlated with PAS scores. In particular, the palliative consultant pain ratings and the DS-DAT were strongly correlated with total PAS scores, and the five PAS sub-factors. Importantly, the PAS sub-factor of resistance to care was strongly correlated with three of the pain variables. Major study implications include the need for increased use of palliative pain consultants in LTC, and the need for nursing staff to realize that when demented residents resist care, it may be a potential clue that the resident is experiencing untreated pain. / xv, 116 leaves ; 29 cm.