The majority of today's elderly people were primarily infected with Mycobacterium tuberculosis at a time when no effective chemotherapeutic treatment was available. With the progressive decline in cell mediated immunity that accompanies aging, the potential to reactivate a dormant lesion, or to be re-infected increases. The latter particularly applies in areas of high density living e.g. homes for the elderly. The incidence of pulmonary tuberculosis in whites in South Africa is very similar to that in industrialized countries (approximately 16/100 000). In a survey of old age homes in East London (South Africa) involving 809 white subjects the prevalence rate was found to be 1403/100 000; clusters were found in individual homes where up to 10% of residents had tuberculosis. The age specific incidence in the community for whites was 86/100 000, and in homes for the aged the incidence in 648 elderly subjects followed for 2 years was 1080/100 000. It is concluded that the elderly living in high density accommodation constitute a high-risk group for the development of the disease. The diagnosis of pulmonary tuberculosis in the elderly may be complicated by the high prevalence of atypical radiographic changes, difficulty in obtaining sputum, and the high false-negative rate of the tuberculin skin test. Thus, the value of haematological and biochemical abnormalities in 93 elderly tuberculotics, 113 elderly non-tuberculotics and 264 young tuberculotics were investigated. The results in the elderly tuberculotic patients were: Normochromic normocytic anaemia (70%), leucocytosis (55%), thrombocytosis (33%), rapid ESR in 90%, lymphopenia (22%) and monocytopenia (37%); hyponatraemia (60%), hypokalaemia (42%) and hypoalbuminaemia (83%), serum bilirubin (20%) and alkaline phosphatase, aspartic transaminase and lactic dehydrogenase are elevated in approximately 2/3 of patients. In comparison with the younger group (mean age 48 years) with cavitating tuberculosis, the prevalence of elderly patients (with generally mild and non-cavitating disease) with elevated bilirubin, alkaline phosphatase and liver enzymes was approximately 50% higher. When the results of liver enzyme elevations in the elderly tuberculotics were compared retrospectively with elderly patients with non-tuberculotic destructive lung disease, the former group had significantly higher values. The sensitivity (76%), specificity (48%) and positive predictive value (60%) suggest that liver enzyme abnormalities may provide useful contributory data in the non-invasive diagnosis of pulmonary tuberculosis in the elderly. The chest radiographs in 93 consecutive cases of bacteriologically proven pulmonary tuberculosis showed infrequent apical involvement (7%), with the most frequent abnormality being opacification of the middle and lower zones of the lungs; half the cases had a pleural reaction. cavitation occurs in only 1/3 of patients, and was sited equally in the apical zones and in the mid and lower zones. These findings contrast with the pattern of cavitating apico-posterior disease commonly seen in reactivated tuberculosis in younger adults. A series of 21 patients was studied to compare the yield of sputum smear examination with sputum culture for M. tuberculosis. Sputum production in non-cavitating disease was found to be infrequent and unpredictable and the number of bacilli is usually scanty. Repeated Culture of sputum for M. tuberculosis is required to improve the likelihood of obtaining a positive bacteriological diagnosis. On the basis of this study at least 4 negative sputum cultures are required to exclude the disease. In a study of 10 patients the impact of 4-drug therapy on the viability of M. tubercle in their sputum was assessed. Viable tubercle bacilli continue to be excreted in patients with cavitating pulmonary disease on treatment for up to 9 weeks. It is suggested that patients with cavitating disease should probably not be allowed to return to high density accommodation for the elderly until their sputum is clear of acid fast bacilli on sputum smear examinations. The usefulness of using annual tuberculin skin reaction (Mantoux) tests as a screening procedure was evaluated in 648 residents in old age homes. The criteria for further investigation for pulmonary tuberculosis was either recent conversion to positive (reaction equal to 10 mm or more) or a year-on-year increase of greater than 12 mm, or any reaction> 20 mm. 206 subjects were identified as "possibly having the disease" and of these the diagnosis of pulmonary tuberculosis confirmed in 13 cases. 10/13 patients had Mantoux reactions of greater than 20 mm and 3/13 between 10 mm and 19 mm. As a result of this study the recommendation is made that a yearly Mantoux test is a useful screening procedure, and will help identify a population who should be further investigated with chest radiographs and sputum cultures.

No description available.

Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.

As the number of elderly individuals in the population continues to increase, the demand for alternatives to group care settings will also increase. Homes for adults represent an example of the diversification of long term care options by providing care to elderly individuals in a setting that is more home-like and less institutionalized than traditional nursing homes. Since previous research is often limited to nursing home residents, the study of home for adult residents offers a fresh approach to sample selection, and provides reassurance that the needs of elderly residents are indeed being met not only in terms of custodial care but also in a therapeutic sense that enhances life satisfaction. In this study, the relationship of integrity/despair, locus of control, and life satisfaction was examined in a sample of elderly persons who reside in homes for adults. The participants were 17 males and 83 females, ranging in age from 60 to 95 and reporting fair to good health. It was hypothesized that elderly individuals who felt in control of their lives would also be more satisfied with life, Additionally, it was proposed that elderly individuals who looked back on their lives and were not satisfied would be afraid to die and would feel little or no control over their lives. Death anxiety, as measured by the Death Anxiety scale (Templer, 1970) was used to define integrity/despair. The indicator of locus of control was the Mastery Scale (Pearlin & Schooler, 1978), and life satisfaction was assessed with the Philadelphia Geriatric Center Morale Scale (Lawton, 1975). Correlation analysis yielded the following results: (a) the more internal an individual’s locus of control score, the lower the death anxiety score, (b) the more internal the locus of control, the higher the life satisfaction score, and (c) the higher the life satisfaction, the lower the death anxiety score. These findings supported the hypotheses and indicate that elderly individuals who feel in control are also satisfied with their lives and are not afraid to die. / Master of Science

The Ecological Q-Sort was developed specifically for the measurement of self-concept in older adults. Self-concept is defined as individuals' perceptions of themselves in relationship to their environment. Consequently, self-concept is contextual, multidimensional and varies with the situation. The Ecological Q-Sort was subjected to convergent and discriminant validational procedures in the present study. Correlational analyses provided support for both convergent and discriminant validity, suggesting that this instrument measures ecological, domain specific self-concept in older persons. However, multivariate analysis of variance did not yield significant main effects or interactions for sex, marital status, and health as observed on the sets of ecological and non-ecological self-concept measures.

The purpose of this research was to examine specific coping methods used by the elderly as they adjust to the environment of a long-term care facility, and to examine the correlations between these coping methods and levels of depressive symptomatology.

Orientador: Guita Grin Debert / Tese (doutorado) - Universidade Estadual de Campinas, Insituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-15T07:22:48Z (GMT). No. of bitstreams: 1 Alcantara_AdrianadeOliveira_D.pdf: 1830987 bytes, checksum: 68df3abd480569d71d864a8e37a46562 (MD5) Previous issue date: 2010 / Resumo: A questão central desta pesquisa foi saber como as trocas intergeracionais de apoio familiar se configuravam em unidades domésticas, compostas de, pelo menos, três gerações, no meio rural e urbano, levando em conta a oposição cunhada por Camarano entre "família de idosos", em que o chefe da unidade doméstica é o idoso, e "família com idosos", em que o idoso é parente do chefe. Com base em etnografias realizadas em Fortaleza (CE) e no Distrito de Jordão (Sobral-CE), o trabalho aponta as singularidades do processo de envelhecimento nesses dois contextos. A descrição do cotidiano de tais famílias, dos significados atribuídos às relações entre gerações e do impacto das transformações acarretadas pelo direito à aposentadoria exige uma revisão de determinadas convenções, pois as experiências aqui trazidas revelam-se de tal modo heterogêneas, que bloqueiam a tentativa de padronizar seja a família, seja a velhice. / Abstract: The central question of this research was how the Intergeneration relations of family support is configured in households composed of at least three generations in country and urban areas, taking into account the opposition coined by Camarano and "family nursing" in which the head of household is elderly and "elderly family" in which the elderly is related to the head. Based on ethnographic studies conducted in Fortaleza (CE) and the District of Jordan (Sobral-CE), the study analyzes the singularities of the aging process in these two contexts. The description of the daily life of such families, the meanings attributed to the relations between generations and the impact of changes brought about by the retirement law requires a revision of certain agreements, since experiments show brought here is so heterogeneous, that block attempt standardize it's family, is old age. / Doutorado / Doutor em Antropologia Social

Communication forms the foundation of social interaction. For older adults, however, there is known to be an increased risk of developing conditions that interfere with the ability to communicate. These conditions may occur for a variety of reasons, including age-related changes in physical or sensory functioning, injury, and disease. It is estimated that 55% of all Medicare beneficiaries have a communication impairment of some kind. Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment is associated with social measures, whether there is an interaction between communication impairments and physical disability, and to examine the role of relationship-control strategies in maintaining access to a larger or more supportive social network. A mixed-methods study design was employed. Community-dwelling older adults were surveyed about the size and diversity of their social networks, frequency of social interactions, and physical and mental health (n = 240) and qualitative data were collected from a smaller subsample. Findings demonstrated that communication impairment was a significant independent predictor for key characteristics of social relationships, including the composition of the social network, certain types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was a significant predictor for higher levels of loneliness and depression. In addition two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Additional insights were provided by the qualitative results. These findings may guide future clinical practice and research by providing a better understanding of the role of communication in health, disability, and the risk of social isolation.

published_or_final_version / abstract / toc / Social Work and Social Administration / Master / Master of Philosophy

Thesis (M. Soc. Sc.)--University of Hong Kong, 1997. / Includes bibliographical references.