No / Reducing hospital admissions of older adults with ambulatory care sensitive conditions is a government priority. Yet relatively little is known about current health care practice in UK nursing homes. We studied approaches to developing understanding of current health care practices in UK nursing homes using a methodology of data-extraction from retrospective care home records combined with key informant interviews. Older adults with an exacerbation of one of 4 ambulatory sensitive conditions that warranted decision making around admission to hospital or continued primary-care led nursing home care were 178 identified and recruited for participation. Care home records were examined using a proforma for data-extraction. These data were combined with care-plans to construct a brief care narrative. The relevant progress notes/daily record of care-given at the time of the decision making were used to construct a visual time-line of events. For those participants who consented, the key multiple stake holders in care were identified: non-professional carers, care-home workers, caring professionals and care-managers. These data were used to generate supplementary trigger questions and topics for semi-structured interviews. This enabled questions raised by the care record to be identified and explored. Implications of the findings for practice and research will be discussed. / NIHR

Merging from on-ramps to mainline traffic is one of the most challenging driving maneuvers on freeways. The challenges are further heightened for older drivers, as they are known to have longer perception-reaction times, larger acceptance gaps, and slower acceleration rates. In this research, VISSIM, a microscopic traffic simulation software, was used to evaluate the influence of the aging drivers on the operations of a typical diamond interchange. First, drivers were recorded on video cameras as they negotiated joining the mainline traffic from an on-ramp acceleration lane at two sites along I-75 in Southwest Florida. Several measures of effectiveness were collected including speeds, gaps, and location of entry to the mainline lanes. This information was used as either model input or for verification purposes. Two VISSIM models were developed for each site – one for the existing conditions and verification, and another for a sensitivity analysis, varying the percentage of older drivers and Level of Service (from A to E), to determine their influence on ramp operational characteristics. According to the results, there was a significant difference in driving behavior between older, middle-aged, and younger drivers, based on the measures of effectiveness analyzed in this study. Additionally, as the level of service and percentage of older adult motorists increased, longer queues were observed with slower speeds on the acceleration lanes and the right-most travel lane of the mainline traffic.

Introdução: A verificação periódica do peso corporal (PC), e as mudanças ocorridas ao longo do tempo, embora pouco realizada, é essencial no cuidado em saúde de idosos. A promoção do PC estável dependerá, pois, do conhecimento de fatores que levam tanto ao ganho como a perda de PC na velhice. Objetivos: avaliar as trajetórias de mudança de PC e os fatores relacionados à diminuição ou aumento do PC em idosos, no período de seguimento de 10 anos. Métodos: Essa pesquisa é parte do Estudo SABE (Saúde, Bem-Estar e Envelhecimento), longitudinal de múltiplas coortes, com inclusão de dados da primeira onda iniciada em 2000 e reavaliada em 2006 e 2010: composta por uma amostra probabilística de indivíduos com idade >=60anos (n=571). Mudanças no índice de massa corporal (IMC) <-5% foram consideradas como diminuição no PC e >5% como aumento do PC. Realizou-se modelo de regressão logística múltipla e modelo de regressão linear de efeitos mistos para avaliar longitudinalmente os fatores associados à mudança de PC, e a relação da perda ou ganho com a mortalidade. Resultados: em média o IMC aumentou até os 65 anos e diminuiu após os 75 anos. Na segunda avaliação, em 2006, 34,00% dos participantes diminuíram o PC, e 18,22% aumentaram. Já em 2010 apenas 12,49% dos participantes diminuíram (PC) enquanto quase 40% ganharam. Ao longo dos dez anos, foram associados ao aumento do PC a idade (p<0,001), o consumo de álcool (p<0,05), ter duas ou mais doenças crônicas (p<0,001) e a inatividade física (p<0,001); a diminuição de PC associou-se ao tabagismo (p<0,05), sexo masculino (p<0,001) e relato de diminuição de ingestão no último mês (p<0,001); a mortalidade foi associada a diminuição de PC (p<0,001). Especificamente em 2006, o relato de perda, não intencional, de >3kg (RR: 3,67; p<0,001) foi um fator de risco para diminuição de PC. E em 2010 foram fatores de risco à diminuição de PC, duas ou mais doenças crônicas (RR: 2,28; p<0,05), internação (RR: 3,82; p<0,001), saúde auto avaliada como má (RR: 4,30; p<0,01), diabetes (RR: 1,94; p<0,05), dificuldade de fazer compras (RR: 3,09; p<0,001), relato de diminuição de ingestão ((RR: 3,66; p<0,05), relato de perda, >3kg (RR: 3,37; p<0,001) e dificuldade de mastigar comidas duras (RR: 2,09; p<0,05); o consumo de álcool (RR:0,42; p<0,05) foi um fator protetor à diminuição do PC; e o relato de perda de peso (>3kg) não intencional (RR:0,46; p<0,05) e a dificuldade de engolir bem (RR: 0,44; p<0,05) foram fatores de proteção para o ganho de PC ao longo dos anos avaliados. Conclusão: a diminuição de PC, associada à mortalidade, ocorreu principalmente em idosos mais longevos. Por outro lado, o ganho de PC aumentou entre os anos avaliados. Fatores clínicos, funcionais e de estilo de vida estiveram relacionados a mudança de peso corporal. O monitoramento e prevenção de mudanças do peso corporal de idosos deve fazer parte da rotina de cuidados em saúde. A investigação das consequências da obesidade no envelhecimento é um dos desafios de estudos adicionais. / Introduction. Checking body weight periodically as well as changes occurred through time, although not performed often enough, is essential to take care of the elderly health. The promotion of a stable body weight will depends on factors that leads to body weight increase and its decrease as well. Objectives: To evaluate body weight trajectories of change and the factors that lead to body weight increase or decrease in a ten years period. Methods: This research is part of the SABE (Health, Welfare, and Aging) study, which is longitudinal with several cohorts, and included data of the first wave that began in 2000 and was re-evaluated in 2006 and 2010: Composed of a probabilistic sample of individuals who were 60 years old or older. (n=571). Changes in body mass index: <5% was considered body weight decrease and >5% was considered body weight increase. A multiple logistic regression model and mixed effect linear regression model were used to evaluate longitudinally the factors related to body weight change and its relationship with mortality. Results: In average, the body mass index increased until 65 years and diminished after 75 years. In the second evaluation, in 2006, 34% of the participants diminished their body weight and 18% increased it. However, in 2010 just 12, 5% of the participants decreased their body weight while 40% increased it. In ten years, many factors were associated with the body mass increase, such as age (p<0,001), alcohol consumption (p<0,05), having two or more chronic diseases (p<0,001) and physical activity (p<0,001); body mass decrease was associated with cigarette smoking (p<0,05), male sex (p<0,001) and reporting reduced ingestion in the previous month (p<0,001); mortality was associated with body weight decrease (p<0,001). Specifically in 2006, reporting more than >3kg (RR: 3,67; p<0,001) loss was a risk factor for decreasing body weight. And in 2010 the risk factors for body weight loss were two or more chronic diseases (RR: 2,28; p<0,05), being admitted to the hospital (RR: 3,82; p<0,001), health status being self-evaluated as bad (RR: 4,30; p<0,01), diabetes (RR: 1,94; p<0,05), difficulties to go shopping (RR: 3,09; p<0,001), reporting ingestion decrease ((RR: 3,66; p<0,05), reporting losing more than >3kg (RR: 3,37; p<0,001) and difficulties to chew food (RR: 2,09; p<0,05); alcohol consumption (RR:0,42; p<0,05) was a protective factor to body weight loss; and reporting unintentional weight loss (>3kg) (RR:0,46; p<0,05) and difficulties to swallow (RR: 0,44; p<0,05) were protective factors for body weigh increase along the years which were evaluated. Conclusion: body weight loss, linked with higher morality, was associated with older elderly subjects. On the other hand, body weight gain increased in the period that was analyzed. Clinical factors and lifestyle were related to body weight change. Monitoring and preventing body weight changes among elderly patients should be part of routine health care. The investigation of obesity consequences in the aging process is one of the challenges of academic studies.

O processo de envelhecimento é universal, contínuo, heterogêneo, de caráter lento e complexo. Dentre os possíveis danos do processo de envelhecimento destaca-se o comprometimento cognitivo e a síndrome da fragilidade. O objetivo deste estudo foi sintetizar o conhecimento sobre a associação entre a síndrome da fragilidade e o comprometimento cognitivo do idoso. Para este estudo, foi adotado o referencial do The Joanna Briggs Institute (2017) e dentre os modelos propostos por este Instituto e considerando os objetivos deste estudo, optou-se pela revisão sistemática de etiologia e fatores de risco, que se desenvolveu em nove passos. O primeiro é a elaboração do protocolo. O segundo foi a formulação da questão de estudo e teve como referência a estratégia PEO. No terceiro foram definidos os critérios de inclusão e exclusão. Posteriormente, no quarto passo, foi realizada a busca dos artigos com a utilização das seguintes bases de dados: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) e a Excerpta Medica Database (EMBASE), além da busca manual, tendo como resultado uma amostra inicial de 3024 estudos. A seguir, no quinto passo, foi realizada a seleção dos artigos, após serem excluídos os duplicados, houve a seleção por título e resumo e leitura na íntegra dos artigos selecionados. Tais ações foram realizadas por três revisores, sendo incluído um total de 10 artigos no estudo e posteriormente a avaliação crítica. O sétimo passo se refere à extração dos dados, seguida de síntese e análise e, por último a apresentação dos resultados. Os estudos incluídos apresentaram diferentes definições operacionais sobre a síndrome da fragilidade. A definição mais utilizada foi o Fenótipo da Fragilidade, utilizada em nove estudos. Já a avaliação do comprometimento cognitivo foi realizada por instrumentos validados para cada população de estudo, dos quais destaca-se o Mini Exame do Estado Mental (MMSE), uma vez que esteve presente em cinco estudos. Sobre as associações entre a síndrome da fragilidade e o comprometimento cognitivo, três estudos identificaram a associação por meio da medida de Odds Ratio (OR) e de quatro estudos foi possível estabelecer a relação pela análise do Relative Risk (RR). Assim, foram realizadas duas meta-análises entre a síndrome da fragilidade e o comprometimento cognitivo. Na primeira, pela comparação do OR, demonstrou-se que os idosos frágeis apresentam 1,24 mais chance de apresentarem comprometimento cognitivo em relação aos não frágeis. Já, na segunda metaanálise, realizada através do RR, os resultados encontrados não foram estatisticamente significantes. Assim, os resultados sugerem que a ausência da uniformidade entre os estudos para avaliar a síndrome da fragilidade e o comprometimento cognitivo, compromete a comparação entre os resultados. Tornase evidente a necessidade de desenvolver outras pesquisas na área que unifiquem a avaliação dessas duas condições de saúde, tendo em vista sua relevância para a prevenção de desfechos adversos de saúde / The aging process is universal, continuous, heterogeneous, with a slow and complex character. Possible and noteworthy damages of the aging process include cognitive impairment and the frailty syndrome. The objective of this study was to synthesize knowledge about the association between the frailty syndrome and cognitive impairment in older adults. In this study, the authors adopted the framework of the Joanna Briggs Institute (2017) and among the models proposed by this institute, and considering the objectives of this study, a systematic review of etiology and risk factors was chosen and developed in nine steps. The first step was the protocol creation. The second step was the formulation of the study question, which was based on the PEO strategy. At a third moment, inclusion and exclusion criteria were defined. Next, at the fourth step, articles were searched in the following databases: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) and the Excerpta Medica Database (EMBASE), in addition to a manual search as well, which resulted in an initial sample of 3,024 studies. At the fifth step, the articles were selected, once duplicates were removed, and later there was a second selection by title, abstract, and reading of the full texts selected. These actions were conducted by three reviewers, who reached a total of 10 articles to be included in the study. The seventh stage consisted of the data extraction, followed by its synthesis and analysis, and, at last, the presentation of the results. The included studies presented different operational definitions regarding the frailty syndrome. The most commonly used definition was the Frailty Phenotype, which was used in nine studies. The cognitive impairment evaluation was conducted by means of tools previously validated to each study population, among which the Mini-Mental State Examination (MMSE) stood out, for being present in five studies. Regarding the associations between the frailty syndrome and cognitive impairment, three studies identified an association by means of the Odds Ratio (OR) measurement, and in four studies it was possible to establish a relationship by the Relative Risk (RR) analysis. Thus, two meta-analyses were conducted between the frailty syndrome and cognitive impairment. The first, by comparison of the OR, showed that frail older people had 1.24 higher chances of presenting cognitive impairment in relation to non-frail individuals. In the second meta-analysis, performed through the RR analysis, the results found were not statistically significant. Therefore, the results suggest that the absence of uniformity among the studies to assess the frailty syndrome and cognitive impairment compromises their comparison. Hence, there is a clear need for developing further research in the area to consolidate the assessment of these two health conditions, considering their relevance to preventing adverse health outcomes

Denna kvalitativa studie med etnografisk metodansats syftar till att beskriva samt förstå vad vårdhundsinsatsen betyder för äldres välbefinnande ur ett interaktionistiskt perspektiv och vilka övriga effekter som insatsen bidrar till. Studiens resultat bygger på fyra observationer som utförts under pågående vårdhundsinsatser på ett äldreboende i en mellanstor svensk kommun, samt fem kompletterande intervjuer med relevant yrkespersonal. Resultatet visar att vårdhundar bidrar till äldre personers välbefinnande genom att skapa en meningsfullhet i vardagen. Hunden möjliggör för brukare att släppa sin oro om så bara för en liten stund samt ger hälsofrämjande effekter i form av bland annat en ökad fysisk aktivitet. Förutsatt att brukaren inte besitter en rädsla eller allergi kopplad till hundar. Utifrån resultatet har slutsatsen om att äldres psykiska hälsa behöver bejakas samt prioriteras lika högt som deras fysiska hälsa framkommit, genom att implementera vårdhundsinsatsen i större omfattning inom äldreomsorgen. / This qualitative study based on ethnographic methodology aims to describe and understand the meaning of the animal-assisted therapy for older persons´well-being from an interactionist perspective and what other effects this can contribute to. The result of the study is based on four observations that were conducted at a care home in a medium-sized municipality in Sweden, as well as five complementary interviews with some of the professional staff. The result shows that therapy dogs contribute to the well-being of the older adults by creating a meaningfulness in their everyday life. To make it possible for older persons to let go of their concerns if only for a little while as well as to give health-promoting effects in the form of, among other things, increased physical activity. Assuming that the older person do not have a fear or allergy associated with dogs. From the result, the conclusion is that the mental health of older persons needs to be treated as well as their physical health, by implementing therapy dogs to a greater extent within eldercare.

Denna kvalitativa studie med etnografisk metodansats syftar till att beskriva samt förstå vad vårdhundsinsatsen betyder för äldres välbefinnande ur ett interaktionistiskt perspektiv och vilka övriga effekter som insatsen bidrar till. Studiens resultat bygger på fyra observationer som utförts under pågående vårdhundsinsatser på ett äldreboende i en mellanstor svensk kommun, samt fem kompletterande intervjuer med relevant yrkespersonal. Resultatet visar att vårdhundar bidrar till äldre personers välbefinnande genom att skapa en meningsfullhet i vardagen. Hunden möjliggör för brukare att släppa sin oro om så bara för en liten stund samt ger hälsofrämjande effekter i form av bland annat en ökad fysisk aktivitet. Förutsatt att brukaren inte besitter en rädsla eller allergi kopplad till hundar. Utifrån resultatet har slutsatsen om att äldres psykiska hälsa behöver bejakas samt prioriteras lika högt som deras fysiska hälsa framkommit, genom att implementera vårdhundsinsatsen i större omfattning inom äldreomsorgen / This qualitative study based on ethnographic methodology aims to describe and understand the meaning of the animal-assisted therapy for older persons´well-being from an interactionist perspective and what other effects this can contribute to. The result of the study is based on four observations that were conducted at a care home in a medium-sized municipality in Sweden, as well as five complementary interviews with some of the professional staff. The result shows that therapy dogs contribute to the well-being of the older adults by creating a meaningfulness in their everyday life. To make it possible for older persons to let go of their concerns if only for a little while as well as to give health-promoting effects in the form of, among other things, increased physical activity. Assuming that the older person do not have a fear or allergy associated with dogs. From the result, the conclusion is that the mental health of older persons needs to be treated as well as their physical health, by implementing therapy dogs to a greater extent within eldercare

El presente proyecto de tesis esta compuesto por un centro de día y residencia para el adulto mayor el cual esta ubicado en el distrito de San Martín de Porres debido al gran porcentaje de personas de la tercera edad y por el déficit de centros de atención residencial. La residencia del proyecto busca dar alojamiento a las personas de la tercera edad que cuentan con dependencia física y/o psíquica y precisan de cuidados especiales mediante ambientes que se adaptan al estado de cada usuario. Asimismo, el centro de día cuenta con ambientes de pedagogía, recreación y asistencia medica para los usuarios de la residencia y del distrito. El proyecto busca mejorar la calidad de vida del adulto mayor mediante espacios intergeneracionales, los cuales son ambientes de encuentro, intercambio social y cultural entre distintas generaciones. Además, por medio de la arquitectura multisensorial busca la activación de los sentidos del adulto mayor y que estos minimicen la desorientación y el desconcierto dentro del edificio. Conservando y promoviendo su autonomía física y psicológica. Por ultimo, mediante la accesibilidad universal busca que los ambientes se adapten a las distintas condiciones del usuario considerando los cambios físicos que se producen en esta etapa final de la vida. / The present thesis project is composed of a day and residence center for the elderly which is located in the district of San Martín de Porres due to the large percentage of elderly people and the shortage of residential care centers. The residence of the project seeks to provide accommodation for the elderly who have physical and / or mental dependence and need special care through environments that adapt to the state of each user. Likewise, the day center has pedagogy, recreation and medical assistance environments for residents and district users. The project seeks to improve the quality of life of the elderly through intergenerational spaces, which are meeting environments, social and cultural exchange between different generations. In addition, through the multi sensorial architecture, it seeks the activation of the senses of the elderly and that these minimize the disorientation and bewilderment within the building. conserving and promoting their physical and psychological autonomy. Finally, through universal accessibility, it seeks to adapt the environments to the different conditions of the user, considering the physical changes that occur in this final stage of life. / Tesis

Aging becomes one of the urgent topics in Taiwan, therefore new product and services must be established in respond to this issue. In recent years, online social network have been one of the most accelerative business model spreading across internet. Facebook has been one of the most influential role model among all. An opportunity gap is identified within these two phenomenon. The present paper is to initiate an innovative business model on worldwide geographic social network – based on the target market of senior travelling demand. This innovative business model will be satisfying the discovered gap. The establishment of this innovation business model is based on the process of Innovation SCREW: (1) Search; (2) Combination; (3) Re-search, Re-Combination; (4) Experiment, Evaluation; (5) Work, Weigh. Through this framework, it brings to the possible establishment of this platform. In addition, by using of secondary datasets that lead to comprehend further to consumer behavior and market demand. As the result, based on this innovative platform, it is hoping to create a new online worldwide geographic social network that can improve services on senior’s travelling demand.

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.

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.