- 5 - SUMMARY This thesis is dedicated to the assessment of the current state of education and care for the elderly, and outlines ways to improve care through education and, ultimately, to achieve life satisfaction of seniors. The thesis is written in the form of a comparison of scholarly sources dealing with the education and care of the elderly, and the current legislation of the Czech Republic. The thesis also includes an empirical study which draws on a quantitative questionnaire survey in a selected nursing home. This investigation aims at further education of the elderly and its effect on life satisfaction of population in this age group. Key words: Old age, aging, older adult, elderly education, social services for the elderly.

Made available in DSpace on 2016-06-02T20:19:26Z (GMT). No. of bitstreams: 1 6742.pdf: 1859845 bytes, checksum: 55f9adab2f16f9d072fe52a977ca84e7 (MD5) Previous issue date: 2015-03-24 / Background: Hypoalgesia related to hypertension has been described and studied by many authors over the last few decades, but little is known about how it behaves in the elderly. Therefore the aim of this study was to establish whether there are differences in pain sensitivity between hypertensive and normotensive older adults. For this, we selected seventy-two elderly of which 36 were normotensive and 36 were hypertensive and the pressure pain threshold (PPT) was assessed on seven points bilaterally in both groups by means of pressure algometry. Two-factor analysis of variance (ANOVA) group and gender was performed, and the effect size was calculated using Cohen s index. Results: The PPT values were higher in the group of hypertensive older adults compared to the normotensive ones; that difference was significant (P < 0.05) for the following points: right and left trochanters, left trapezium, left L3/L4 and left anterior tibialis muscle. The correlations exhibited by the PPTs were stronger in the group of hypertensive older adults; hypoalgesia was more generalized among the hypertensive adults compared to the normotensive ones. Gender did not influence that difference, although the magnitude of the difference was greater among males compared to females. Conclusion: Hypoalgesia, as assessed by means of PPT, exhibited a relationship with arterial hypertension in older adults. The influence of gender on hypoalgesia exhibited by hypertensive individuals is controversial. / Contextualização: A hipoalgesia relacionada à hipertensão arterial tem sido descrita e estudada por muitos autores ao longo das últimas décadas, porém sabe-se pouco sobre o como ela se comporta na população idosa. Por isso o objetivo do presente estudo foi identificar se existem diferenças entre a sensibilidade dolorosa de idosos normotensos e a de idosos hipertensos. Para isso, foram selecionados setenta e dois idosos sendo 36 normotensos e 36 hipertensos e foi avaliado o limiar de dor à pressão (LDP) em ambos os grupos em 7 pontos bilaterais por algometria de pressão. Foi realizada a análise de variância (ANOVA) de dois fatores (grupo e gênero) e cálculo de tamanho da diferença pelo índice de Cohen. Resultados: O grupo de idosos hipertensos apresentou LDP maior do que o grupo de idosos normotensos, sendo significativas as diferenças (p<0,05) nos pontos trocanteres direito e esquerdo, trapézio esquerdo, L3-L4 esquerda e tibial anterior esquerdo. As correlações entre os LDPs no grupo de hipertensos foram maiores, sendo a hipoalgesia mais generalizada, que nos normotensos. O gênero não influenciou nessa diferença ainda que os idosos tenham apresentado tamanhos de diferença maiores entre os grupos do que as idosas. Conclusão: A hipoalgesia avaliada pelos limiares de dor à pressão encontra-se relacionada à hipertensão arterial em idosos. A influência do gênero no comportamento da hipoalgesia do hipertenso é controversa.

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

Given the stress involved in caring for elders, the propensity for abuse among the older adult population continues to be a problem, as the number of caregivers providing care in the home is increasing to meet the demand of an increasing population of older adults. One solution is to implement video surveillance in the home. The purpose of this phenomenological, retrospective and prospective study was to describe the perceptions and experiences of caregivers that affect stress in the home care setting and to describe participants' perceptions about the impact of video surveillance in the home environment on caregiver stress and elder abuse. Using a lens of critical ecological framework and privacy theory, the research questions inquired about the specific experiences of stress and the perceptions of the use of home surveillance of caregivers in the home. A sample of 9 older adult home caregivers were recruited from the United Jewish Council of the East Side Home Attendant Service Corp. Findings revealed that increased family, community, and agency involvement and support may offset the feelings of isolation of the home care environment and ensure the caregiver is given opportunities to engage in strategies designed to help cope with the inherent stressors of the job. In addition, video camera surveillance in the home care setting may provide social support through observation of the situation in the home, supporting both social control on the behavior of the caregiver and direct evidence of quality of care for the caregiver. The findings of the study help to highlight effective intervention strategies based on the specific stressors and stress relievers identified, serving to reduce the potential for older adult abuse and neglect in the home care setting.

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In the literature, the experience of ‘care’ and ‘caregiving’ has been well documented and widely researched. Caregivers are recognized as people (family and friends) who provide unpaid substantial care for family members. Over time, research has increased awareness of caregivers as a distinct social group and has also contributed to caregiving being a widely recognized social issue. However, despite this increased awareness and continued concern for caregivers, much of the literature focuses on adult caregivers. As a result, the experiences of other caregiving populations, such as the youth and young adults, continues to be overlooked and underrepresented. Therefore, there is a need to explore and understand the unique experience of this population and how they give meaning to their experiences. Young caregivers (YCs) are children (5-18) and young adults (18-25) who provide substantial (unpaid) care for a family member who has an illness or disability (Stamatopoulos, 2016). Research on this population is scant and there exists many notable gaps in the literature in terms of diversity, age-based differences, programming and best practices for intervention. More specifically, there is a gap in understanding the experiences of young caregivers who are affected by progressive and incurable chronic brain diseases such as Alzheimer’s Disease or a Related Dementia. As such, this dissertation explores the experiences of YACs affected by ADRD, in terms of their personal experiences with ADRD (knowledge, dementia care and care practices), perceptions of their caregiving role and how they navigate the caregiving role. It builds on scholarship on young caregivers to broaden existing knowledge by using a phenomenological approach, known as Interpretive Phenomenological Analysis, to explore their caregiving experiences and the meaning they give to these experiences in-depth (n=12). It also aims to challenge the dominant assumptions about young caregivers by giving voice to this population by situating the young caregivers as the experts in their own lives. Findings indicate that the caregiving experience for YACs is complex, and situated within a larger socio-political context, which impacts the overall experience of care. Overall, the findings contribute to knowledge on the experiences of care among YACs and highlight the need for more inclusive research and practices on addressing caregiving among this group. / Dissertation / Candidate in Philosophy / This dissertation explores the lived experiences of young adult caregivers (YACs) caring for an older adult with Alzheimer’s Disease or a Related Dementia. Research on this group of caregivers is limited, particularly YACs (ages 18-25) who provide substantial (unpaid) caregiving for an older adult affected by Alzheimer’s or a Related Dementia. Therefore, a key aim of this research is to generate awareness and shed light on the nature of caregiving as experienced by this overlooked population of caregivers. As such, this dissertation aims to understand how young caregivers give meaning to, interpret and make sense of their caregiving experience. To understand the caregiving experience of YACs, I conducted interviews with 12 YACs from Canada and the United States and analyzed their perspectives in detail. The findings shed light on the many factors that shape the caregiving experiences. In addition, the findings show that more research is needed to understand the differences amongst young caregivers to better support their needs. In general, the research can contribute to existing knowledge on young adult caregivers, as well as relevant programs and policies.

Technology development in the sub-field of older adult care has always been on the back-burner compared to other healthcare areas. But with increasing life expectancy, this is poised to change. With the increasing older adult population, the current older adult care facilities and personnel are struggling to keep up with demand. Research conducted in the Netherlands [1] found 33,000 older adults were awaiting admission into a home for the elderly showing that demand far exceeds availability. This huge demand for older adult care has resulted in a decrease in the quality of care being provided. A recent study involving older adults aged 65 and above [2] compared the quality of care given to older adults in nursing homes in the UK and found it to be inadequate. While it is true that giant strides have been made in the field of personal health and fitness [3], we have to acknowledge that these technologies have not found widespread adoption in the elderly communities for a number of reasons which include lack of education, cognitive impediments, low-income and techno-phobia [4]. We believe that older adult care technologies should be approached from a different perspective in order to maximize outcomes. Inventions in the health care space are a moving target and a significant degree of technical aptitude and interest is required to keep up with these changes. My research work will be focused on developing a distributed system infrastructure that will enable large-scale monitoring of vital signals and early detection of emergency situations in nursing homes and assisted living communities. This new approach will increase automation in nursing homes leading to a reduction in running cost and an increase in capacity

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<p>The increased recognition of chronic disease (CD) has been accompanied by an era of medical technology, intended to better treat and manage CDs such as type 1 diabetes. Since the discovery of insulin in 1921, the treatment and management of type 1 diabetes has significantly improved, and witnessed innovations such as the insulin pump. Yet, as the population ages within a technological society, the implications of advancements in diabetes care and its relationship with older adults is of great concern. How do older adults identify and make use of these new technologies? How do technological advances challenge traditional life course models or expected transitions of growing old? How do older adults continue to cope and manage with a CD in their advanced years? The objective of this study was to explore how older adults with type 1 diabetes relate to management devices used in their daily routines. Five open-ended and semi-structured interviews were conducted with older adults living with type 1 diabetes (recruited through the Canadian Diabetes Association [CDA] and the Hamilton Health Sciences [HHS] Diabetes Care and Research Program [DCRP], Hamilton, Ontario). Interviews were transcribed and analyzed drawing on analytic techniques of grounded theory. Open, axial and selective coding was used in accordance to the constant comparative approach. Themes included living longer with type 1 diabetes, how type 1 diabetes challenges traditional models of aging and the lifecourse perspective, and older adults welcoming the use of technology. Overall findings suggested technology used for the daily treatment and management of type 1 diabetes may permit increases in one’s quality of life (QOL), yet challenge policies and practices within healthcare settings to ensure older adults maintain independent self-management strategies.</p> <p>Keywords: aging, chronic disease, technology, treatment, type 1 diabetes, older adult, diabetes community</p> / Master of Arts (MA)