Globally, old age has been identified as one of the key causes of poverty. Governments all over the world have taken the initiative to introduce policies aimed at protecting the elderly from poverty. However in most developing countries, the plight of the elderly often falls on the informal systems of care such as the extended family. This often leaves the elderly more vulnerable to poverty as the informal systems of care are becoming increasingly unreliable. This study explored the impact which an economic crisis characterized by hyperinflation and high unemployment had on the lives of elderly persons in a suburb called Mucheke in Masvingo, Zimbabwe, focusing mainly on their social networks. Most of the literature on Zimbabwe emphasizes that often people who are institutionalized in old age homes in Zimbabwe were those people who had weaker social networks, particularly due to the fact that they were of foreign origin. These individuals did not have an extended family they could rely on in Zimbabwe, whilst at the same time their links with their families had been broken due to a prolonged stay in a foreign country. Black locals rarely sought to be institutionalized in old age homes. However with the economic crisis, many facets of the elderly people’s lives were altered. These alterations included the depletion of the extended family’s capacity to continue its role of providing care to the elderly as resources were limited. The government on its own had been paralyzed by the economic crisis and no longer provided care for the destitute and desperate elderly people as had been the norm. The elderly established different coping strategies to see them through the crisis. The civil society also began to play a more central role in assisting the needy as the crisis worsened. / Thesis (M.Dev.Studies)-University of KwaZulu-Natal, Durban, 2009.

A thesis submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy Final Submission June, 2015. / The HIV and AIDS pandemic has increased the numbers of orphans globally. The severity of the problem is greater in developing countries, especially in Sub Saharan Africa. In Malawi, as in many other developing countries, grandparents have stepped in and have embraced the role left by the deceased parents, seeing the orphans through school, providing food, clothing and shelter for them, even where the grandparents themselves have no steady source of income. Despite the heavy burden placed on grandparents as a result of HIV and AIDS, limited attention has been given by governments, scholars and researchers to documenting in detail the challenges faced by the elderly who look after orphaned children. This study examined the challenges faced by elderly people looking after children orphaned by HIV and AIDS in Malawi using the Sustainable Livelihoods Framework (SLF). This framework looks at household needs and holistically categorises them in terms of social, financial, physical, natural health, and government policies. Following a qualitative approach, this study used a phenomenology approach in documenting the challenges facing the elderly in Malawi, with a special focus on the Rumphi and Zomba districts. The livelihood approach is part of rural development theories that has moved away from the conventional approaches towards development to holistic understanding of the relationship between poverty and economic development. The study also provided a case study on the role of social pensions in Lesotho. Social protection, which is part of social development, focuses on local community development with the emphasis not only on economic development, but also on improvement of health, education, environment and standard of living as critical contributors to sustainable development. This is seen as a medium that discourages dependency and promotes the participation of people in their own development. The aim was to profile social protection benefits for the elderly in Lesotho as an example so that insights could be drawn from the experience. The study used structured and semi-structured interviews and focus group discussions as tools to elicit information from grandparents, orphans, community leaders, teachers, local leaders and policy makers. The findings of the study indicate that the level of rural poverty in elderly headed households has increased due to the challenges resulting from the HIV and AIDS pandemic. The Sustainable Livelihoods Approach presented in this paper advocates that sustained development is only successful if it is based on evidence and understanding of household or community needs holistically and systematically. This study has highlighted five key elements required to understand the elderly households through the Sustainable Livelihoods Framework. Firstly, the evidence from this research challenges the SLF in that it does not take into account all key factors necessary to understanding the elderly households’ needs, As a result, this study proposes other necessary enhancements to the SLF, such as the role of cultural practices as part of social capital in supporting elderly livelihoods, especially where patrilineal and matrilineal family systems exist. Secondly, evidence from this study indicates that the notion of social capital that includes dependency on community networks as key in improving the general livelihood of societies has completely diminished due to community fatigue in relation to offering care and support. The study further reveals enhancements in the forms of social capital like belonging to “secret friendships” or being a member of the village banking scheme. However these social networks have limited elderly membership because of community perceptions that elderly members may not contribute much, be it financially or otherwise, hence the elderly are excluded from social networks. Thirdly, as a result of the many challenges faced by the elderly, this research has highlighted an increase in negative coping strategies in elderly households due to limited support from government and other stakeholders. Negative coping strategies in this regard include engaging in activities like casual labour (ganyu), selling alcohol, school dropouts, selling green maize and begging. The more the elderly adopt negative coping strategies, the more vulnerable they become over time. Fourthly, the livelihoods framework has been used in this study to provide a full understanding of situation of the elderly headed households. This approach provides a new dimension to this body of knowledge as it is used for the first time on elderly households. The research presents a foundation that will require future researchers to look at elderly households holistically and systematically within their context using this research as a guideline or as a point of reference. Finally, this research suggests a possible framework that would address the needs of the elderly, with a combination of the livelihoods framework as the analysis tool and the social pensions as the response mechanism for alleviating the burden on elderly headed households. Social pensions will act as a poverty cushion to the elderly members of the society to meet their needs in raising orphaned children. This research conclusively reinforces the role of social protection for supporting the elderly livelihoods. The researcher’s contribution to theory is embedded in the premises of integration of livelihoods frameworks as an analysis tool that provides an holistic picture of understanding elderly household challenges and needs. Social protection through social pensions can be an intervention for supporting the household challenges of the elderly. The combination of these two frameworks results in an holistic and systematic analysis of elderly livelihoods and subsequent support necessary to respond to their challenges. / MT2016

The majority of dependent older people rely on informal care to meet their long-term care needs. The activity of care-giving can place informal carers at risk of experiencing financial poverty and welfare loss, including poor health, injuries and time poverty. This thesis argues that states should recognise and treat the informal care of older people as a social risk by providing informal carers and the older people they care for with adequate statutory protection against the risks which they face. A qualitative case study was conducted to analyse the extent to which care policies in England protect informal carers and the older people they care for against care-related risks. A policy simulation technique, the model care relationship matrix, was employed as a data collection and analysis tool. The matrices incorporated thirteen care relationship types and all of the care policy mechanisms in England, including cash benefits, care services, and employment-related support. Government documents and semi-structured interviews with practitioners and managers from a range of public sector and third sector agencies were used to determine the statutory support each care relationship would be entitled to receive. The way in which institutional structures, processes and actors within the policy environment can affect the level of statutory protection provided to care relationships was also analysed. The study’s findings reveal that the English state recognises but does not treat informal care as a social risk. The state’s treatment of informal care-givers and their care-related risks is inconsistent, unpredictable and inadequate. Some informal care-givers have access to inadequate levels of statutory protection, while the risks experienced by other groups of informal carers are left unprotected and privatised. Moreover the policy environment, itself, is revealed to produce risks due to being complex, fragmented, and adversarial in nature. Overall informal carers are found to occupy a marginalised and devalued position in the English care policy system.

Hospitalizations are a major driver of Medicare spending and adverse outcomes for the 5.3 million elderly Americans with dementia. This is a growing problem given aging and longevity trends. Within the home health care setting, about 3.5 million mostly frail elderly Medicare beneficiaries receive care and 27% are hospitalized annually. Estimates of dementia prevalence range from 31 to 60%, yet little is known about the hospitalization of home health care patients with dementia. This study addresses knowledge gaps on the prevalence, characteristics, hospitalization rate and risk factors of these patients, and explores whether hospitalization risk factors are moderated by dementia. A systematic literature review on hospitalization risk factors in the home health care setting was completed and the findings informed the selection of variables and hypotheses for this study. This was a retrospective cohort study and the sample was patients admitted to one large non-profit home health care agency during 2014 (n=57,888). Data were from the Outcome and Assessment Information Set and other home health agency data captured at the start of care. The conceptual framework guiding the analysis was Andersen’s Behavioral Model of Health Services Use. Because more than half of those who would meet clinical criteria for dementia are undiagnosed, the operational definition of dementia for this study was a diagnosis of dementia or Alzheimer’s disease, or an indication of cognitive impairment in the start of care assessment. Multivariable logistic regression was used to identify characteristics of dementia patients and hospitalization risk factors, and to explore dementia as a moderator of hospitalization risk factors. Prevalence of dementia among the study sample was 41.6%. Consistent with prior studies on the general dementia population, older age, Black and Hispanic race/ethnicity, Medicaid eligibility, fall risk, congregate living, more comorbidities, behavioral symptoms, depression, assistance with activities of daily living, and communication disabilities were associated with dementia. However, contrary to prior studies, serious health status, higher need for assistance with activities of daily living, and higher use of health services were negatively associated with dementia. The hospitalization rate for patients with dementia (12.9%) was significantly higher than the rate for patients without dementia (10.7%). Hospitalization risk factors of dementia patients that were consistent with prior studies among home health patients included male gender, Black race, Medicaid eligibility, number of comorbidities, higher need for assistance with activities of daily living, cardiovascular conditions, dyspnea, cancer, diabetes, renal disease, skin ulcers and higher health services use. The moderator analysis found that dementia attenuated the effect of some hospitalization risk factors and had no effect on others. This study was a first step toward better understanding the characteristics and hospitalization risk factors of home health care patients with dementia. Findings from this research can inform practice, policy and future research on home health care patients with dementia.

The aim of this dissertation is to study the effect of adult children's education on the health and economic wellbeing of their parents in old age. This dissertation contributes to the field of human capital theory through enhancing the understanding of the connections between adult children and parents in old age. It studies large nationally representative data sets in the US and China. The findings highlight the potential importance of pathways through which children’s human capital affects parents in later life and suggest that offspring’s human capital (education) is important for parental health and old-age support. This research has important implications for the amelioration of health disparities related to intergenerational inequality in both the U.S and China.

A total of 180 patients participated in the study, with 30 withdrawn due to various reasons. At 12 weeks, 76% patients treated with SSB, 78% patients treated with 4LB, and 31% patients treated with usual care alone had completed ulcer healing. The hazard ratios for healing for 4LB and SSB relative to the control group were 3.14 (95% CI = 1.74-5.67) and 2.72 (95% CI = 1.53-4.86), respectively. The key findings indicated the significant effects of compression bandaging resulted in a higher proportion of complete ulcer healing; reduction in ulcer size, pain severity, and pain interference; and improvement in quality of life and lifestyle activity. Across the 12-week study period, the present study also highlighted the significant improvement of the psychosocial composite outcome among the three study groups. Furthermore, the reduction in pain severity and pain interference accounted for the major contribution to the total effect of the psychosocial composite outcome. Therefore, effective pain control and minimizing the effect of pain on daily life is essential in promoting ulcer healing. It is evident that the application of compression bandaging with either 4LB or SSB is feasible and more effective than the current usual care with no compression. This study add new knowledge to the psychosocial benefit of compression bandaging for venous ulcer patients living in the community; and support incorporating compression bandaging in the routine venous ulcer care. Further studies are therefore suggested to focus on the assessment of the cost-effectiveness of and the satisfaction and experience of both patients and nurses with compression bandaging using different high compression bandage systems. / The study was a randomized controlled trial. Those patients who participated in the experimental groups received compression bandaging with either the 4LB or SSB along with a local usual care. In contrast, the control group participants received usual care. A 12-week study intervention was given individually to the study participants. The research outcome of this study was the proportion of complete ulcer healing, ulcer size, pain severity, pain interference, disease-specific and generic health-related quality of life measures, and lifestyle activity. The instruments used include VeV MD stereophotogrammetry, Brief pain Inventory, The SF-12 Health Survey, Charing Cross Venous Ulcer Questionnaire, and the Frenchay Activity Index. Data analysis involved the use of descriptive statistics and inferential statistics such as survival analysis, one way analysis of variance (ANOVA), multivariate analysis variance (MANOVA), doubly multivariate analysis of variance (Doubly MANOVA), and Roy-Bargman stepdown analysis were used. / Venous ulcer is the most serious clinical consequence of chronic venous insufficiency. It is a chronic health problem that afflicts older people as well as health care professions. Its chronicity, together with its high recurrent rate, creates not only a big challenge to nurses' workload and health cost, but it also has a direct impact on patients' physiological and psychosocial well-being. Compression bandaging has been identified as the mainstream form of treatment for venous ulcer in previous literature, although this is not very well known by the nurses in Hong Kong. Previous studies have confirmed that the proportion of complete ulcer healing is improved with high compression as compared to no compression. However, a definite conclusion on the effectiveness of different high compression systems, such as the four-layer compression system (4LB) and short-stretch compression system (SSB), was not found. Most importantly the treatment impacts on proportion of complete ulcer healing, ulcer size, pain severity and pain interference, health-related quality of life, and lifestyle activities are essential influences on patients' participation in venous ulcer care and treatment choice. These limited data leave a gap in today's knowledge on venous ulcer management in relation to both patients and health care providers. Therefore, the aim of this study is to examine the effect of two compression bandage systems, the 4LB and SSB, in promoting ulcer healing in terms of the proportion of complete ulcer healing and ulcer size, as well as the psychosocial well-being including pain, heath-related quality of life, and lifestyle activity for older people in the community. / Wong, Kit Yee Irene. / "December 2007." / Adviser: Diana T. F. Lee. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4672. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 248-268). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Gerontology / Master / Master of Social Sciences

The ageing population is growing rapidly in Hong Kong. In addition, the distribution of the elderly concentrates to live in the old urban districts including Central and Western, Wan Chai, Eastern, Sham Shui Po, Kowloon City, Wong Tai Sin, Kwun Tong and Yau Tsim Mong. In order to provide care services for elderly people, the principle of “ageing of place” is adopted by the government aim to the elderly live in a familiar environment. In order to provide a suitable living environment for the elderly, the government has implemented a series of policies on housing, recreational facilities and social elderly services for the elderly who live in the old urban districts. In order to understand whether the elderly are satisfied with the services to be provided by the government, three districts including Central and Western district, Eastern district and Wan Chai district are picked up as target of study which are a high proportion of the elderly living in. Opinions are demanded from the elderly and the representatives of Owners’ Corporation who live in these districts in order to investigate the perception of existence living environment, the recognition of the financial incentive schemes, the most important facilities and elderly services for them in daily life, the satisfaction level of the recreational facilities and the social elderly centre and the importance of maintenance of relationship with neighbours in the old urban districts. The paper finally raised several recommendations for improvement of living environment and elderly services in the old urban districts. They are providing better facilities for the elderly, increasing amount of financial incentive providing more funding for the non-government organization, providing sufficient place for the social elderly centre, providing more recreational facilities and enhancing service delivery. With the better living environment and sufficient of elderly services, the elderly can maintain a healthy life in the old urban districts. / published_or_final_version / Housing Management / Master / Master of Housing Management

Aging is a universal problem that has to be recognized and formally addressed. The investigating of innovative opportunities and ideas in the building of a community that could cater the needs of elderly community is in immediate need. Planning for the aged, not just quantitatively, but qualitatively, is therefore on the top of the political agenda. Hong Kong is facing challenges resulted from an aging demographic population structure. Rapid rate of aging of the population implies addressing retirement needs is going to be a big challenge for government to tackle. Government needs to prepare and plan to provide sufficient service for the growing elderly population. The assessment of the current policies is in need now in order to formulate a strategic and comprehensive plan to allow aging in place. Aging in place requires policies and programs provided on the ground of comprehensive understanding of the aging processes and contexts. While existing programs tends to focus on physical aspect, it is important to evaluate aging within the context of neighborhood as an important place of aging. To break through from the current planning framework to provide for the aged, there is a need to rethink the possibility of employing community planning framework to better engage different stakeholders through local planning initiatives. This study attempts at brainstorming and suggesting possibility in amending existing planning and policies to cater for the changing demography. The interest of the study is to explore the role of public life in facilitating healthy aging. In addition, evaluate the role of neighborhood as important physical and social places which contributes to well being of older people. / published_or_final_version / Urban Planning and Design / Master / Master of Science in Urban Planning