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published_or_final_version / Social Work and Social Administration / Master / Master of Social Sciences

Background Population ageing is a major public health concern globally as older people with disabilities or suffering from chronic diseases are expected to live longer. The demographic shift in Hong Kong is particularly pronounced and increasing resources on elderly healthcare will add substantially to the government’s financial burden. Research has shown the importance of better understanding the healthcare challenges posed by an ageing population in order to promote informed choice, align policy with need, and deliver effective, efficient and sustainable health services. Objectives This dissertation explores the circumstances and factors that influence a household’s decision to place an elderly person in a care home. It considers the decision-making process in the contexts of the interactions and negotiations that take place within and between household members; a key objective is to examine the extent to which the elderly are themselves participants in this decision-making process. Description of the sample The researcher interviewed a total of nine Hong Kong Chinese residents from two private nursing homes. They were between 63 and 92 years of age at the time of the interview and had been residing in a care home for an average of 2.5 years. Methods This is a qualitative research study in which primary data were gathered through face-to-face, semi-structured interviews. The research focused on subjects with high-functional status. An inductive approach to thematic analysis was adopted. Results The majority of the subjects had been admitted to hospital as a result of an acute health incident. They were subsequently transferred to the care home directly from the hospital. The subjects drew a direct link between the health incident and their placement in the care home. It became apparent in the course of the interviews, however, that other contextual factors had played an important role in the decision-making process, determining how the subjects themselves retrospectively rationalized their relocations. Over the course of data analysis, family relations, assumed gender roles, perceptions of self-identity, and practical constraints were identified as themes that impacted upon the decision-making process in relation to placement decision within a household setting. The findings suggested the degree to which the broader context of the subjects’ past life experiences permeated the decision-making process. It also underscored the importance of the roles and responsibilities assumed by the elderly. Conclusion By examining how the elderly themselves discuss their experiences and justify their choices, the study sheds light on the cultural assumptions, conventions and traditions that shape how subjects perceive norms of behaviour, expectations and responsibilities. Future studies might extend the scope of research further to incorporate the views of household members, who are also potential caregivers. Given that the subjects were admitted to care homes after an acute health episode, which resulted in hospitalization, it would also be worth exploring alternative options in relation to the discharge arrangements for elderly persons. This study would also benefit from further research into the comprehensive long-term care system in Hong Kong, including the provision of services, long-term housing, healthcare choices, and the financing of long-term care. / published_or_final_version / Public Health / Master / Master of Public Health

This study investigated the effects of an intervention designed to reduce the wandering of an 80 year old female resident of a long term care facility. A behavioral analysis of natural contingencies which maintained behaviors incompatible with wandering was conducted and the data from this analysis used to develop an intervention. The intervention simulated a dining room table and coffee break which naturally maintained sitting. An ABAC design revealed that this intervention was functionally related to a reduction in the proportion of a twenty minute interval spent wandering. The discussion focuses on possible causes of wandering and future directions for establishing a behavioral technology to control wandering.

The purpose of this manual is to provide information for caregivers to enhance the understanding of the confused, institutionalized geriatric resident, and to identify, describe, and develop skill areas for implementing an effective plan of caregiver/resident interaction.The intended learner population for use of the manual is the institutional caregiver providing direct, daily care for the older facility resident. The manual is designed for either individual or small group training.ContentThe training manual is divided into five instructional units. Unit 1, "A Profile of the Confused, Geriatric Resident," provides a sketch of the physical and emotional considerations so much a part of the institutionalized geriatric population. Unit 2, "The Role of Attitudes in Caregiving for the Institutionalized Elderly," explores how attitudes toward the elderly resident are developed, and explains the use of stereotyping in the development of attitudes and through the care provided by the worker.The third unit, "Abandoning Old Roles, Assuming New Roles," focuses upon the various social roles forfeited or lost as a consequence of institutionalization of the older adult. In addition, functional and dysfunctional roles often assumed by the long-term care resident are presented as well. The final narrative unit, "Communication: Its Role and Practice in the Long-term Care Facility," outlines the function of communication skills in the resident/caregiver interaction and discusses ways of developing various communication techniques to support the therapeutic role of the institutional caregiver.The closing unit provides professional growth references for institutional caregivers. Materials include annotated bibliographical references, simulation and gaming materials, films, and videotapes.Design and ApplicationAs mentioned, the material in the manual is designed for either group or individual use. Each learner unit is prefaced with intended learner objectives. The various manual units conclude with unit material summaries and unit glossary. In addition, each narrative unit contains exercises or discussion guides to further promote and reinforce intended objectives for individual units.Those learners desiring additional resources for growth and development may utilize the annotated bibliographic and information unit, arranged by unit topics, to further individual pursuits.

The purpose of this study is to identify how elderly subjects perceive their transition from home to institutional living. The study was conducted with a convenience sample of five subjects, 6-13 months following their admission to a unit which provides care for dependent elderly clients. The methodology introduced by Glaser and Strauss (1967), for the discovery of grounded theory, was used. A conceptualization of the transition to institutional living as five sequential and inter-related phases is introduced. These phases are: anticipation, reaction, interpretation, negotiation and integration. In the first two phases subjects' responses to challenges to development, introduced by the transition, tend to predominate. The third and fourth phases are characterized by subjects' working through these challenges to achieve mastery within the new situation. The final phase is manifest in each individual's attributing personal meaning to the transition within the context of his or her total life. Mastery within the new situation is achieved through problem solving approaches to increasing dependency, acceptance of personal responsibility for adjustment, and the perception of institutionalization as but one incident in each individual's life history. This transition was found to differ from those described amongst younger populations. It is proposed that this difference occurs as a function of developmental stage, frailty, and the environmental situation. The findings of this study a) emphasize the holistic nature and complexity of nursing practice with frail elderly clients, b) support the use of concepts from developmental theory as a basis for nursing practice with elderly clients, and c) suggest ways in which nursing education and research may contribute to the development of nursing care for elderly clients. / Applied Science, Faculty of / Nursing, School of / Graduate

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Public Health / Master / Master of Public Health

The study problem was that sane individuals found institutionalizing a family member stressful, and family members required assistance in coping. The purposes of the study were to examine threat appraisal, degree of threat, and coping responses in a sample of family members of newly institutionalized elderly. The study was a descriptive correlational investigation which utilized Lazarus' theory of stress and coping as the theoretical framework.There were 21 questionnaires received from a convenience sample obtained through four nursing hens in the vicinity of a small city in Indiana. Five major categories of threat were identified. A high degree of threat was associated with each category. Both problem-focused coping and emotion-focused coping were utilized.Pearson product-mcinent correlation was used to determine that no significant relationship existed between coping responses utilized and degree of threat. ANOVA was used to reveal that there were no significant differences between coping responses utilized and demographic variables. Each scale was determined to be reliable by usage of Cronbach's alpha. / School of Nursing