published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This dissertation looks at old age homes in British Columbia between 1920 and 1960. It describes and explains how changes in institutional care for aging men and women intersected with professional ideals, welfare state economics and political imperatives. It also considers how broader developments altered the physical and cultural world of the institution and the strategies employed by the elderly. / Facilities for the elderly changed significantly during the period. In 1920 provision of residential care for older British Columbians was extremely limited, and existing institutions operated under a poorhouse model, providing only custodial care. By 1960 a sizeable network of provincially regulated facilities had developed. Medical professionals urged that these establishments be medical facilities and that the elderly receive compassionate, therapeutic care. / However, circumstances inside these facilities limited change. While some institutions were run along medical lines, new policy initiatives were modified by strong historical links with older systems of custodial care and punitive poorhouse ethics.

The purpose of the study was to validate the use of the Geriatric Functional Rating Scale (GFRS) in assessing cognitively impaired individuals 65 years of age and older to determine the need for institutionalization. The population of interest consisted of individuals 65 years of age and older exhibiting cognitive impairment and residing in Delaware County, Indiana. A nonrandomized two-group experimental design was utilized for the study. Eighty subjects were selected from two subpopulations consisting of 40 institutionalized and 40 noninstitutionalized elderly.Two geriatric assessment tools were used for the study, the Mental Status Questionnaire (MSQ) and the Geriatric Functional Rating Scale (GFRS). The hypothesis for the study stated that the mean GFRS score of the noninstitutionalized subjects, the control group, would be significantly greater than the mean score of the institutionalized subjects, the experimental group.The MSQ scores as well as the means and standard deviations for the seven subscales of the GFRS were reported for the two groups. A one-tailed t-test was used to test the hypothesis. A decision with regard to the hypothesis was made at the .05 level.Findings of the study included the following:1. The subjects ranged in age from 65 to 92 years, were 90 percent female, and predominantly Protestant, 88 percent.2. The MSQ scores for the combined groups ranged from minimal cognitive impairment, 71 percent, to severe cognitive impairment, four percent.3. The total mean score on the GFRS for the institutionalized group was 6.8 indicating a need for institutionalization.4. The total score on the GFRS of the noninstitutionalized was over 10 times higher at 70.7.5. The noninstitutionalized group scored significantly higher in the GFRS (p<.00) than the institutionalized counterparts.In conclusion, the research supports the use of the Geriatric Functional Rating Scale in assessing the need for institutionalization in cognitively impaired individuals, 65 years of age and older in Delaware County, Indiana. / Department of Educational Administration and Supervision

Made available in DSpace on 2014-08-13T14:50:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-11-29Bitstream added on 2014-08-13T18:00:57Z : No. of bitstreams: 1 000750035.pdf: 2030515 bytes, checksum: 03239f5573eff2a95bc9a82c9eec449d (MD5) / O aumento recente da incidência e gravidade de Staphylococcus aureus tem suscitado diversos estudos abordando sua epidemiologia em instituições fechadas. Isolados de S. aureus resistentes à meticilina (methicillin resistant S. aureus, MRSA) são agentes comuns de infecção em hospitais. Nos últimos anos, a atenção dos epidemiologistas e clínicos tem se voltado aos MRSA de origem comunitária, associados a infecções graves de pele e trato respiratório. Nesse contexto, as Casas de repouso representam espaços de especial interesse, já que são instituições intermediárias entre a comunidade e os serviços de saúde. Não há dados sobre prevalência de S. aureus e MRSA em Casas de repouso no Brasil, um país onde somente 0,8% da população idosa são institucionalizadas. O presente estudo teve delineamento transversal e objetivou identificar a prevalência e fatores de risco para colonização por S. aureus como um todo e MRSA em particular. Foram incluídos 300 idosos vivendo em Casas de repouso no município de Bauru (SP). A colonização foi analisada através de coleta de swabs nasais dos sujeitos da pesquisa. Estes foram cultivados, e nos casos de isolamento de S. aureus, foi realizada a caracterização molecular da resistência à meticilina. Adicionalmente, os isolados de MRSA foram submetidos à genotipagem por Pulsed-Field Gel Electrophoresis (PFGE). Para análises de fatores de risco, foram levantados os prontuários dos sujeitos de pesquisa. Dados demográficos, internações, procedimentos e uso de antimicrobianos foram identificados. Análises univariadas e multivariadas (regressão logística) foram aplicadas. As prevalências identificadas para S. aureus e MRSA foram 17,7% e 3,7%, respectivamente. A idade avançada e a internação recente em hospitais foram preditores independentes para colonização por S. aureus como um todo. Os fatores associados à colonização por MRSA foram à residência em instituições de ... / The recent increase in the incidence and severity of Staphylococcus aureus gave rise to many studies on its epidemiology in closed institutions. Isolates of methicillin-resistant Staphylococcus aureus (MRSA) are usual agents of infection in hospitals. In recent years, the attention of epidemiologists and clinicians has turned to MRSA of community origin, associated with severe infections of skin and respiratory tract. In this context, nursing homes represent areas of special interest, since they are intermediary institutions between the community and health services. No data on the prevalence of S. aureus and MRSA in nursing homes in Brazil, a country where only 0.8% of the elderly population is institutionalized. This cross-sectional study aimed to identify the prevalence and risk factors for colonization by S. aureus as a whole and MRSA in particular. We enrolled 300 elderly living in nursing homes in the city of Bauru, São Paulo State, Brazil. Colonization was analyzed by collecting nasal swabs of research subjects. Whenever S. aureus was isolated, we performed molecular characterization of methicillin resistance. Additionally, MRSA isolates underwent genotyping by pulsed-field gel electrophoresis (PFGE). For analysis of risk factors, we reviewed the charts of research subjects. Demographics, hospitalizations, procedures and uses of antimicrobials were identified. Univariate and multivariate (logistic regression) were applied. The prevalence identified for S. aureus and MRSA were 17.7% and 3.7%, respectively. Old age and recent hospitalization in hospitals were independent predictors of colonization with S. aureus as a whole, while small or medium-sized facilities and recent hospital admission were associated with carriage of MRSA. In the molecular analysis of 11 MRSA isolates, six were identified as carriers of chromosome cassette SCCmec type II (typically hospital), and two as carriers of SCCmec IV (associated with the community). ...

Background: International research has clearly indicated that the world’s population is ageing: almost all countries in the world are experiencing a significant growth in the proportion of older persons in their population. This is also true for developing countries such as South Africa that are beginning to show signs and symptoms of an ageing population. Among Southern African Development Communities (SADC), South Africa has the highest number of ‘senior citizens’. Population reports indicate that the population of old people rose from paltry 2.8 million in 1996 to more than 4 million in 2011 and this is expected to skyrocket to seven million by 2030. In spite of the increasing number of senior citizens in socio-structural landscapes in South Africa, there is still lack of adequate, workable and effective policy frameworks for the wellbeing of the elderly. There is also paucity of psychological data of the elderly, especially along racial divides to determine whether the after-effects of apartheid still hold sway or not in post-apartheid South Africa. This study was conceived to investigate the psychological well-being of the elderly in Buffalo City, Eastern Cape, South Africa between two racial-ethnic elderly groups. The specific objectives of the study were to explore the relationship between the socio-demographic characteristics and psychological well-being of the black (Xhosa) and white (English) elderly in Buffalo City, South Africa and second, to validate the relationship between psychological well-being and physical activity, loneliness, spirituality/religiosity as well as ageism among the sampled population. The set-point theory, selective optimisation compensation theory (SOCT) as well as the continuity theory were employed to guide the conduct of the study. Method: Psychological measuring instruments were deployed to collect data for the study from a total of 301 elderly respondents in retirement and private individual homes (191 isiXhosa and 110 English speaking elderly). Both simple random sampling (SRS) and purposive sampling procedures were used to select the respondents. The measuring instruments included the Ryff Scales of Psychological Well-being (RSPWB), Physical Activity Scale for the Elderly (PASE), Assessment of Spiritual and Religious Sentiments Scale (ASPIRES), University of California at Los Angeles (UCLA) Loneliness Scale, the Palmore Ageism Survey scale and a biographical questionnaire. Data was analysed using MANOVA, One-way variance analysis and regression coefficient. The racial differences logically influenced the selection of the respondents for the study. Results: The study revealed a significant statistical relationship between physical activity (PA) and psychological well-being of the elderly, regardless of the sociodemographic variables. PA showed a significant relationship with psychological wellbeing of the elderly. The study also discovered that loneliness correlates significantly with all four of the psychological well-being scales. It shows that the higher the levels of loneliness experienced by the elderly, socio-demographic variables controlled, the lower the levels of psychological well-being in terms of autonomy, environmental mastery, purpose in life, and self-acceptance. However, with the exception of the relationship between loneliness and purpose in life, ethnic affiliation moderates autonomy, environmental mastery and self-acceptance. English elderly constantly experienced higher levels of autonomy than the isiXhosa elderly do with an increase in loneliness. The study also found a positive relationship between ageism and psychological well- being. However, with low levels of ageism, the English elderly, in comparison with the isiXhosa elderly, is likely to show higher levels of autonomy. In addition, a significant statistical relationship between ageism and environmental mastery and purpose in life was found among the isiXhosa elderly. Although, with an increase in ageism, there is a slight increase in autonomy in both groups, the English elderly throughout showed higher levels of autonomy than the isiXhosa elderly showed. The study found a positive relationship between religiosity/spirituality and psychological well-being of the elderly. However, race could moderate the relationship between prayer fulfillment and psychological well-being at all four levels (autonomy, environmental mastery, purpose in life, and self-acceptance). With an increase in prayer fulfillment, the autonomy of the English elderly increases fairly quickly, while the autonomy of the isiXhosa elderly decreases slightly. Comparatively, the study found that isiXhosa elderly reported lower levels of psychological well-being than the English elderly. Conclusion/Recommendation: The study concludes that there is the need to develop a solid national data bases on needs and use of services, and process of ageing in order to access research data to assist planning, dissemination, delivery and evaluation of effective service delivery for the elderly population in South Africa, especially along racial divides.

Made available in DSpace on 2014-08-13T14:50:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-26Bitstream added on 2014-08-13T17:59:54Z : No. of bitstreams: 1 000769602.pdf: 885305 bytes, checksum: 57c057d257078b94be3ceeef4048a3fc (MD5) / O envelhecimento da população tem se tornando um dos maiores desafios das últimas décadas, principalmente no que diz respeito à saúde pública, em países em desenvolvimento, como o Brasil. Objetivou se avaliar a qualidade de vida, saúde mental, autonomia funcional, risco de quedas de idosos que frequentam as Unidades Saúde da Família na cidade de Nova Campina. Trata-se de um estudo transversal descritivo, no qual foram aplicados instrumentos de avaliação geriátrica, validados para a população idosa, em 250 indivíduos cadastrados nos serviços de saúde do município. A análise revelou que as mulheres foram a maioria e com maior fragilidade. Mesmo os idosos referindo uma ou mais doenças consideram seu estado de saúde bom. O impedimento físico não alterou suas atividades básicas da vida diária, mas houve interferência significativa nas atividades instrumentais. A saúde mental apresentou-se preservada, o escore diminuído deveu-se ao fato da baixa escolaridade, não caracterizando distúrbio. Sentem-se felizes com a vida que vivem. Sinalizo que foi fator protetor para saúde mental, morar com algum familiar e viver em sua própria casa. Em relação marcha e equilíbrio observou-se que os idosos conseguem se movimentar livremente, chamando atenção para as mulheres que apresentaram maior lentidão na execução dos testes, em especial Time Up and Go, não apresentando riscos acentuados para quedas. A maioria referiu ter sofrido queda no ultimo ano e 14,94% sofreu fratura, em especial as mulheres. Os dados analisados possibilitaram identificar a condição real de saúde desses indivíduos inseridos na comunidade. Chama atenção para a importância de se implantar políticas municipais que garanta o acesso aos serviços de saúde, bem como ações de cuidados integrais, de acordo com as demandas de cada indivíduo, nas suas necessidades comprometidas. Atenção especial deve se dar ... / The aging of the population is becoming one of the biggest challenges in decades, particularly with regard to public health in developing countries like Brazil. Aimed to evaluate the quality of life, mental health, functional autonomy , risk of falls in patients attending Family Health Units in the City of New Campina. This is a descriptive cross-sectional study in which geriatric assessment instruments validated for the elderly population , in 250 enrolled in health services in the municipality individuals were applied. The analysis revealed that women were the majority and more fragile. Even the elderly referring to one or more diseases consider their health good. The physical impairment did not alter their basic activities of daily life, but there was significant interference in instrumental activities. Mental health was preserved, the score decreased was due to the fact of low education level, featuring disorder. Are happy with the life you live. I signal that was a protective factor for mental health, living with a family and live in your own home. In relation gait and balance it was observed that the elderly can move freely, calling attention to the women who had greater slowdown in the execution of tests, in particular Time Up and Go, showing no pronounced risks for falls. The majority reported having been dropped in the past year and 14.94 % suffered fractures, particularly women. The data analyzed possible to identify the actual health status of these individuals within the community. Calls attention to the importance of implementing municipal policies that ensure access to health services as well as comprehensive care actions, according to the demands of each individual in their needs compromised. Special attention should be given to professional training, on the topic aging and quality of life of persons assisted, especially the elderly. Also draws attention to the trainers of health bodies to this issue of elder ...

The purpose of this study was to determine if there is a difference in functional communication skills between elderly persons in nursing homes and those living independently in the community. Thirty non-institutionalized elderly subjects were given the Western Aphasia Battery (WAB) screening tool. These scores were compared to WAB screening scores obtained from 20 institutionalized subjects. The difference between these scores was statistically significant. The institutionalized subjects' scores were also correlated with a Facilitators Evaluation of Communication Skills (FECS) inventory. Results showed a moderate correlation between the institutionalized subjects' WAB screening score and their FECS rating. The benefits of a screening tool for elderly populations are discussed.

Using a pre- and post-test design with both experimental and control groups, the research was conducted to see if life review improved the independence, depression, and integrated functioning of the institutionalized elderly. The elderly on the long term care unit of an acute care hospital waiting to be placed in a long term care facility were studied using a pre- and post-test design. Patients who were not depressed and could communicate in English were included in the study. They were randomly assigned to the experimental and control groups when possible. Patients in the experimental groups attended eight life review sessions over a four week period while the control groups carried on with the usual activities on the unit. Three scales, the Geriatric Depression Scale, Activities of Daily Living Evaluation Form, and the Geriatric Rating Scale were administered before the four week period and after. Data was also collected during the sessions on group process using the Group Process Observational Checklist on the experimental groups. Demographic data was collected on all the patients in the study. It was found that the experimental group did become more independent, integrated and less depressed. This study indicated that life review is beneficial for the institutionalized elderly but, it could not show exactly what variables in the life review process contributed to these positive results. Replication studies are needed to validate these findings. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

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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