University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)

In recognition of the inherently inflationary nature of retrospective reimbursement, the Reagan Administration enacted legislation that substantially changed Medicare's hospital reimbursement system. The Prospective Payment System (PPS) mandated paying hospitals a fixed payment, set in advance, based on the patient's diagnosis rather than retrospectively paying for all services delivered to a patient. Critics contend that PPS introduces incentives for hospitals to conserve resources during the hospital stay and to shift care to less costly settings, both potentially affecting quality of care to the elderly. The question addressed by this dissertation is whether there were changes in the discharge health status and post-hospital placement of Medicare beneficiaries as a result of the implementation of PPS. Using a quasi-experimental time-series PRE/POST design, data was collected from the medical records of 2,619 Medicare beneficiaries (1,258 in the PRE-PPS period; 1,361 in the POST-PPS period) hospitalized between 1981 and 1986. Two large (300+ beds) and two medium-sized (100-300 beds) hospitals, representative of hospitals in the Portland metropolitan area, served as data collection sites. Medical records were selected from five Diagnosis Related Groups (DRGs): three medical DRGs (stroke, heart failure, and pneumonia) and two surgical DRGs (hip replacement and major joint pinning). Analysis of the data show that overall length of stay declined from 11.3 days in the PRE-PPS period to 8.6 days in the POST-PPS period, a reduction of 2.7 days and significant at the p = $<$.001 level and a significant increase in Dependency between the PRE and POST periods for four of the five DRGs studies (Stroke, Pneumonia, Heart Failure, and Hip Replacement). Finally, an analysis of differences in post-hospital placements shows a significant increase in POST-PPS placements to home alone (p = $<$.05), home health (p =.01), and for hospital transfers (p = $<$.001). Though limited in its generalizability, the data presented in this dissertation support the contention that Medicare patients are leaving the hospital sooner, in more dependent states of health than before PPS, and that greater numbers of potentially high care patients are being discharged to home and to home health.

Indiana University-Purdue University Indianapolis (IUPUI) / The life expectancy of humans in today's era have increased to a very large extent due to the advancement of medical science and technology. The research in medical science has largely been focused towards developing methods and medicines to cure a patient after a diagnosis of an ailment. It is crucial to maintain the quality of life and health of the patient. It is of most importance to provide a healthy life to the elderly as this particular demographic is the most severely affected by health issues, which make them vulnerable to accidents, thus lowering their independence and quality of life. Due to the old age, most of the people become weak and inefficient in carrying their weight, this increases the probability of falling when moving around. This research of iterative nature focuses on developing a device which works as a preventive measure to reduce the damage due to a fall. The research critically evaluates the best approach for the design of the Pre-Fall detection system. In this work, we develop two wearable Pre-Fall detection system with reduced hardware and practical design. One which provides the capability of logging the data on an SD card in CSV format so that the data can be analyzed, and second, capability to connect to the Internet through Wifi. In this work, data from multiple accelerometers attached at different locations of the body are analyzed in Matlab to find the optimum number of sensors and the best suitable position on the body that gives the optimum result. In this work, a strict set of considerations are followed to develop a flexible, practical and robust prototype which can be augmented with different sensors without changing the fundamental design in order to further advance the research. The performance of the system to distinguish between fall and non-fall is improved by selecting and developing the most suitable way of calculating the body orientation. The different ways of calculating the orientation of the body are scrutinized and realized to compare the performance using the hardware. To reduce the number of false positives, the system considers the magnitude and the orientation to make a decision.

The point of concentration for this study was to estimate the extent to which health-promoting habits might predict medication-compliant practices among older adults. The purpose was to recognize potentially non-adhering persons, identify attitudes leading to healthy habits, and signal any practices contributing to non-compliant behaviors. Selected were patients who ranged in age from minimum 62, lived independently, self-administered medication regimes, had a chronic ailment that had persisted for at least 12 months, and regularly attended a geriatric clinic sited in the midwestern United States. A non-probability convenience sample (n = 100) was analyzed by a descriptive correlational approach to test self-proclaimed relations between health habits and compliant practices. The instrument used to measure health habits that would enrich life was the Health-Promoting Lifestyle Profile II created and promoted by Walker, Sechrist, and Pender (1995). The tool used to decide levels of medication adherence was a compliance profile created specifically for this study. Demographic information was collected for age, race, marital status, gender, and education. Descriptive statistics were calculated for each variable and Pearson product-moment correlation coefficient was utilized to decide what, if any, real and measurable interrelationships exist between the health-promoting habits and medication-compliant practices among an older population. The t-test was utilized in determining differences in both healthpromoting lifestyle habits and medication-compliant practices between older males and females. The significance level used to evaluate every theory was p < .05. Discovery gave no statistically critical relationship between overall health-promoting lifestyle habits and medication-compliant practices among the constituents of an older populace. Findings gave no significant variance between men and women in either lifestyle habits or compliance practices as a whole, but the HPLP II categories of Interpersonal Relations and Nutrition did mirror a significant difference between genders. / Department of Physiology and Health Science

No description available.

This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary teams are the best practice in the care of older adults, who require both medical and social services. However, maintaining functional collaborative teams has been an ever-present challenge to health and social care organizations. Research has found that institutional support is critical for teams to benefit patients and organizations alike. This study examined the role of institutional context in supporting interdisciplinary teams (IDT) in the care of older adults through interviews of the management and staff of the Program for All-Inclusive Care of the Elderly (PACE) in six states. PACE organizations must commit to an interdisciplinary model of care consisting of 11 different disciplines from across the professional spectrum. The research question posed for this study was: What elements of institutional context support the use of interdisciplinary teams in the care of older adults? Due to the standardized team structure used, PACE was selected as the model to see how institutions at macro and micro levels support the work done by PACE teams and possibly highlight where support is still lacking. A case study approach drawing upon qualitative methods was used to examine policy-regulative, cultural-cognitive, normative, relational, and procedural elements of institutional context and the extent to which they support collaborative teamwork. Thirty-two interviews were conducted with administrators and team members from seven PACE programs across the country. For these PACE programs, five elements and 14 categories of support were identified by the interviewees. Policy and regulatory elements constrain and systematize behavior. PACE IDT experience these constraints and systems through regulatory body practices, resource allocation, and quality measurement. Cultural-cognitive elements mediate between an IDT's external environmrder to make sense of what is happening. PACE IDTs create meaning through their interactions with their external environments through interdependence, demographic characteristics, and organizational structure. Normative findings constrain behavior and confer the rights and duties of IDT members, which arise from organizational mission and values, leadership, and professient and the response of the IDT in oonal boundaries. Relational elements emphasize relationships among IDT members and team interaction with the organization's environment. Social constructs within the team affect role definition and communication, which support IDT practice. Procedural support standardizes practices to maintain highly functional teams. In order to support IDT practice, PACE organizations highlighted recruitment and retention, time and space, and training and education as the primary ways to support IDTs. These categories illustrate the complexity of supporting teams and actualizing teamwork in practice. These findings suggest that PACE is succeeding in supporting the IDT model and provides lessons for other organizations that wish to do the same.

A study entitled `Phenomenological study of ageing amongst the older persons in Zambia' was undertaken with the purpose of gaining an understanding of the ageing phenomenon within the Zambian context and provide frameworks that could be used by policy-makers and health professionals to formulate guidelines or interventions relevant to the lived experiences of older persons and the meaning attached to ageing or being old, and consequently maintain or improve the quality of life of older persons of Zambia. The objectives of the study were to describe (1) the lived experiences of the older persons of Zambia, and (2) the meaning they attached to ageing or being old within the Zambian context. A transcendental phenomenological design within the qualitative naturalistic approach was used to guide the research process and to assist the researcher to reach the purpose and objectives of the study. Focus group and in-depth individual interviews were conducted to generate data from twenty-seven (27) informants. Fifteen (15) informants participated in the focus group interviews and twelve (12) in in-depth individual interviews. In total, 24 in-depth individual interviews were conducted in term of two interviews per informants, and two focus group interviews. Data collection covered a period of three months. Coliazzi (1978) and Giorgi (1985) techniques for qualitative data analysis were used and verbatim excerpts form the transcribed interviews were used to support the themes that emerged from data and to provide a richer picture of the situation. Three frameworks derived from the findings of this study: (1) framework of the lived experiences of older persons of Zambia, (2) framework of the meaning of ageing or being old and (3) framework for understanding ageing within the Zambian context. The researcher believed that these frameworks would make a meaningful contribution toward the understanding and the development of policies and interventions that would assist in enhancing or maintaining the quality of life of older people of Zambia. The main findings of the results of this study indicated three most significant dimensions of the lived experiences of the older persons (health, socio-economic and psychosocial) that need to be taken into account when planning for any programs or interventions aimed at maintaining or improving the quality of life of older persons of Zambia. These interventions and programs should also address the negative feelings or meanings attached to the above experiences. The main findings of the results of this study also showed that the meaning of being old or ageing in Zambia does not depend on the health, socio-economic and psychosocial living experiences of the older person but it depends largely on the inner values of the older persons, such as spiritual, emotional and cultural beliefs. This means that maintaining or improving the quality of life of older persons in Zambia would require comprehensive programs or interventions that should take into account the health, socio-economic, psychosocial, spiritual, emotional and cultural needs of the older people. / Health Studies / D. Litt. et Phil. (Health Studies)

A study entitled `Phenomenological study of ageing amongst the older persons in Zambia' was undertaken with the purpose of gaining an understanding of the ageing phenomenon within the Zambian context and provide frameworks that could be used by policy-makers and health professionals to formulate guidelines or interventions relevant to the lived experiences of older persons and the meaning attached to ageing or being old, and consequently maintain or improve the quality of life of older persons of Zambia. The objectives of the study were to describe (1) the lived experiences of the older persons of Zambia, and (2) the meaning they attached to ageing or being old within the Zambian context. A transcendental phenomenological design within the qualitative naturalistic approach was used to guide the research process and to assist the researcher to reach the purpose and objectives of the study. Focus group and in-depth individual interviews were conducted to generate data from twenty-seven (27) informants. Fifteen (15) informants participated in the focus group interviews and twelve (12) in in-depth individual interviews. In total, 24 in-depth individual interviews were conducted in term of two interviews per informants, and two focus group interviews. Data collection covered a period of three months. Coliazzi (1978) and Giorgi (1985) techniques for qualitative data analysis were used and verbatim excerpts form the transcribed interviews were used to support the themes that emerged from data and to provide a richer picture of the situation. Three frameworks derived from the findings of this study: (1) framework of the lived experiences of older persons of Zambia, (2) framework of the meaning of ageing or being old and (3) framework for understanding ageing within the Zambian context. The researcher believed that these frameworks would make a meaningful contribution toward the understanding and the development of policies and interventions that would assist in enhancing or maintaining the quality of life of older people of Zambia. The main findings of the results of this study indicated three most significant dimensions of the lived experiences of the older persons (health, socio-economic and psychosocial) that need to be taken into account when planning for any programs or interventions aimed at maintaining or improving the quality of life of older persons of Zambia. These interventions and programs should also address the negative feelings or meanings attached to the above experiences. The main findings of the results of this study also showed that the meaning of being old or ageing in Zambia does not depend on the health, socio-economic and psychosocial living experiences of the older person but it depends largely on the inner values of the older persons, such as spiritual, emotional and cultural beliefs. This means that maintaining or improving the quality of life of older persons in Zambia would require comprehensive programs or interventions that should take into account the health, socio-economic, psychosocial, spiritual, emotional and cultural needs of the older people. / Health Studies / D. Litt. et Phil. (Health Studies)