published_or_final_version / Public Administration / Master / Master of Public Administration

Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.

Illich, a critic of the medical profession in industrial societies, researched the "damage done" by the medical establishment on three levels. This study presents an application of Illich's three-level theory of iatrogenesis to a sample of elderly people in old-age homes in and around Pretoria. Fifty in-depth interviews were conducted with old-age home residents. In the focus on clinical iatrogenesis, the aspect of defenceless patients was investigated. With regard to social iatrogenesis, focus was on the interpretation of attitudes revealing an increased medical dependency. Cultural iatrogenesis, which involves the influence of values and norms on thinking patterns, is investigated in terms of the impact of institutionalisation on the autonomy, independence and personal responsibility of residents. Illich's solution to the problem of medicalisation is to be found in the de-bureaucratisation and de-industrialisation of society. Based on the assumptions of critical theory, the emancipation of the individual is suggested as a basis of Illich's proposed structural societal changes / M.A. (Sociology)

No description available.

This study examined the outcomes that clients are experiencing with the Adult Protective Services System in the County of San Bernardino. The study was exploratory and discriptive. Data were extracted from closed case records from the period of September 1, 1999 until August 31, 2000.

No description available.

Challenging a long-held attachment to the medical model, this research develops a cultural model placing local governments at the center of policy making and refocusing policy attention on mobility, housing, the built environment and services. To examine the phenomenon of age friendly policy adoption by cities and the magnitude of adoption, a 21-question web-based survey was administered to a sample of 1,050 cities from the U.S. Census having a population over 10,000 and having at least 14% of their population aged 65 years and over. The goal of the questionnaire was to help identify what kind of policy objectives cities establish to facilitate the opportunity for older adults to live healthy and independent lives in their communities as they age. Multiple linear and ordinal regression models examined the likelihood of policy action by cities and provide evidence as to why some cities support more age friendly policy actions than others. Evidence illustrates theoretical advancement providing support for a cultural model of aging. The cultural model includes multiple factors including bureaucratic responsiveness reflected in the management values of the administration. Findings show variation in the integration of a cultural awareness of aging in the municipality's needs assessment, strategic goals, citizen engagement strategies, and budgetary principles. Cities with a cultural awareness of aging are more likely to adopt age friendly policies. Findings also provide support for the argument that the public administrator is not the driving sole factor in decision making. A shared spaced with mobilized citizen need of individuals 65 and over is identified.

Indiana University-Purdue University Indianapolis (IUPUI) / Social support has been shown to positively impact various aspects of health across the lifespan, including sexual health and well-being. While past research on sexual well-being has tended to focus on the earlier stages of the life course, notably adolescence and young adulthood, this is a largely ignored area of research past the reproductive stage of life. Current research finds that while social support, from partners, family, and friends alike, has generally positive influences on health in mid to late adulthood, these outcomes are varied in regards to sexual well-being. This thesis aims to (1) assess the role of friend support in the sexual well-being of older adults and (2) to explore if physical and mental health are significant mediators of this relationship, using data from Wave II of the National Social Life, Health, and Aging Project (NSHAP). This study found that sixty two percent of older adults are not having sex as much as they would like and 61% feel that their sex life is lacking in quality. Increased feelings of openness with friends was associated with satisfaction with sexual frequency (p=.055). However, a significant association could not be established between satisfaction with quality of sex life and friend support. In addition, physical and mental health status were not found to be significant mediators.

In South Africa prior to 1994, community-based care and support services were established for whites only. The majority of older African (black) persons received informal support from their adult children and relatives. This has waned over the years due to the social and economic changes that have put into doubt the continued viability of such support. The Older Persons Act of 2006 requires social workers to establish community-based care and support services for older persons. Hence, the study was conducted to understand the factors that influence social workers in establishing CBCSS for older persons in Bloemfontein in the Free State Province. A qualitative research method was undertaken to accomplish the goal of the study. Purposive and snowball sampling techniques were used to identify suitable participants. Face-to-face semi-structured interviews were conducted with fifteen social workers who provide services to older persons. The data was analysed through Tesch’s (cited by Creswell, 2009:186) eight steps of qualitative analysis and data verification was conducted following Guba’s (Kreftling, 1991) model. The major finding is that there is a need for social workers to specialise in older persons programmes (gerontology). For the programmes to be a success, it is recommended that the Department of Social Development (DSD) strive to retain social workers who are knowledgeable and experienced in older persons programmes. / Social Work / M.A. (Social Science)

published_or_final_version / Social Work / Master / Master of Social Sciences