Older people can be defined in different ways depending on the country’s social policies and also their health status. The health interventions overlook the vulnerability of older people regarding their individual health needs and their general susceptibility to chronic illnesses. Increasing economic disparities between races and inequalities in access to health services despite a large expansion in government social grants is another growing challenge. The major socio-economic changes has also contributed and enhanced the health challenges of older people in rural areas. This study aims to investigate the health perceptions and experiences of older people in rural areas and explore the factors that influence the quality of health of older people in South Africa. The study relied on focus group interviews (FGIs) and in-depth interviews (IDIs) to acquire an in-depth assessment and overall understanding of the life course and health perceptions of older people. Results reveal that even though health has evolved in South Africa over time, more challenges continue to affect the health of older people in rural areas where there are constant issues of low socio-economic status, poverty, migration and poor education attainment. The findings also suggest that, under the new political power there has been a change in the management of health care systems. Older people in KwaDumisa also face challenges with access to health care facilities.

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

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.

I analyzed the 2004 and 2006 Health and Retirement Study data to test structural equation models of the quality of life (QOL) construct. The participants (N = 1352) were non-institutionalized individuals aged 42 and older (M = 65.70, SD = 10.88), with an average education of 12.73 years (SD = 2.96) and of varied ethnicities. The results indicated that physical functioning, affective experience, life satisfaction and social support could serve as indicators for a second order QOL factor. Furthermore, the developed QOL model explained 96% of the variance of the CASP-19 (Control, Autonomy, Self-realization and Pleasure), a QOL measure that reflects fulfillment of psychological needs. The results also indicated that Depression and Life Satisfaction are related through reciprocal causation and that Physical Functioning is more likely to cause a change in Depression than the reverse. The results suggest that QOL is a complex, multidimensional concept that should be studied at different levels of analysis.

Differences in Mexican American ethnicity, family and friend social support, and importance of diabetes self-management as related to diabetes management in the older adult population were evaluated with the University of Michigan Health and Retirement Study (HRS) 2003 Diabetes Study. Comparisons were made between Mexican Americans with Type II diabetes and similar non-Hispanic Caucasian and African American individuals with Type II diabetes. Neither family/friend social support nor importance of diabetes self-management were significant predictors of HbA1c levels. Results did not support the idea that perception of receiving support from family/friends or placing importance on diabetes self-management covaried with lower HbAlc level (family/friend: beta = -.13, t = -1.47, p = .143; self management: beta = .08, t = .55, p = .584).

This research project aims to clarify the factors that impact successful aging in Assisted Living facilities (ALFs) in Denton County, Texas. We hypothesize that social disengagement decreases physical and mental components of quality of life. This exploratory research project employed standardized questionnaires to assess residents in the following domains; HRQOL, social engagement status, level of cognition, depression, and the level of functioning. This study collected data from 75 participants living in five ALFs. The average of Physical Component Scale (PCS) and Mental Component Scale (MCS) was 35.33, and 53.62 respectively. None of the participants had five or more social contacts out of facilities, and two-third of them had two or less social contacts. On average, those participants who were more socially engaged had higher score of MCS compared with disengaged counterparts. The level of physical function significantly affects social engagement, when people with more disabilities are more likely to be socially disengaged. Social engagement and depression significantly impact MCS, when depression is a mediating factor between social engagement and mental component of quality of life. Considering the expansion in aging population in the United States within the next three decades, the demand for high quality long-term care will skyrocket consequently. This study reveals that external social engagement can sustain HRQOL of residents in assisted living facilities.

CONCLUSION: A multi-faceted hand hygiene intervention with pocket-sized containers of alcohol-based hand rub was effective in increasing hand rubbing compliance and reducing incidence of total infections requiring hospitalization in elderly LTCFs. Its effect on outbreaks still needs further investigations. The questionnaire developed in this study may be a simple and effective method to assess the attitude and compliance change of the HCWs after implementing a hand hygiene programme. / DESIGN: Clustered randomized controlled trial / INTERVENTIONS: After a 3-month run-in period, we randomized three LTCFs to the treatment and three to the control group. The treatment group received pocket-sized containers of alcohol-based hand rub, education and reminding materials. The control group received basic life support education and workshops. They were followed up for another seven months. We measured the hand hygiene compliance of the HCWs by direct observation and recorded the incidence of infections of the residents from their hospital discharge summaries. / OBJECTIVE: To investigate the effectiveness of a multi-faceted hand hygiene programme with pocket-sized containers of alcohol-based hand rub for infection control in elderly long-term care facilities (LTCFs) / OUTCOMES & DATA ANALYSIS: Primary outcomes were direct observed compliances of hand washing and antiseptic hand rubbing of the HCWs, incidence of infections requiring hospitalization and death rate due to infection of the residents, and outbreaks of the LTCFs. Secondary outcomes were change in hand hygiene attitude and self-reported compliance. / PARTICIPANTS: All health care workers (HCWs) of the LTCFs recruited by snowball sampling. Their job categories were nurses, nursing assistants and physiotherapists. / RESULTS: In the treatment group, the compliance of alcohol-based hand rubbing increased significantly from 1.5% (5/333) to 15.9% (233/1465) (p=0.001) and total compliance increased from 25.8% (86/333) to 33.3% (488/1465) (p=0.01) after intervention. Total incidence of infections decreased from 31 cases in 21,862 resident days (1.42 per 1,000 resident-day (rd)) to 33 cases in 50,441 resident days (0.65 per 1,000 resident-day) (p=0.002) and death rate due to infection decreased from 8 cases in 21,862 resident days (0.37 per 1,000 rd) to 5 cases in 50,441 resident days (0.1 per 1,000 rd) in the treatment group (p=0.01). Pneumonia significantly decreased by 0.63 per 1000 rd (p=0.001). In the control group, there were no changes in both antiseptic hand rubbing and hand washing. The total incidence of infections increased from 0.49 to 1.04 per 1000 rd (p=0.004) and no change in death rate due to infection (p=0.45). No outbreaks of influenza and norovirus occurred during the whole study in both groups. / SETTING: Six LTCFs for the elderly / The attitude of antiseptic hand rubbing on infection control increased significantly in the treatment group but there was no change under different situations in the control group. The self-reported compliance of antiseptic hand rubbing increased significantly in the treatment group. There were no changes on the self-reported compliances in the control group. The agreement of the direct observed results and the self-reported compliances was 75% (kappa coefficient = 0.5). / Yeung, Wing Kin. / Adviser: Tze Wai Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 100-106). / 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, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

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)

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Optimal aging is strongly related to personality factors along with health-behavior habits. Personality has played a key role in understanding the interactions between human behavior and the environment and as a vital predictor in determining health outcomes of individuals. Although previous studies have found links between personality traits and health, less is known about more process-oriented personality constructs, such as goals and self-regulatory strategies as linkages between traits and health outcomes. The purpose of this study is to explore the dynamic linkages of personality and health by examining how daily health-goal progress is associated with daily positive and negative affect as well as whether the association between health-goal progress and positive and negative affect can be predicted by personality traits of neuroticism and conscientiousness. Main research questions are: 1) Are daily positive and negative affect associated with daily health-goal progress? 2) To what extent are the traits of neuroticism and conscientiousness related to the overall levels of daily health-goal progress over a 100-day time period? 3) Do neuroticism and conscientiousness moderate the relationships between daily positive affect and daily health-goal progress as well as between negative affect and daily health-goal progress? This study was guided by developmental systems theory (Ford & Lerner, 1992) and the six-foci model of personality (Hooker & McAdams, 2003). This study utilized data from the "Personal Understanding of Life and Social Experiences" (PULSE) project that was a 100 day internet-based, daily study of Oregon residents over the age of 50. The sample for this study (N = 76) included participants who have participated at both baseline (initial survey) and the microlongitudinal phase (over 100 days). Personal health goals, neuroticism, and conscientiousness were measured at baseline. Daily health-goal progress, daily positive affect, and negative affect were measured over 100 days. Multilevel modeling analysis was used to examine within-person variations and between-person differences in daily health-goal progress and daily positive and negative affect by estimating an intercept (initial status) and slope (change) for each individual. The results of this study show that first, daily health-goal progress was positively coupled with daily positive affect and negatively coupled with daily negative affect within persons. Second, the associations between daily positive affect and daily health-goal progress and between daily negative affect and daily health-goal progress varied between individuals. Third, health-goal progress on the previous day was positively related to concurrent positive affect and negatively related to concurrent negative affect. Fourth, individuals high in neuroticism and individuals high in conscientiousness were only marginally likely to experience higher levels of health-goal progress over the 100-day period compared to those with low scores. Fifth, individuals high in neuroticism when experiencing high levels of negative affect tended to report lower levels of daily health-goal progress. These findings may provide enhanced knowledge of patterns of day-to-day variability within persons and lead to better health care. Moreover, the findings of the current study suggest that health-improving interventions could be targeted individually to participants based on knowledge of the linkages between daily goal progress and daily affect and personality traits. Ultimately, the personality of older adults may act as risk factors and/or protective factors in the processes of aging during the second half of life. / Graduation date: 2013