Medication management constitutes a large part of registered nurses' (RNs) daily work in municipal elderly care. They are responsible for monitoring multimorbid older persons with extensive treatments, and they often work alone, without daily access to physicians. RNs’ drug monitoring is, in this thesis, based on the concept of pharmacovigilance. Pharmacovigilance is about the science and the activities that aim to improve patient care and safety in drug use, that is, to detect, assess, understand and prevent drug-related problems. The overall aim was to explore conditions for pharmacovigilance from a nursing perspective, focusing on implications of RNs’ competence and use of a computerized decision support system (CDSS). Both quantitative and qualitative research methods were used, including a questionnaire (I), focus group discussions (II), individual interviews (III) and an intervention study (IV). In total 216 RNs and 54 older persons participated from 13 special accommodations, located in three different regions. RNs who had completed further training in pharmacovigilance rated their medication competence higher than those who had not. However, there was no difference between groups in the number of pharmacovigilant activities they performed in clinical practice (I). The RNs appeared to act as “vigilant intermediaries” in drug treatment. They depended on the nursing staff's observations of drug-related problems. The RNs continuously controlled the work of staff and physicians, and attempted to compensate for shortcomings in competence, accessibility and continuity (II). RNs’ use of a CDSS was found to affect drug monitoring, including aspects of time, responsibility, standardization of the work, as well as access to knowledge and opportunities for evidence-based care (III). The CDSS detected significantly more drug-related problems when conducting medication reviews, than the RNs did. Nevertheless, this did not result in any significant improvement in the quality of drug use in the follow up, three and six months later (IV). This thesis contributes to the recognition of pharmacovigilance from a nursing perspective. Increased medication competence seems to be insufficient to generate pharmacovigilant activities. RNs depend on other health care professionals and organizational conditions in order to perform their work. A CDSS has the potential to support RNs, both in structured medication reviews and in daily clinical practice. Inter-professional collaboration is crucial, with or without a CDSS, and the entire team needs to be aware of and take responsibility. Other important conditions is the existence of well-functioning communication channels, competence across the team, and established procedures based on current guidelines.

Bakgrund: Den psykiska ohälsan bland befolkningen har ökat under de senaste decennierna och medellivslängden i Sverige ökar kontinuerligt. Risken att drabbas av depression var vanligare hos personer över 65 år. Depression påverkar personens känslor, tankar och beteende negativt. Det är av vikt att upptäcka, diagnostisera och behandla depression för att minska personens lidande samt minska samhällskostnader som depression medför. Personcentrerad vård är ett etiskt förhållningssätt och syftar till att involvera den enskilda personen, samt anpassa vården efter dennes behov. Sjuksköterskor arbetar ofta självständigt i vården av den äldre personen med depression. Syfte: Syftet med studien var att belysa sjuksköterskors upplevelser av att möta och vårda den äldre personen med depression. Metod: En metasyntes (Noblit och Hare, 1988) med kvalitativ design. Resultat: Metasyntesen resulterade i fyra huvudteman; organisationens betydelse, vikten av hög kompetens, vikten av att ge tid, betydelsen av ett holistiskt förhållningssätt. Teamarbete och resurser var grundläggande för att kunna stötta den äldre personen med depression. Kunskap, erfarenhet samt normmedvetenhet underlättade identifiering av depression och bidrog till god omvårdnad. Skapandet av en relation med den äldre personen tog tid och byggdes på tillit samt kontinuitet. Att se till hela personen och relationens betydelse påverkade omvårdnaden positivt. Slutsats: Stöttning från organisationen behöver finnas, mer utbildning behöver erbjudas samt möjlighet att få tid i mötet och vården av den äldre personen med depression för att kunna förbättra omvårdnaden. Det kan inte nog betonas hur viktigt det är att sjuksköterskan får resurser som ger möjligheter att skapa en personcentrerad vård. / Background: Mental illness among the population has increased in recent decades and life expectancy in Sweden is continuously increasing. The risk of suffering from depression was generally more common for people over 65 years of age. Depression negatively affects the person's feelings, thoughts and behaviour. It is important to detect, diagnose and treat depression in order to reduce the person's suffering and reduce the societal costs that depression entails. Person-centered care is an ethical approach and aims to involve the individual, as well as adapt care to his or her needs. Nurses often work independently in the care of the elderly person with depression.Aim: The aim of the study was to describe nurses' experiences of meeting and caring for the elderly person with depression. Method: The study is a metasynthesis (Noblit and Hare, 1988) with a qualitative design. Results: The metasynthesis resulted in four main themes; the importance of the organization, the importance of high competence, the importance of giving time, the significanceof a holistic approach. Teamwork and resources were essential in order to be able to support the elderly person. Knowledge, experience and norm awareness facilitated the identification of depression and contributed to good nursing. The creating of a relationship with the older person took time and was built on trust and continuity. Looking at the whole person and the importance of the relationship had a positive impact on nursing. Conclusion: Support from the organization needs to be available, more education needs to be offered as well as the opportunity to have time in the meeting and care of the elderly person with depression in order to improve care. It cannot be emphasized enough how important it is for the nurse to receive resources that provide opportunities to create a person-centered care.

Bakgrund: Antalet äldre i befolkningen blir fler och behovet av palliativ vård ökar. Socialstyrelsen har tagit fram nationella kvalitetsindikatorer som speglar de viktigaste aspekterna av god palliativ vård, där brytpunktssamtal utgör en av dessa. Syfte: Att undersöka om brytpunktsamtal med patient har någon betydelse för den palliativa vården personer 65 år eller äldre erhåller under sin sista levnadsvecka. Metod: Kvantitativ icke-experimentell retrospektiv registerstudie med data från Svenska palliativregistret. Resultatet har analyserats med sambandstest och logistisk regressionsanalys. Resultat: Signifikanta samband mellan brytpunktssamtal med patient och samtliga av de undersökta kvalitetsindikatorerna för god palliativ vård påvisades. De personer som erhållit brytpunktssamtal fick under sin sista levnadsvecka i högre grad munhälsan bedömd, smärtskattades i högre utsträckning samt hade i högre utsträckning smärtstillande opioid och ångestdämpande läkemedel ordinerade vid behov. Däremot avled fler personer med trycksår hos de som hade haft brytpunktssamtal än de som inte haft det. Slutsats: Att signifikanta samband finns mellan brytpunktssamtal med patient och måluppfyllelsen av Socialstyrelsens indikatorer för god palliativ vård tyder på att brytpunktssamtalet har betydelse för kvaliteten på den palliativa vården som personer 65 år eller äldre erhåller. / Background: The number of older people in the population is growing and the need for palliative care is increasing. The National Board of Health and Welfare has developed national quality indicators to reflect upon the most important aspects of good palliative care, end-of-life (EOL) conversations is one of them. Purpose: To examine whether EOL conversation with patients have any significance for the palliative care people 65 years or older receive during their last week of life. Method: Quantitative non-experimental retrospective registry study with data from the Swedish Palliative Registry. The results have been analysed with correlation tests and logistic regression analysis. Results: Significant relationships between EOL conversations with patients and the investigated quality indicators were demonstrated. During the last week of life, the people who received EOL conversations to higher extent had their oral health and their pain assessed, and they had opioid pain-relieving drugs and anti-anxiety drugs prescribed to a higher extent. However, more people died with pressure ulcers than in those who had had a EOL conversation than in those who had not. Conclusion: The fact that there are significant connections between EOL conversation with the patient and the goal fulfilment of the indicators for good palliative care indicates that the EOL conversation is important for the quality of the palliative care people 65 year or older receive.

The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

Bakgrund Varje år avlider ungefär 1 procent av Sveriges befolkning vilket motsvarar cirka 90 000 personer. Av dessa avlider cirka 36 procent på särskilt boende. Smärta är ett vanligt förekommande symtom hos äldre personer som vårdas i livets slut. Att identifiera smärta och lindra smärta blir således centralt och en viktig del av arbetet för den omvårdnadsansvariga sjuksköterskan. Syfte Syftet är att beskriva sjuksköterskors erfarenheter av att identifiera smärta och använda omvårdnadsåtgärder för att lindra smärta hos den äldre personen boende på särskilt boende i livets slut. Metod Metoden är en kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer har använts för insamling av data där sjuksköterskor med minst ett års erfarenhet av särskilt boende där personer över 65 vårdas i livets slut inkluderades som informanter. Innehållsanalys gjordes enligt en metod beskriven av Graneheim och Lundman (2004). Resultat Studiens resultat presenteras i fyra kategorier; Relation central vid vård i livets slut, Identifiering av smärta är svårt, Omvårdnadsåtgärder lindrar smärta och Ett kvalificerat team främjar omvårdnaden. Samtliga kategorier presenteras med tillhörande underkategorier. Slutsats Studiens resultat visade på att personkännedom möjliggjorde personcentrerad vård och ökade möjligheten att individanpassa omvårdnadsåtgärder och att enklare identifiera äldre personers smärta. Omvårdnadspersonal saknade kunskap om identifiering av smärta och smärtlindring med omvårdnadsåtgärder. Det var sjuksköterskor som hade ansvar att handleda och kompetensförsörja teamet däremot visar resultatet att sjuksköterskor inte följer riktlinjer gällande användning av skattningsinstrument vid identifiering av smärta och inte heller hade fullgoda kunskaper om de fyra dimensionerna av smärta. / Background Each year approximately 1 percent of Sweden’s population dies, which corresponds to approximately 90 000 people. Of these, about 36 percent dies while living in special housing. Pain is a common symptom in older people receiving end-of-life care. Identifying pain and alleviating pain thus becomes central and an important part of the work of the nurse responsible for care. Aim The aim is to describe nurses’ experiences of identifying pain and using nursing interventions for pain relief in older people living in special housing at the end of life. Method The method used is a qualitative interview study with and inductive approach. Semistructured interviews have been used for the collection of data were nurses with at least one year of experience of working in special housing for people older than 65 years of age in end-of-life care were included as informants. Content analysis was done according to a method described by Graneheim and Lundman (2004). Results The result of the study is presented with four categories; Relationship central for end-oflife care, Identifying pain is difficult, Nursing interventions alleviate pain and A qualified team promotes nursing. All categories are presented with associated subcategories. Conclusions The results of the study show that knowledge of the person made person-centered care possible and increased the possibility to individualize nursing interventions and made it easier to identify pain in older people. Nursing staff lacked knowledge about identifying pain and alleviating pain with nursing interventions. It was nurses who had the responsibility to tutor, and competence supply the team however the results show that nurses does not follow guidelines regarding estimation instruments when identifying pain and neither do they have satisfactory knowledge of the four dimensions of pain.

No description available.

Stumbo and Peterson (2004:9) argue that the participation in meaningful leisure activities may lead to the improvement of elderly people’s health, well-being and quality of life. Changes which are associated with old age, such as the increase in adverse health conditions; however has a significant impact on leisure participation of the elderly (Austin et al., 2006:49). For the purpose of this study, the following questions need to be answered: a) Are physical, social, spiritual and cognitive leisure activities part of the leisure profile of persons sixty years and older? b) Do structural, interpersonal and intrapersonal constraints play a role in limiting the leisure participation of persons sixty years and older? c) Does a relationship exist between participation in physical, social, spiritual and cognitive leisure activities and perceived well-being of people sixty years and older? d) Can a leisure activity paradigm be compiled to indicate the leisure participation of persons sixty years and older? To answer these questions, this study focused on using a phenomenological research design to enquire about the meaning of the leisure phenomenon in elderly people’s lives (Fouché, 2005:270). This study was developed in accordance with the mixed methodological approach referred to by De Vos (2005b:361) as a combination of quantitative and qualitative research used in a single study. For the purpose of this study, one hundred and ten elderly people (men and women), sixty years and older and members of the Potchefstroom Service Centre for the Aged, participated. An availability sample was used to identify the participants who completed the questionnaire and participated in the focus group interview. Seventy two participants (60 females and 12 males) completed the questionnaire, whereby eight participants (5 females and 3 males) participated in the focus group interview. According to the results, respondents 60-64 years old indicated that they participate more in social, creative and cultural, and general leisure activities. Although 60% of these respondents (60-64 years) experience low levels of health, 80% still participate in physical leisure activities. The results suggested that these respondents (60-64 years) also participate less in travelling and outdoor leisure activities than respondents 65-74 years old and 75 years and older. Regarding respondents 65-74 years old, the results indicated higher levels of participation in social leisure activities, followed by general leisure activities. These respondents (65-74 years) participate more in travelling and outdoor leisure activities than the other age groups (60-64; 75 and older). Compared to the respondents 60-64 years, the leisure participation in creative and cultural and physical activities of respondents 65-74 years is significantly lower, even if the results showed they have a healthier health profile than respondents 60-64 years. The results showed that respondents 75 years and older participate more in general leisure activities, followed by social leisure activities and creative and cultural leisure activities. In comparison with respondents 60-64 years, respondents 75 years and older participate more in travelling and outdoor leisure activities. Although respondents 75 years and older, according to the results, have a healthier health profile than respondents 60-64 years and 65-74 years, participation in physical leisure activities was still very low. Regarding the relation between the leisure profile and the different types of living arrangements, it showed that respondents living in retirement villages participate more in social, general and physical leisure activities whereas respondents living in their own homes, participate more in general, social and creative and cultural leisure activities. However, respondents living with their children or family, or in a communal home, participate more in social leisure activities. In terms of the importance of leisure participation in elderly people’s life, the results indicated that 60% respondents 60-64 years, acknowledge leisure participation as very important in their lives, whereas 6% respondents 65-74 years and 75 years and older (21%), indicated leisure participation as not important. According to the respondents’ health profile, in relation to living arrangements and gender, women respondents living in retirement villages experience lower health levels than those living with their children or family, or in communal homes as well as male respondents. The results indicated that most of the respondents who experience average to low health levels, participate in social leisure activities whereas those who participate in outdoor leisure activities experience average health levels. In terms of happiness, well-being and quality of life, the male respondents living in retirement villages experience higher levels of happiness, well-being and quality of life compared to those living with children or family, or in communal homes. Women respondents living in their own homes or with their children or family, or in communal homes experience the highest levels of happiness, well-being and quality of life. This study also suggests that elderly people’s leisure participation can be programmed and planned by using a leisure activity pyramid. This leisure activity pyramid place social activities at the foundation of the leisure program, from where general, creative and cultural, physical, outdoor and travelling leisure activities can develop. The results showed, elderly people have a need to experience leisure benefits; hence the leisure benefits respondents 65-74 years old experience, includes interaction with others, whereas respondents 75 years and older indicated that they experience personal growth as a leisure benefit. Respondents (male and female) 65-74 years old indicated that meeting other people was the biggest leisure benefit, whereas respondents 60-64 years indicated that they participate in leisure activities to experience physical challenges while respondents 75 years and older participate in leisure activities to experience relaxation. In terms of the constraints which can limit participants’ leisure participation or exclude them from it, the respondents experience financial shortages as the most important constraint. The results showed that constraints are experienced differently between gender and age groups. Hence, the male respondents 65-74 years old and female respondents 75 years and older, indicated a shortage of time as the most important constraint, while male respondents 75 years and older, as well as female respondents between 60 and 74 years, indicated financial shortages as the most important constraint. According to the results, it seemed that respondents 85 years and older experience time and security, economic and structural, personal and programming as constraints. Respondents living in a flat on the same premises as children or family, experience time and security as constraints in contrast to those living with children or family, who experience economic and personal constraints. According to this study it is clear that old age and the provision of leisure services to older people, is a very complex issue. In the light of this information it is necessary for tertiary institutions to provide specialized training for recreation students, in the field of providing leisure services to older people, to meet the complex leisure needs of the elderly. / Thesis (PhD (Recreation Science))--North-West University, Potchefstroom Campus, 2013

Stumbo and Peterson (2004:9) argue that the participation in meaningful leisure activities may lead to the improvement of elderly people’s health, well-being and quality of life. Changes which are associated with old age, such as the increase in adverse health conditions; however has a significant impact on leisure participation of the elderly (Austin et al., 2006:49). For the purpose of this study, the following questions need to be answered: a) Are physical, social, spiritual and cognitive leisure activities part of the leisure profile of persons sixty years and older? b) Do structural, interpersonal and intrapersonal constraints play a role in limiting the leisure participation of persons sixty years and older? c) Does a relationship exist between participation in physical, social, spiritual and cognitive leisure activities and perceived well-being of people sixty years and older? d) Can a leisure activity paradigm be compiled to indicate the leisure participation of persons sixty years and older? To answer these questions, this study focused on using a phenomenological research design to enquire about the meaning of the leisure phenomenon in elderly people’s lives (Fouché, 2005:270). This study was developed in accordance with the mixed methodological approach referred to by De Vos (2005b:361) as a combination of quantitative and qualitative research used in a single study. For the purpose of this study, one hundred and ten elderly people (men and women), sixty years and older and members of the Potchefstroom Service Centre for the Aged, participated. An availability sample was used to identify the participants who completed the questionnaire and participated in the focus group interview. Seventy two participants (60 females and 12 males) completed the questionnaire, whereby eight participants (5 females and 3 males) participated in the focus group interview. According to the results, respondents 60-64 years old indicated that they participate more in social, creative and cultural, and general leisure activities. Although 60% of these respondents (60-64 years) experience low levels of health, 80% still participate in physical leisure activities. The results suggested that these respondents (60-64 years) also participate less in travelling and outdoor leisure activities than respondents 65-74 years old and 75 years and older. Regarding respondents 65-74 years old, the results indicated higher levels of participation in social leisure activities, followed by general leisure activities. These respondents (65-74 years) participate more in travelling and outdoor leisure activities than the other age groups (60-64; 75 and older). Compared to the respondents 60-64 years, the leisure participation in creative and cultural and physical activities of respondents 65-74 years is significantly lower, even if the results showed they have a healthier health profile than respondents 60-64 years. The results showed that respondents 75 years and older participate more in general leisure activities, followed by social leisure activities and creative and cultural leisure activities. In comparison with respondents 60-64 years, respondents 75 years and older participate more in travelling and outdoor leisure activities. Although respondents 75 years and older, according to the results, have a healthier health profile than respondents 60-64 years and 65-74 years, participation in physical leisure activities was still very low. Regarding the relation between the leisure profile and the different types of living arrangements, it showed that respondents living in retirement villages participate more in social, general and physical leisure activities whereas respondents living in their own homes, participate more in general, social and creative and cultural leisure activities. However, respondents living with their children or family, or in a communal home, participate more in social leisure activities. In terms of the importance of leisure participation in elderly people’s life, the results indicated that 60% respondents 60-64 years, acknowledge leisure participation as very important in their lives, whereas 6% respondents 65-74 years and 75 years and older (21%), indicated leisure participation as not important. According to the respondents’ health profile, in relation to living arrangements and gender, women respondents living in retirement villages experience lower health levels than those living with their children or family, or in communal homes as well as male respondents. The results indicated that most of the respondents who experience average to low health levels, participate in social leisure activities whereas those who participate in outdoor leisure activities experience average health levels. In terms of happiness, well-being and quality of life, the male respondents living in retirement villages experience higher levels of happiness, well-being and quality of life compared to those living with children or family, or in communal homes. Women respondents living in their own homes or with their children or family, or in communal homes experience the highest levels of happiness, well-being and quality of life. This study also suggests that elderly people’s leisure participation can be programmed and planned by using a leisure activity pyramid. This leisure activity pyramid place social activities at the foundation of the leisure program, from where general, creative and cultural, physical, outdoor and travelling leisure activities can develop. The results showed, elderly people have a need to experience leisure benefits; hence the leisure benefits respondents 65-74 years old experience, includes interaction with others, whereas respondents 75 years and older indicated that they experience personal growth as a leisure benefit. Respondents (male and female) 65-74 years old indicated that meeting other people was the biggest leisure benefit, whereas respondents 60-64 years indicated that they participate in leisure activities to experience physical challenges while respondents 75 years and older participate in leisure activities to experience relaxation. In terms of the constraints which can limit participants’ leisure participation or exclude them from it, the respondents experience financial shortages as the most important constraint. The results showed that constraints are experienced differently between gender and age groups. Hence, the male respondents 65-74 years old and female respondents 75 years and older, indicated a shortage of time as the most important constraint, while male respondents 75 years and older, as well as female respondents between 60 and 74 years, indicated financial shortages as the most important constraint. According to the results, it seemed that respondents 85 years and older experience time and security, economic and structural, personal and programming as constraints. Respondents living in a flat on the same premises as children or family, experience time and security as constraints in contrast to those living with children or family, who experience economic and personal constraints. According to this study it is clear that old age and the provision of leisure services to older people, is a very complex issue. In the light of this information it is necessary for tertiary institutions to provide specialized training for recreation students, in the field of providing leisure services to older people, to meet the complex leisure needs of the elderly. / Thesis (PhD (Recreation Science))--North-West University, Potchefstroom Campus, 2013

INTRODUCTION. D’ici 2030, le Québec comptera 180 000 personnes aînées vivant avec un trouble neurocognitif (PATNC). Les TNC entraînent des enjeux d’interaction personne environnement – l’aîné interagissant avec son environnement humain (proche aidant) ou non humain (domicile) – compromettant ainsi le maintien à domicile. Basée sur le Modèle de compétence, l’Évaluation à domicile de l’interaction personne environnement (ÉDIPE) – version cognitive vise à combler le manque d’instruments validés ciblant ces enjeux. Cet instrument comprend trois sections (Exploration des problèmes cognitifs et de leur impact; Évaluation de l’interaction; Validation et interprétation du processus d’évaluation) évaluées lors d’entrevues, d’observations et de mises en situation; deux échelles (ordinale; dichotomique) qualifient l’interaction personne-environnement. Ce Mémoire porte sur l’étude de la fidélité interexaminateurs de l’ÉDIPE–version cognitive. MÉTHODOLOGIE. Basés sur la Théorie classique de la mesure, deux ergothérapeutes indépendants et formés ont administré simultanément l’ÉDIPE–version cognitive à 30 dyades (PATNC-proches aidant), à domicile (3,2h/évaluation). Pour chaque item, le coefficient kappa, le pourcentage d’accord et l’erreur-type ont été calculés. RÉSULTATS. Les coefficients kappa varient entre -0,053 et 1,000 (pourcentages d’accord 50%-100%); la majorité (80%) varie d’Acceptable à Presque parfait. DISCUSSION. La formation et l’application rigoureuse du guide de passation soutiennent la fidélité interexaminateurs de l’instrument. Plusieurs coefficients faibles démontrent un pourcentage d’accord élevé, référant aux paradoxes de Feinstein et Cicchetti. CONCLUSION. Cette étude documente la fidélité interexaminateurs d’un instrument prometteur comblant une lacune dans la compréhension de l’interaction personne environnement des PATNC vivant à domicile. Poursuivre la validation de l’ÉDIPE–version cognitive appuiera davantage son utilisation en clinique et en recherche. / INTRODUCTION. By 2030, Quebec will have 180,000 older people living with a neurocognitive disorder (OPLwNDs). Neurocognitive disorders lead to issues affecting the person-environment interaction – the older adult interacting with his or her human (caregiver) or non-human (home) environment – thereby compromising aging in place. Based on the Model of Competence, the Home Assessment of Person-Environment Interaction (HoPE)-Cognitive Version aims to fill the gap in validated tools targeting these issues. This tool has three sections (Exploration of cognitive problems and their impact; Assessment of interaction; Validation and interpretation of the assessment process) that employ interviews, observations and task performance; two scales (ordinal; dichotomous) qualify the person-environment interaction. This Master’s thesis examines the interrater reliability of the HoPE-Cognitive Version. METHODOLOGY. Based on classical test theory, two independent, trained occupational therapists simultaneously administered the HoPE-Cognitive Version to 30 dyads (OPLwND-caregiver), at home (3.2 h/assessment). For each item, the kappa coefficient, percentage of agreement and standard error were calculated. RESULTS. Kappa coefficients ranged from -0.053 to 1.000 (percentages of agreement 50%–100%); the majority (80%) ranged from Acceptable to Almost Perfect. DISCUSSION. Training and rigorous application of the assessment guide support the tool’s interrater reliability. Several low coefficients demonstrate a high percentage of agreement, referring to Feinstein and Cicchetti’s paradoxes. CONCLUSION. This study documents the interrater reliability of a promising tool that fills a gap in understanding the person-environment interaction of OPLwNDs living at home. Further validation of the HoPE-Cognitive Version will support its use in clinical and research settings.