L’objectif de cette étude de cas multiples est d’identifier les facteurs associés à l’intégration de l’approche écologique dans la programmation de prévention-promotion (PP) offerte aux aînés par des organisations locales de santé du Québec. Le modèle de Scheirer a guidé l’étude réalisée dans cinq CSSS choisis en fonction de la dimension écologique de leur programmation PP. Une analyse documentaire et des entretiens semi-dirigés auprès de 38 professionnels et gestionnaires ont constitué la stratégie de collecte de données. Trois catégories de facteurs ont été examinées : les facteurs professionnels, organisationnels et environnementaux. Les résultats suggèrent que les normes organisationnelles, les priorités concurrentes, la structure des équipes, les partenariats avec l’environnement externe, les préjugés, de même que la formation et l’intérêt du personnel influencent le degré d’intégration de l’approche écologique au sein des programmations. Ces résultats permettront de dégager des leviers d'action en vue d’optimiser l’offre de services en prévention-promotion destinée aux aînés. / This multiple case study investigates conditions that influence the integration of an ecological approach in disease prevention and health promotion (DPHP) programs offered to older adults by local health organizations in Quebec. Scheirer’s implementation model guided the study in five CSSS that were selected to portray differing degrees of ecological character in their DPHP programs. Data collection proceeded through content analysis of thirty-eight semi-structured interviews conducted with professionals and managers as well as document analysis. Professional, organizational and environmental factors were explored. Results indicate that the ecological character of programs is influenced by organizational norms, competing priorities, team structure, external partnerships, preconceived ideas regarding DPHP for older adults as well as professional interest and training. These results suggest avenues for action to optimize the impact of services offered to an ageing population through disease prevention and health promotion programs.

The problem of this study was a test of a specific videotape designed to influence the actions of tour guides for older adult groups. The purposes of the study were to observe guide performances and older adult responses before and after training in techniques for sharing information with older adults in public spaces. The hypotheses were tested. 1) Guides after training would exhibit significant differences in behaviors of pointing, repeating, pausing, questioning, conversing, facing art when talking, talking inaudibly, pacing rapidly. 2) Older adult drop-outs would decrease on tours with especially trained guides.

Le stress oxydatif et la formation des radicaux libres sont impliqués dans plusieurs mécanismes de la mort neuronale qui caractérisent la maladie d'Alzheimer. Les antioxydants sont reconnus comme une source de protection contre le stress oxydatif et peuvent avoir un effet protecteur sur le développement de la maladie d’Alzheimer. Cette étude visait à évaluer le potentiel antioxydant, par le biais du score « oxygen radical absorbance capacity » (ORAC), de l’alimentation habituelle de personnes âgées atteintes de la maladie d’Alzheimer en comparaison avec des témoins appariés pour l’âge sans problèmes cognitifs. L’hypothèse stipulait que les patients atteints de la maladie d’Alzheimer ont une alimentation dont le potentiel antioxydant est inférieur à celui des témoins sans problèmes cognitifs. L’étude a consisté en des analyses secondaires de données provenant de l’étude « Nutrition-Mémoire » (NMS), durant laquelle quarante-deux patients avec une démence du type Alzheimer (DTA) probable et leurs aidants étaient suivis pendant une période de dix-huit mois. Pour la présente étude, les données provenaient de trois jours de collecte alimentaire, ont été colligées au début (T0) de l’étude NMS, selon la méthode « Multiple-Pass ». Le potentiel antioxydant de l’alimentation a été déterminé à l’aide de la description des aliments énumérés dans la base de données des valeurs ORAC de l’USDA. Les résultats de l’étude ont montré que les patients avaient une alimentation dont le potentiel antioxydant était inférieur à celui des témoins (13784,07 ± 7372,70 μmol TE/100g contre 23220,54 ± 10862,55 μmol TE/100g, patients et témoins, respectivement; p<0,0001). Les analyses de régression hiérarchique pas à pas montraient que l’IMC, l’éducation, et le groupe (patients, témoins) étaient des facteurs influençant le score ORAC total. La consommation des aliments riches en antioxydants est un comportement préventif à faible risque qui pourrait bénéficier des individus susceptibles de développer la maladie d'Alzheimer. / Oxidative stress and the formation of free radicals are involved in several mechanisms of neuronal death that are characteristic of Alzheimer's disease. Antioxidants are known to help defend against oxidative stress and may protect against the development of Alzheimer's disease. This study aims to evaluate the antioxidant potential, using the “oxygen radical absorbance capacity” (ORAC) score of the diet of older adults people with Alzheimer's disease compared with cognitively-intact age-matched controls. It was hypothesized that the antioxidant potential of the diet of elderly people with Alzheimer's disease will be lower than that of controls without cognitive problems. The current study is a secondary analysis of data obtained from the "Nutrition-Memory study" (NMS). The NMS study recruited forty-two patients with probable Alzheimer’s disease, and their caregivers, and followed them over a period of eighteen months. The current study focuses on three days of dietary data collection, compiled at the beginning (T0) of the NMS study. The antioxidant potential of the diet was determined using the list of ORAC scores highlighted in the USDA database for the oxygen radical absorbance capacity of selected foods. Our results showed that the diet of patients (13784.07 ± 7372.70 μmol TE/100g) had a lower antioxidant potential than that of controls (± 23220.54 10862.55 μmol TE/100g). Moreover, BMI, education and group-status were factors that influenced the total ORAC score. Eating foods rich in antioxidants is a low risk preventative behaviour that could benefit individuals susceptible to developing Alzheimer’s disease.

Le but général de la thèse consiste à mieux connaître l’influence du milieu d’évaluation (domicile vs clinique) sur la réalisation de tâches liées à la préparation de repas auprès de personnes âgées fragiles. La thèse s'articule autour de trois objectifs spécifiques, dont les résultats sont présentés dans le cadre de cinq articles scientifiques. Le premier objectif vise à faire état des connaissances relatives au concept de fragilité en ergothérapie et à l'influence du milieu d'évaluation auprès des personnes âgées fragiles. Dans un premier temps, une analyse critique d'écrits portant sur la fragilité a été effectuée. Les résultats (article 1) démontrent la pertinence du concept de fragilité en ergothérapie, en suggérant qu'une meilleure compréhension de ce concept puisse aider les ergothérapeutes à offrir aux personnes fragiles des soins et services mieux adaptés à leurs besoins. Dans un deuxième temps, une recension des études ayant comparé la réalisation d'activités de la vie domestique (AVD) entre les milieux d'évaluation a été réalisée. Les résultats (article 2) révèlent que les personnes âgées sans déficit cognitif important tendent à offrir une meilleure performance à domicile, plutôt qu'en milieu clinique, lors de la réalisation d'AVD. Quelques facteurs, tels que la familiarité avec l’environnement, contribueraient à expliquer cette différence entre les milieux d'évaluation. Cette recension critique suggère que des résultats similaires puissent être obtenus auprès de personnes âgées fragiles. Le second objectif cherche à comparer la réalisation de tâches liées à la préparation de repas entre les milieux d’évaluation auprès de personnes âgées fragiles. Pour atteindre cet objectif, trente-sept personnes âgées répondant aux critères de fragilité (Fried et al.,2001) ont été évaluées en milieux clinique et domiciliaire suivant un devis contrebalancé au moyen du Assessment of Motor and Process Skills (AMPS) et du Performance Assessment of Self-Care Skills (PASS). Les résultats (articles 3, 4 et 5) concourent, dans l'ensemble, à démontrer une meilleure performance des personnes fragiles lorsqu’elles sont évaluées à domicile. Le dernier objectif a pour but d'identifier les facteurs sociodémographiques,physiques, cognitifs, psychologiques et environnementaux susceptibles d'expliquer la différence entre les milieux d'évaluation. Les résultats de la thèse (articles 3, 4 et 5) tendent à démontrer que le déclin de certaines fonctions exécutives constitue un facteur prépondérant pour expliquer une meilleure performance à domicile. Nos analyses révèlent que d'autres facteurs cognitifs, sociodémographiques, psychologiques, physiques et environnementaux contribuent également, mais de façon moins importante, à la différence observée entre les milieux d'évaluation. Les résultats de cette thèse peuvent aider les ergothérapeutes à mieux distinguer les personnes âgées fragiles susceptibles de présenter une performance différente selon le milieu dans lequel elles sont évaluées et conséquemment, pour qui une visite à domicile devrait être préconisée. Les connaissances générées par la thèse pourraient ultimement contribuer à offrir aux personnes âgées fragiles des services mieux adaptés à leurs besoins, tout en favorisant une gestion efficiente des ressources en matière de santé. / This thesis aims to advance the state of knowledge about the impact of assessment settings (home versus clinic) on meal preparation task performance in frail older adults. The thesis has three specific objectives and the results are presented in five articles. The first specific objective aims to review current knowledge about the concept of frailty in occupational therapy and the impact of assessment settings in frail older adults. First, a critical review about frailty was conducted. The results (article 1) demonstrate that a better understanding of the concept of frailty may help occupational therapists provide health care and services better tailored to the specific needs of this population. Second, a review of studies comparing performance of instrumental activities of daily living (IADL) between assessment settings was performed. The results (article 2) reveal that older adults without significant cognitive impairments tend to perform better in IADL tasks when assessed at home. Some factors, such as familiarity with the environment, may explain this difference. Based on this review, similar results might be expected with frail elders. The second specific objective aims to compare meal preparation task performance in home and clinical settings in a population of frail older adults. Thirty-seven frail older adults were thus assessed in home and clinical settings with the Assessment of Motor and Process Skills (AMPS) and the Performance Assessment of Self-Care Skills (PASS), using a counterbalanced design. The results (articles 3, 4, 5) globally demonstrate significantly better performance of participants when assessed at home. The third specific objective aims to identify demographic, physical, cognitive, psychological and environmental factors that may explain differences between assessment settings. The results (articles 3, 4, 5) indicate that a better performance in the home setting was mostly related to a decline in certain executive functions. Other cognitive, demographic, psychological, physical and environmental factors also contribute to explain the differences between assessment settings but to a lesser extent. Our findings may help occupational therapists identify frail older adults likely to present a different performance in the clinical setting and thus for whom home assessments would be advisable. Our findings could ultimately mean that frail clients are provided with services adapted to their needs, while ensuring an efficient allocation of health care resources.

Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

No description available.

No description available.

Este estudo é dedicado a uma análise das mudanças ocorridas nas situações de vida da população de idosos rurais de Santana da Boa Vista – Rio Grande do Sul, a partir do acesso aos benefícios previdenciários. Insere-se em um Programa Interdisciplinar de Pesquisa que busca integrar enfoques multidisciplinares na análise do desenvolvimento rural em regiões do Estado do Rio Grande do Sul, mais especificamente a chamada Metade Sul. Trata-se de uma região social e economicamente marginalizada que sofre crescente desaceleração econômica, com reflexos sociais importantes, quando comparada a outras regiões do Estado. Dentre os objetivos, além de descrever e analisar as mudanças ocorridas na vida de idosos rurais do município de Santana da Boa Vista, a partir da cobertura previdenciária, buscou-se conhecer o papel do idoso beneficiário, na família e analisar suas interrelações. Investigaram-se alterações nos padrões de sucessão da família e bases em que se constituem as “novas” relações de poder e autoridade. Trata-se de um estudo exploratório e descritivo com coleta e análise qualitativa de dados por meio de roteiro de entrevista, combinando perguntas fechadas e abertas, com 30 idosos, residentes no meio rural do Município estudado, beneficiados pela Previdência Social. Para análise dos dados optou-se por trabalhar com o conteúdo temático, que consistiu em descobrir os núcleos de sentido que compõem as comunicações, cuja presença ou frequência signifiquem alguma coisa para o objetivo analítico visado. Os resultados alcançados pelas entrevistas mostraram um número maior de homens entre os idosos, grande número de viúvas, baixa escolaridade e predomínio da cor branca. Em relação à situação econômica, constatou-se que a renda dos benefícios previdenciários contribui significativamente para a vida das famílias dos idosos entrevistados, assim como, possibilita a essas melhorias materiais nas condições de vida. Os problemas de saúde são basicamente doenças crônicas comuns ao envelhecimento, sendo que, as limitações geradas por elas estão geralmente ligadas à capacidade de continuarem trabalhando na atividade agrícola. A religiosidade está presente na vida de todos os idosos e influencia suas relações sociais. As relações de vizinhança foram consideradas fundamentais aos entrevistados, manifestadas pela solidariedade e ajuda mútua. Observou-se, a partir das concepções e percepções próprias dos idosos, que os benefícios previdenciários proporcionamlhes diminuição da sua “carga” de trabalho, pois recebem um dinheiro regular mês a mês, bem como continuarem morando no meio rural, lugar do qual não cogitam sair e, principalmente, um maior empoderamento perante suas famílias, ajudando os filhos e netos, com quem planejam o futuro e criam estratégias de sobrevivência para se manterem no meio rural. / This study analyzes the changes which occurred in the life situations of the rural older adult population of Santana da Boa Vista – Rio Grande do Sul, with the social welfare benefits. The study is part of an Interdisciplinary Research Program that aims at integrating a multidisciplinary focus on the analysis of the rural development in areas of the state of Rio Grande do Sul, more precisely in the region known as Metade Sul. This is a socially and economically marginalized area that presents increasing economic degradation, with important social consequences, when compared to other regions of the state. In addition to describing and analyzing the changes that occurred in the life of the rural older people in the town of Santana da Boa Vista from the social welfare help, we endeavored to understand the role of the older adult beneficiary in the family and to analyze their interrelations. Changes were investigated in family succession patterns and also in the bases that constitute the ‘new’ relations of power and authority. Therefore, it is an exploratory and descriptive study with collection and qualitative data analysis via interviews, combining closed and open questions. For the data analysis we preferred to work with the thematic content which consisted in discovering the nucleus of meaning that compose the communication, whose presence or frequency represents something for the aimed analytical focus. The results obtained from the interviews showed a larger number of men among the older people, with a great number of them being widows, having a lower education than the average and most of them being white. Regarding the economic situation, we verified that the income provided by the social welfare benefits contributes dramatically to the life of the families of the older people being interviewed, making it possible material improvements in the living conditions. The health problems are basically chronic diseases common of ageing, and the limitations generated by them are in general related to the capacity of continuing the rural work activities. Religion is present in all the older adults’ life and influences their social relations. Neighborhood relations, manifested through solidarity and mutual help, were considered fundamental by the interviewees. From the conceptions and perceptions of the older adults, it was observed that the social welfare benefits allow them to diminish their workload, since they receive a regular amount of money per month, while they go on living in the rural environment (a place which they do not consider leaving). The benefits also give them a larger power in front of their families, since they can help their children and grandchildren, with whom they plan the future and create survival strategies to remain in the rural environment. / Este estudio se centra el un análisis de los cambios ocurridos en las situaciones de vida de las personas de mayor edad en el medio rural de Santana da Boa Vista – Rio Grande do Sul, después del acceso de los beneficios de la seguridad social. Se inserta en un Programa Interdisciplinario de Investigación que busca integrar enfoques multidisciplinarios en el análisis del desarrollo rural en regiones del Estado do Rio Grande do Sul, más específicamente en la llamada Metade Sul. Esta es una región social y económicamente marginada que sufre una creciente desaceleración económica, con reflejos sociales importantes, cuando comparada con otras regiones del Estado. Entre los objetivos, além de describir y analizar los cambios ocurridos en la vida de las personas de mayor edad el rural del municipio de Santana da Boa Vista, después del acceso a la seguridad social, se busca conocer el papel de la persona de mayor edad jubilado, en la familia y analizar las relaciones de la familia con él. Se investigaron las alteraciones en los patrones de sucesión de la familia y las bases sobre las que se constituyen las "nuevas" relaciones de poder y autoridad. Se trata de un estudio exploratorio y descriptivo con recolección de información y análisis de tipo cualitativo de los datos a través de una guía de entrevista, que combina preguntas cerradas y abiertas, con 30 personas de mayor edade, residente en el medio rural del Município estudiado, beneficiados por el Seguridad Social. Para el análisis de los datos se opto por trabajar con el contenido temático, que consistió en descubrir los núcleos de sentido que componen las comunicaciones, cuya presencia o frecuencia significan algo para el objetivo analítico propuesto. Los resultados alcanzados a partir de las entrevistas mostraron un número más grande de hombres entre las personas de mayor edad, un gran número de viudas, baja escolaridad y predominio del color blanco. En relación con la situación económica, se constató que el ingreso a la seguridad social contribuyó de manera significativa para la vida de las familias de las personas de mayor edad entrevistadas, permitiéndoles mejoras materiales en las condiciones de vida. Los problemas de salud están en su mayoría relacionados con enfermedades crónicas comunes al envejecimiento, donde las limitaciones generadas por aquellas están generalmente articuladas a la capacidad de ellos para continuar trabajando en la actividad agrícola. La religiosidad está presente en la vida de todas las personas de mayor edad e influencia sus relaciones sociales. Las relaciones de vecindad fueron consideradas fundamentales para los entrevistados, manifestadas a través de la solidaridad y la ayuda mutua. Se observó, a partir de las concepciones y percepciones de ellos que los beneficios de la seguridad social les proporcionan una reducción en su “carga” de trabajo, porque reciben un dinero regular mes a mes, así como continúan viviendo en el medio rural, lugar del cual ellos no piensan en salir y, principalmente, un mayor empoderamiento frente a sus familias, ya que ayudando a los hijos y nietos, con quien planean el futuro y crean las estrategias de supervivencia para permanecer en el medio rural.

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence levels are not well known. Following face-to-face interviews with adults age 60 and older, Colaizzi'€™s data analysis strategy demonstrated thematic older adult reports of constant anxiety, loss of confidence, and activities of daily living (ADLs) avoidance as perceptions of FOF; traumatic health incidence, loss of health, and decreased quality of life as contributing factors in FOF; and depending on others, loss of muscle strength, and loss of balance as to how FOF affected older adult independence levels. Recommendations for future research include exploring the influence of gender, race, education level, and socioeconomic status on FOF in older adults. This study may enhance social change through greater FOF awareness and added context among caregivers.

This dissertation examines the associations between adult Latina daughters’ HIV risk behaviors and that of their older Latina mothers’ HIV risk behaviors. The central hypothesis of the study is that adult Latina daughters’ influence their older mothers’ behaviors and that such behaviors interact with the level of their attachment. Older Latinas are a vulnerable population that face cultural risk factors, health care provider bias, and engage in low rates of HIV testing. The primary mode of HIV infection for Latinas is through heterosexual contact. Yet, traditional gender norms such as marianismo belief place pressure on Latina women to be submissive to their partners, disregard their infidelities, and not attempt to negotiate condom use, increasing the risk of HIV infection among Latinas via heterosexual sex with their primary partners. Efforts by the CDC to increase HIV testing have emerged as a critical part of HIV prevention. However, research has indicated that older Latinas are less likely to speak to a health care provider about safe sex practices or HIV testing than their younger counterparts. Despite health care providers having strong influences over Latinas’ decisions to perform health related tests, physicians are not endorsing HIV testing for their older patients. This in part, leads to a disproportionate number of late stage diagnoses among older adults. Evidence suggest that adult daughters are a source of support and assistance in health-related issues for their aging mothers and are uniquely positioned to influence their mothers’ health-related behaviors and decisions. Additionally, mother-daughter attachment has been found to be a protective factor to other risky health behaviors. The present study (1) Examined the association between recurrent HIV risk behaviors of adult Latina daughters and those of their older Latina mothers and (2) examined the moderating effect mother-daughter attachment have on those associations. No statistical significance was found in examining the association between adult Latina daughters and their older mothers, nor was attachment found to be a moderator on those associations. Findings show culture may be the significant factor influencing the lack of association between adult Latina daughters and their older mothers. Results add to the literature and scientific field of social work and public health. Additionally promoting studies on cultural barriers that may exist in adult Latina daughter and older mother upward communication as techniques to promote healthy behaviors among older Latinas.