Thesis (MPhil)--Stellenbosch University, 2010. / Chronic diseases have been described as “the biggest public health threat society has ever faced” (World Economic Forum, 2010). The forecast from both the World Health Organization and the World Bank is that the morbidity and mortality rate of these diseases will impact severely on low and middle-income countries (WHO, 2005). The burden of disease in South Africa comprises both communicable and non-communicable burden maladies, including high rates of HIV/AIDS and tuberculosis (TB). A high incidence of injury, peri-natal and maternal disorders also contributes to the health burden (Mayosi, Flisher, Lalloo, Sitas, Tollman & Bradshaw, 2009). The country is approaching a demographic transition with an accelerating ageing population. The factors contributing to the ageing of the population differ from those of the rest of the world (Haldenwang, 2009). The Western Cape Province is unique in its position as the province in South Africa with the highest life expectancy, a population change rate that is double the national average, and a higher than average older population (Provincial Government of the Western Cape, Department of Health. 2010. Strategic Plan 2010-2014). An extensive literature survey employing an integral environmental scanning approach was used to determine the impact of ageing on the burden of disease in the Western Cape. The connection between ageing, chronic disease and physical functionality was explored in a non-standardised questionnaire and in the literature survey. An evaluation of the Western Cape Department of Health Strategic Plan 2010-2014 found that non-communicable diseases and mental health issues that constitute about 28 per cent of the burden of disease (WHO, 2008) are not considered in future planning. This study shows that the Western Cape Province has limited time to prepare for the expanding and accelerating ageing population. The analysis of the questionnaire and the literature survey forms the foundation for the building of scenarios to visualise possible health futures in 2030 in the Western Cape. The desirable scenario is a balance between life expectancy and health expectancy.

The overall purpose of the present study was to examine the strategies used by older adults with regard to both foot placement and hand contact location as they enter (ingress) and exit (egress) a vehicle. A cross-sectional study was used to identify and, in turn, examine the participants’ ingress and egress strategies in relation to their physical mobility and other characteristics. All participants had a valid driver’s license and they completed the following: 1) demographic (self-report) questionnaires; 2) clinical measures of physical mobility (i.e. Timed Up and Go, Berg Balance Scale, One Legged Stance test, Rapid Pace Walk test). A physical mobility index was also developed using these clinical measures. During both ingress and egress, older drivers were more likely to use one-foot strategies, which are considered less stable. Participants who used one-foot ingress and egress strategies had better overall physical mobility. The armrest location was used by the majority of older drivers for both ingress and egress, and is used most often during one-foot strategies. Participants who used multiple hand contact locations during ingress/egress had lower physical mobility than participants who used a single hand contact location or made no contact with the vehicle. Finally, the results from this study can inform educational materials targeting this population and determining design changes to the automobile that can prevent injuries to older drivers. / Thesis / Master of Health Sciences (MSc)