This thesis organizes information that will assist a community in the selection or construction of a context sensitive integrated senior healthcare system model. The senior healthcare system within Sault Ste. Marie, Ontario is used as a case study. Institutional Ethnography is used to collect data guided by a change management model adapted from the literature. Data sources were non-participant observations, key informant interviews, focus groups, and texts. Institutional ethnographic local and high level analyses methods were used to analyze this data. Results identified many more restraining than driving forces for integration within Sault Ste. Marie’s senior healthcare system. Study findings indicate that macro level activities are perpetuating micro level obstacles to integration. These results can be used to identify where improvements need to be made at the macro level in order for successful change to occur at the micro level.

Syfte: Syftet var att undersöka om det fanns någon association mellan deltagande i kulturella aktiviteter och känsla av sammanhang bland äldre personer på två äldreboenden. Metod: Ett frågeformulär baserat på Antonovskys SOC-13-formulär med tillagda egenformulerade frågor, såsom kön, ålder, deltagande i kulturella aktiviteter och funktionsnivå användes.  Frågeformuläret delades ut till 76 personer över 65 år utan demenssjukdom på två äldreboenden i mellansverige och besvarades av 40 respondenter. Materialet bearbetades och analyserades i statistikprogrammet SPSS, där beskrivande statistik framställdes och ett chi-två-test samt en logistisk regression genomfördes. Resultat: Ingen statistiskt signifikant association mellan deltagande i kulturella aktiviteter och känsla av sammanhang fanns. Däremot fanns en association mellan funktionsnivå och KASAM-poäng.  Ju lägre funktionsnivå, det vill säga ju mer hjälp respondenten behövde i sin vardag, desto lägre känsla av sammanhang tenderade respondenten att ha. Slutsats: Funktionsnivå verkade ha högre inverkan på en individs känsla av sammanhang än deltagande i kulturella aktiviteter i den givna studiepopulationen. / Objective: The purpose of this study was to investigate whether there was any association between participation in cultural activities and sense of coherence among seniors living in two nursing homes. Methods: A questionnaire based on Antonovskys SOC-13-questionaire was used, with added self-formulated questions including gender, age, level of physical function and participation in cultural activities. The questionnaire was distributed to 76 people 65 years and older without dementia at two nursing homes in central Sweden and 40 respondents answered the questionnaire. The material was processed and analyzed in the statistic computer program SPSS, where descriptive statistics were prepared and a chi-square analysis and logistic regression analysis was performed. Results: No statistically significant relationship between participation in cultural activities and sense of coherence could be seen. However, there was a correlation between the level of function and SOC scores. The lower level of function, i.e. the more help the respondent needed in everyday life, the lower sense of coherence. Conclusion: Functional level seems to have greater impact on an individual's sense of coherence than participation in cultural activities in the given study population.

Healthcare reforms and restructuring have been a global phenomenon since the early 1980s. The major structural reforms in the healthcare system in New South Wales (NSW) including the introduction and implementation of the area health management model (1986), the senior executive service (1989) and performance agreements (1990), heralded a new era in management responsibility and accountability. It is believed that the reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of competencies required for senior healthcare managers in meeting the challenges in the new era. However, limited studies have been conducted which examined how health reforms affected its senior health executive workforce and the above changes. Moreover, no study on senior healthcare managers has focused specifically on NSW after the major reforms were implemented. The purpose of this research was to examine how reforms in the NSW Health public sector affected its senior health executive workforce between 1990 and 1999 in terms of their roles and responsibilities, the competencies required, and the challenges they faced. This study, from a broad perspective, aimed to provide an overview of the NSW reforms, the forces behind the reforms and the effects the reforms may have had on senior health managers as predicted by the national and international literature. This study also explored the changes to the senior health executive workforce in the public sector during the period of rapid change in the 1990s and has provided indications of the managerial educational needs for future senior healthcare managers. Both quantitative and qualitative data have been collected by this study using triangulated methods including scientific document review and analyses, a postal questionnaire survey, and in-depth telephone interviews. The findings from the two quantitative methods informed and guided the development of the open-ended questions and overall focus of the telephone interviews. This study found differences in the characteristics and employment-related aspects between this study and previous studies in the 1980s and 1990s, and identified four major tasks, twelve key roles and seven core competencies required by senior health executives in the NSW Health public sector between 1990 and 1999. The study concludes that the demographic characteristics and the roles and responsibilities of the NSW Health senior executive workforce since the reforms of the 1980s have changed. This study also identified seven major obstacles and difficulties experienced by senior health executives and suggested that during the introduction and implementation of major healthcare reforms in NSW since 1986, barriers created by the ‘system’ prevented the achievement of its full potential benefits. Although this study did not focus on detailed strategies on how to minimise the negative impact of the health reforms on the senior health executives or maximise the chance of success in introducing new changes to the system, some suggestions are proposed. Most significantly, the study has developed a clear analytical framework for understanding the pyramidal relationships between tasks, roles and competencies and has developed and piloted a new competency assessment approach for assessing the core competencies required by senior health managers. These significant findings indicate the need for a replication of the study on an Australia-wide scale in order to extend the generalisability of the results and test the reliability and validity of the new competency assessment approach at various management levels in a range of healthcare sectors. This is the first study acknowledging the impact of the introduction of the area health management model, the senior executive service and performance agreements in the NSW public health system through an original insight into the personal experiences of the senior health executives of the reforms and examination of the major tasks that senior health executives performed and relevant essential competencies required to perform these tasks. The possible solutions identified in this study can guide the development of strategies in providing better support to senior healthcare managers when large-scale organisational changes are proposed in the future.

The dissertation describes the quality of seniors´ life in homes for seniors. It is difficult to create a generally valid definition of the quality of life because of multidimensional and objektive character of this problem. But it is possible to look for factors having influence on the quality of life and for understanding of needs connected with subjective perception of the quality of seniors' life. The definition of theoretical connections in the first part of the work is concentrated on the problem of growing old and old age in connection with looking into the quality of seniors? life. Special attention is payed to the problem of life quality in general with regard to the quality of seniors? life. In the research part there are results and their use in practice. A quantitative research strategy (especially a method of interwieving) was used to reach the research intent. The author of the dissertation has used a combination of three questionnaires created by the World Health Organization which are focused on seniors´ life quality research ? their standardized Czech version: WHOQOL?OLD, WHOQOL?BREF and the questionnaire concernig attitudes to growing old and old age ? AAQ. The main aim of the dissertation was to find out a level of the quality of seniors´ life in homes for seniors, to evaluate the quality of life in various life domains from the point of view of their importance for general satisfaction with the quality of life. The author has researched an influence of sociodemographical indicators on subjective perception of the quality of seniors´ life in homes for seniors. In the last part of the dissertation there are mentioned particular fields which influence the quality of seniors´ life and there are described factors participating in the quality of life. Paying attention to the quality of seniors´ life in homes for seniors not only by seniors themselves but also by managers of these facilities ? it is a practical benefit of author´s dissertation. Several homes for seniors have showed interest in cooperation to create manuals for key management.These manuals will become a methodical material for creation of individual plans for seniors in homes for seniors. Knowledge of factors impressing the quality of seniors´ life can help to define needs of seniors in homes for seniors and to make easier planning aims of provided services. Other practical benefit of this work is publishing a special scientific publication called Quality of seniors´ life in homes for seniors which will be published by Grada Publishing in August 2012. The theoretical solutions and research results of this dissertation will be presented here. The reason of choosing the theme ?Quality of seniors´ life in homes for seniors? was to show an importace of perception of a man based on bio-psycho-social and spiritual level including his subjective outlook on satisfaction of his personal needs. This philosophy is tightly connected with the quality of provided services in long-stay facilities. The quality of provided services can be judged according to objective indicators including subjective perception of particular users.

While the healthy immigrant effect (HIE) has been seen throughout the western world in the adult population; research on the older population shows an inverse relationship between self-reported health and immigration status – i.e., in many instances, a health disadvantage for older immigrants. Explanations for this vary from a lack of selection into population, among older immigrants, to a duration effect; such that perceived health advantages seen in early life dissipate upon reaching older age. While these are the widely accepted reasons for the disappearance of the HIE among older people, not all mitigating factors have been examined in detail. This study aims to identify if there is an association between retirement and the healthy immigrant effect seen in Europe. It uses SHARE data for 27 European countries to examine self reported health (SRH) outcomes & presence of longterm illness’ (LTI) for population groups aged 55-74. The findings indicate the presence of a greater health disadvantage for retired immigrants (versus native-born retirees) as compared with those who are not retired. Additionally, better health outcomes (compared to native-born individuals) were seen for immigrants who retired late (after the age of 65) versus those who retired early. Retirement due to poor health was examined as an explanation for these findings, but it did not appear to affect the results, suggesting the observed patterns are most likely caused by an alternative factor relating to retirement. Further research is recommended to identify these factors.