This study investigates the characteristics of and the interrelationships between disease, disability, service use and social support in a random sample of 647 community dwellers aged 75 years and over. The two broad objectives of the study are: to examine the physical aspects and manifestations of health by investigating disease and disability and the interrelationships between these two factors, and; to examine the social aspects of health by investigating service use and social support and the interrelationships between these two factors. Given the dramatic population ageing in Australia, particularly in the very old age groups, the health, well-being and quality of life of older Australians are of paramount importance and will be well into the future. The proportion of the population with diseases and disabilities increases significantly with age. As the physical aspects of health are manifested with increasing age the social aspects of health also become increasingly important. Older adults, particularly those in advanced old age, are disproportionately high users of health and community services. Despite the high use of services in this age group, far more older adults living in the community rely on their families, friends and neighbours for social support and many older adults use a combination of formal services and informal social support. Little is known about people aged 75 years and over living in the community in Australia. In particular, significant knowledge gaps exist with regard to the relationship between disease and disability and that between service use and social support. The characteristics of social support in this group of older adults are also largely unknown. The papers presented in this thesis are based on data collected in The Sydney Older Persons Study (SOPS). This is a large longitudinal multidisciplinary project which began in 1991 in order to investigate the health and service use patterns of people aged 75 years and over living in the community in the Central Sydney Health Area. The initial sample consisted of two groups: first, the Australian Bureau of Statistics (ABS) selected census districts with probability proportional to size and 9271 households were door-knocked to obtain a random sub-sample of the general community (n=320, response rate 73%); second, community-living veterans and war widows residing in the Central Sydney Health Area were selected at random from a list provided by the Department of Veterans Affairs to obtain a veteran/war widow sub-sample (n=327, response rate 82%). Respondents participated in both an interview conducted by a social scientist and a medical assessment performed by a medical practitioner with experience in geriatric medicine. An informant was sought for each respondent and this informant participated in a phone interview conducted by a social scientist. The first paper in this thesis investigates the characteristics of diseases (neurodegenerative, systemic and psychiatric) including their prevalence and association with age. The second paper extends the first by examining the nature of the relationship between disease and disability and in particular which individual diseases and groups of diseases have the greatest impact on disability. The third paper expands the analysis in the second paper by focusing in greater detail on the relationship between disease and disability. The contribution of clinically-diagnosed individual diseases and groups of diseases to three different measures of disability (clinician-rated, informant-rated or proxy and self-report) is investigated here. The fourth paper examines the possibility of disease and disability being the major predictors of service use and social support. It focuses on the determinants of service use and social support using Andersen's behavioral model. The fifth paper investigates the characteristics of social support, in particular gender differences and the socio-demographic variables associated with social support. This is an important research area because lower levels of social support have been found to predict mortality, disease and lower levels of well-being. Finally, the sixth paper links the major themes of the fourth and fifth papers by investigating the relationship between service use and social support. This paper tests Cantor's 'hierarchical-compensatory' mechanism, which predicts a negative association between service use and social support, and the 'bridging' mechanism which predicts a positive association between these two factors. Thus it assesses the extent to which demands for service use and for social support are made together or in a compensatory fashion for respondents of equal disease and disability. The presented work demonstrates that neurodegenerative diseases [dementia, cognitive impairment, parkinsonism, instability (gait ataxia), immobility (gait slowing) and motivation loss/behaviour change] have the largest and most significant increases with age of all disease groups. Therefore the hypothesis made in paper one that neurodegenerative diseases will come to dominate the health care needs of older adults, particularly when combined with population ageing, is supported. Further, results of papers two and three indicate that neurodegenerative diseases result in greater levels of disability, lending credence to the finding that it is these neurodegenerative diseases that are of central importance to the future of the health care needs of older adults of advanced age. While systemic diseases play an important role in disability, the neurodegenerative diseases are under-recognised by self-report and yet are most strongly associated with severe disability. A major recommendation of this study is that assessments and diagnosis of neurodegenerative diseases be included in disability assessments. With regard to the social aspects of health, the fourth paper finds that disease and disability are the main predictors of service use and social support. The fifth paper highlights important gender differences in social support and also finds that lower levels of social support are associated with increased age, male gender, single marital status and lower socioeconomic status. Because it is widely accepted that social support is protective against adverse health outcomes and low levels of wellbeing, these groups of older adults are at risk of poorer health and wellbeing. Finally the sixth paper fills some knowledge gaps with regard to the relationship between service use and social support. It shows that with regard to IADL (instrumental activities of daily living) services and IADL social support, Cantor's 'hierarchical-compensatory' mechanism (negative correlation) applies but with regard to medical services and both ADL (activities of daily living) and IADL social support the 'bridging' mechanism (positive correlation) is supported. These complex interrelationships between disease, disability, service use and social support are summarised schematically in a model. In light of significant population ageing, substantial resources in the form of medical and community services and social support from carers, family, friends and neighbours will need to be devoted to older adults with diseases, in particular neurodegenerative diseases, and to those with disabilities. Given the increasing importance of disease, disability, service use and social support in very old age, it is crucial that knowledge and understanding of these factors and their interrelationships be advanced in order to better allocate and sustain resources and to ultimately improve the health, well-being and quality of life of very old adults.

This qualitative study was interested in what needed to be heard from people who have difficulty in putting one foot in front of the other. The research aimed to expose some of the dominant discourses around mobility difficulties through exploring the relationship discourse has with power and to look for less talked about ways of resisting some of the harmful effects of dominant discourses. It also explored how participants used their spiritual beliefs to establish meaning in their mobility difficulty experiences. The exploring was done by employing discourse analysis as analysing tool to search for dominant and alternate meanings found in experiences of mobility difficulties. Theoretical frameworks included practical theology, pastoral care, narrative practices, postmodern ideas, discourse, social construction theory, deconstruction, qualitative research and action research. The researcher's own experience of mobility difficulties has been used as background where she was both an observer and participant. / Philosophy, Practical and Systematic Theology / M.Th. (Practical Theology with specialisation in Pastoral Therapy)

AFRIKAANS: Hierdie proefskrif ondersoek die ontplooiing van die reg rakende persone met gestremdhede in die rigting van ʼn toenemend inklusiewe en geintegreerde regsorde wat die beskerming en bevordering van die regte van persone met gestremdhede op gelyke grondslag met alle ander persone bewerkstellig. Gestremdheid word aan die hand van twee uiteenlopende modelle beoordeel en hanteer. Die twee modelle - die mediese en die sosiale model van gestremdheid - verteenwoordig uiteenlopende opvattinge oor gestremdheid wat in duidelik onderskeibare regsbenaderings neerslag vind. Oor die onlangse dekades het die sosiale model beduidend veld teen die mediese model gewen. Dit het veral neerslag gevind in die internasionale reg, soos dit die afgelope dekades onder die aanvoering van die Verenigde Nasies in omvattende standaardisering en universalisering van menseregte ontwikkel het. Hierdie ontwikkelings word breedvoerig ondersoek. Die groeiende aanklank van die sosiale model ten koste van die mediese model is eweneens merkbaar in twee ander jurisdiksiegebiede, naamlik Europa – binne die konteks van sowel die Europese Raad as die Europese Unie - en die Verenigde State van Amerika. By albei weerspieel die ontplooiing van die positiewe reg ʼn verandering in die beskouing oor die regshantering van persone met gestremdhede. Daarvolgens word gestremdheid toenemend volgens ʼn sosiale model as ʼn vorm van diversiteit eerder as uitsluitlik in terme van ʼn mediese model as afwykend of abnormaal verstaan. Gestremdheid vereis ʼn besondere regsbedeling ten einde daadwerklike gelyke beregtiging vir persone met gestremdhede te verseker eerder as (net) mediese ingryping in ʼn “afwykende toestand” of ʼn “siektetoestand.” Die veranderde regsbedeling oor gestremdheid word deurlopend deur die prisma van die twee modelle beskryf en beoordeel. Na die uitklaar van die betekenis van die modelle aan die begin van die studie volg ʼn historiese oorsig wat die konteks vorm waarbinne die regsontwikkeling rondom gestemdheidsreg sedert die Tweede Wereldoorlog op internasionale terrein (onder die aanvoering van die Verenigde Nasies), in Europa, die VSA en in Suid-Afrika bespreek word. Die studie sluit af met gevolgtrekkings waarin die klem op ʼn beoordeling van die verandering van die reg rakende gestremdheid in die lig van modelle wat in die eerste hoofstuk toegelig is, val. ENGLISH: The thesis investigates a change in perception and the resulting altered juridical management of persons with disabilities towards a more inclusive and integrated public legal order. Such a change positions the protection and promotion of the rights and interests of persons with disabilities on an equal footing with that of other persons. Disability is dealt with and evaluated in relation to two opposing models. The two models of disability – the medical and the social – represent two different perceptions about disability that are laid down in clearly-distinguishable approaches in law. Over the recent decades the social model has gained considerable ground over the medical model. It has found particular favour in international law, as developed over the past decades in the comprehensive standardisation and universalising of human rights under the leadership of the United Nations. These developments are scrutinised thoroughly. The increasing acceptance of the social model to the detriment of the medical model is apparent in two other areas of jurisdiction, namely, Europe – within the context of the European Council and the European Union – and the United States of America. In both these the development of positive law reflects a change in view regarding the way disability is dealt with by the law. Disability is increasingly understood according to a social model as a form of diversity rather than exclusively in accordance with a medical model. Disability requires a unique legal dispensation in order to ensure genuine equal adjudication for persons with disabilities rather than a (mere) medical intervention as a “deviant state” or an “illness”. The changing legal dispensation regarding disability is continuously described and evaluated through the prism of the two models. After an exposition of the models at the beginning of the study a brief historical overview follows, constituting the context within which legal development since the Second World War in the international arena (by way of the activities of the United Nations), in Europe, the USA and South Africa, is discussed. The study ends with conclusions which emphasise an evaluation of the changes in disability law in light of the models that were expounded in the first chapter. / Thesis (LLD)--University of Pretoria, 2010. / Public Law / unrestricted

<p>A literature review covering both the social construct model and medical model of disability followed by an argument of the importance of leisure and social activities, especially the arts, for people with disabilities. Concluding quantitative and qualitative research through focus groups and surveys, the project ends with a guide to implementing accessibility and inclusion efforts when planning online arts events.</p>

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This study aimed at exploring chronic illness from both the perspectives of the patient, living with the illness and the professional, treating the illness. The epistemological framework is social constructionism. Qualitative research was selected as the research approach. Three in-depth interviews with three patients, suffering with a chronic illness were conducted, as well as three interviews with professionals, who had experience with patients diagnosed with chronic illnesses. Thematic analysis was the method used for the analysis of data. The stories of the participants were reconstructed in terms of themes. A comparative analysis for both participants groups was done, and linked to the relevant literature This study created an understanding of the complexity of chronic illness. The themes identified, highlighted the importance of the patient-professional relationship, specifically in the context of chronic illness. / Psychology / M.A. (Clinical Psychology)

Upon close examination of Education White Paper 6: Building an Inclusive Education System, it became evident that, special schools have a crucial role to play. EWP6 clearly outlines the roles of special schools as resource centres. This entails a paradigm shift from a medical to a social model.The purpose of this research was to investigate the role of resource centres in supporting learners who require high levels of support, in an inclusive education system in the Pietermaritzburg district. The study was conducted at a special school with 23 respondents. The triangulated data were collected through participant observations, open-ended questionnaire and interviews. This study revealed that not only are SSRCs totally committed to the paradigm shift but SSRCs are “leading " the way with regard to implementing inclusive strategies like SIAS process, the curriculum changes and alternate means of assessment. SSRCs are valuable resources that are currently under utilized. / Inclusive Education / M. Ed. (Inclusive Education)

The National Commission of Special Needs in Education and Training (NCSNET) Document (1997) which portrays the new Education Policy in South Africa. clearly states that one of the crucial outcomes is that all possible barriers to learning must be eliminated so that all learners are able to actualise their full potential. Inclusive education, as embedded within the Education Policy, is regarded as an approach which will allow learners to actualise their full potential. This study is a critical reflection on whether inclusive education is practised in primary schools in the Thohoyandou area. The research findings indicated that inclusive education is not practised in the Thohoyandou area. A major factor or barrier in this regard is that teachers and principals are not empowered in terms ofknowledge to practise inclusive education. Other factors acting as barriers to the implementation of inclusive education are that the school buildings do not cater for physically and visually impaired learners as well as the attitudes of teachers, parents and peers are inclined to be negative towards learners experiencing barriers to learning. The community should also be educated and empowered to assist and understand these learners, who will become the future members of the community, more effectively, As inclusive education is one of the means whereby all learners are given the opportunity to actualise their full potential, these barriers must be addressed so that inclusive education can be practised in all primary schools in the Thohoyandou area. A few strategies to implement inclusive education in the Thohoyandou area are suggested by the researcher. / Educational Studies / M. Ed. (Special Needs Education)

Upon close examination of Education White Paper 6: Building an Inclusive Education System, it became evident that, special schools have a crucial role to play. EWP6 clearly outlines the roles of special schools as resource centres. This entails a paradigm shift from a medical to a social model.The purpose of this research was to investigate the role of resource centres in supporting learners who require high levels of support, in an inclusive education system in the Pietermaritzburg district. The study was conducted at a special school with 23 respondents. The triangulated data were collected through participant observations, open-ended questionnaire and interviews. This study revealed that not only are SSRCs totally committed to the paradigm shift but SSRCs are “leading " the way with regard to implementing inclusive strategies like SIAS process, the curriculum changes and alternate means of assessment. SSRCs are valuable resources that are currently under utilized. / Inclusive Education / M. Ed. (Inclusive Education)