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This study explores women's narratives from within and outside of the frail/non-frail binary of public home care services. It focuses on the stories that are commonly told about older women's needs and bodies and the regulatory potential of these accounts. Considering power, language, diversity and change, this study focuses on the way that twelve diverse older women at various social locations (e.g., ability, age, culture, ethnicity, 'race', sexual orientation, and socio-economic status) understand, make meaning, and negotiate the concept of frailty in relation to their everyday lives. The sample includes six women considered 'frail' in relation to service (i.e., according to clinical judgement & home care eligibility guidelines), as well as women not considered 'frail' (i.e., non-service recipients). / The twelve older women's storied responses, illustrations and experiences challenge the various stories that are told about them. Their complex accounts both reflect and reject dominant notions, blur the boundary between the frail and non-frail classifications, expose frailty as contextual, temporal and relative, as well as illustrate the connections between medical and social needs. Their individual accounts highlight how they make meaning of their life events in relation to their diverse experiences and identities, as well as how these identities and interpretations are key to their negotiations of life and needs. The variations between the imposed stories about frailty and women's self-perceptions highlight the research, policy and practice relevance of a narrative approach focused on in-depth local accounts, raise questions about the current priorities within home care services, as well as the future of social work practice with older women considered frail.

Thesis (MNursing)--University of South Australia, 2003.

Abstract: Introduction: The International Resident Assessment Instrument (InterRAI) is a service and needs assessment tool that the Ministry of Health (MoH) was recommended to use by a report “Assessment Processes for Older People” in 2003, authored by the New Zealand Guidelines Group (NZGG). The MoH has implemented a New Zealand wide pilot in order to test the feasibility of InterRAI’s use in the elderly population in New Zealand. Aim: The aim of the dissertation is to provide a descriptive analysis of data from the Canterbury District Health Board (CDHB) Pilot Trial of an InterRAI Homecare Assessment form as a means of assessing the care requirements of the elderly. The data had been collected from 264 people on one, two or three different occasions/assessments. Elderly in the CDHB’s population catchment’s area were assessed between 2005 and 2006, with participants throughout Christchurch and surrounding localities, e.g. Rangiora and Kaiapoi. At the time of assessment approximately 80% were community dwelling and about 20% were inpatients. The data were collected from 264 people on one, two or three different assessment occasions. Methods: The CDHB pilot study data was present in two databases, which was transferred and reformatted from an Excel Spreadsheet format to a statistical programme format for analysis, SAS-9 (2004). The elderly were assessed initially once (called Time One) but some were assessed multiple times, i.e. all participants 264 were assessed once (Time One), 147 (56.7 %) were assessed twice, 65 (24.6%) three times and ten (3.6%) four times. The results presented here are mainly of the first assessment only, as this is the total sample. Results and Discussion: There are 178 females and 86 males, ranging in age from 64 - 95, all English speaking and mainly, New Zealanders, of which most are married or are widowed. The mean and median ages are around 80 years of age. Overall, the reason for movement of elderly, i.e. change in Residential Type was ADL Decline. There was also some correlation with elderly person’s home environment. Possibly the only reason for a non-routine visit to hospital for an elderly person was that the person was alone i.e. no other means of help was available to them. The lack of secondary helpers for the elderly was also important in both elderly person’s movement and non-routine visits to hospital. Conclusions: The results have provided new information for the CDHB. However, more work is required, such as the ethnicity, age–gender range and service use. The CDHB are planning to implement the InterRAI assessment process, into the CDHB’s service delivery, for the elderly population, in Canterbury. Recommendations: Some more time dependent data needs to be analysed i.e. trend analysis across assessments. Further research could focus on two categories, disease coding and medicine usage.

As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particular reference to vitamin D levels. Two thousand and five men and women aged between 65 and 104 years were enrolled in the Falls and Fracture Risk in the Elderly Epidemiology (FREE) study between 1999 and 2003. The key findings from analysis of this population were firstly, that quantitative ultrasound (QUS) measures were higher in men than women independent of age, and that in men there was no significant decline in either BUA or VOS, but in women BUA declined by over 3% per decade and VOS by 1% per decade. Both ultrasound machines used in the study were shown to be reliable, with precision unaffected by advanced age. QUS was found to be sensitive to longitudinal change even in this frail elderly cohort. Vitamin D deficiency was found in the majority of elderly aged care facility residents but supplementation conferred higher serum 25-OH-vitamin D levels. Vitamin D levels were not shown to be related to BUA, VOS or the risk of falling in this population. Serum parathyroid hormone might be important in determining future falls risk. In summary, the results of this thesis give an important insight into the prevalence of osteoporosis and falls in the frail elderly, and how these might be predicted. Future study of prospective fracture rates in this group will then be able to assess relative risk factors for osteoporotic fracture, and identify those individuals who might benefit from directed fracture prevention strategies.

Thesis (Ph. D.)--University of Missouri-Columbia, 2000. / Typescript. Vita. Includes bibliographical references (leaves 134-140). Also available on the Internet.

Thesis (M.S.)--Boston University

Of all the injuries resulting from falls, hip fractures are often the most stressful and produce high levels of disability. The costs of hip fracture for Older Adults are considerable. These include risks of mortality, immediate morbidity associated with surgery, the loss of independence and long term deterioration in levels of functioning. In addition to any loss of function related to physical trauma, psychological trauma i.e. fear of falling, may also produce a decline in levels of physical and social activity which is self imposed. This study investigated the efficacy of a brief cognitive intervention in improving outcome amongst older adults after hip fracture. Two groups of participants were investigated with one group receiving the cognitive intervention and the other group treatment as usual. No significant effect was found in reducing fear of falling. However significant differences were found post-study in cognitive function, instrumental activities and duration of hospital stay suggesting that the intervention was effective in enhancing the outcome of rehabilitation. These results are discussed in relation to self-efficacy theory.

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