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<p>Major changes have occurred in South Africa over the past twelve years. The delivery of health care changed significantly. Community Health Centres (CHCs) became the main service delivery sites within districts. Due to socio-economic changes in the country, the care of dependants, particularly children and the aged, became problematic to families where most of the adult members have to work to secure an income. A focused literature search indicates that informal carers are ill prepared for their task, that there is a need to include these carers in the discharge planning of the dependants and that the carers need to be supported within their families and communities. The aim of this study was to explore the experiences of informal carers during the transition of their elderly dependants from hospital to home, within the home and across different social groupings in the metropolitan area of Cape Town, South Africa. In addition, the involvement of informal carers in the rehabilitation of the elderly was explored.</p>

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Dept. of Gerontology) / Simon Fraser University.

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Dept. of Gerontology) / Simon Fraser University.

Philosophiae Doctor - PhD / Major changes have occurred in South Africa over the past twelve years. The delivery of health care changed significantly. Community Health Centres (CHCs) became the main service delivery sites within districts. Due to socio-economic changes in the country, the care of dependants, particularly children and the aged, became problematic to families where most of the adult members have to work to secure an income. A focused literature search indicates that informal carers are ill prepared for their task, that there is a need to include these carers in the discharge planning of the dependants and that the carers need to be supported within their families and communities. The aim of this study was to explore the experiences of informal carers during the transition of their elderly dependants from hospital to home, within the home and across different social groupings in the metropolitan area of Cape Town, South Africa. In addition, the involvement of informal carers in the rehabilitation of the elderly was explored. / South Africa

Le vieillissement amoindri de façon régulière les capacités physiques, sensorielles et parfois cognitives des individus. Le vieillissement du corps transforme également l'image offerte à autrui et à soi-même. La perception que la personne âgée a alors d’elle-même est une question qui n’est pas sans conséquence. La perception réaliste de ses capacités physiques semble nécessaire dans la réalisation d’actes moteurs alors que la perception optimiste de soi et de l’environnement semble nécessaire au maintien du moral. Notre objectif est d’étudier de façon relativement globale la perception de soi chez la personne âgée. Pour cela, nous étudions les perceptions qu’ont les personnes âgées a de leurs propres capacités dans la réalisation d’actes moteurs (posturabilité sur pente, enjambement d’obstacle), la perception qu’elles ont d’elles-mêmes par la réalisation de questionnaires d’auto-évaluation, en particulier la perception qu’elles ont de leur âge. Nous examinons également les perceptions qu’elles ont d’autrui, en particulier celles qu’elles ont d’autres personnes âgées. L’objectif est d’étudier les impacts positifs et négatifs sur leur santé des perceptions correctes ou erronées des séniors. Nos deux premières études ont mis en évidence l’existence d’un biais de surestimation de capacités posturales chez les participants âgés, qui pourrait être en lien avec une vision positive d’eux-mêmes. Ensuite nos recherches de sont intéressées à l’existence de cette surestimation des capacités motrices chez les personnes âgées présentant une détérioration cognitive (Maladie d’Alzheimer à un stade débutant). Dans une seconde partie, nos recherches se sont tournées vers l’estimation que les personnes âgées ont d’elles mêmes, en étudiant en particulier l’auto-estimation et l’hétéro-estimation de l’âge. Nos études ont montré que les personnes âgées adoptaient en général une vision optimiste d’elles-mêmes et de leurs capacités motrices ne correspondant pas à la réalité. Cette vision optimiste, bien que permettant de maintenir un bon moral peut être liée à la mise en danger sur le plan moteur. / Elderly steadily diminished physical, sensory and sometimes cognitive individuals abilities. The aging body also converts the image presented to others and to oneself. The perception that the elderly person then herself is a question which is not inconsequential. Realistic perception of physical seems necessary in motor actions while the optimistic perception of self and the environment seems necessary to maintain morale.Our goal is to study a relatively comprehensive self-perception in the elderly. For this, we study the perceptions of older people has their own abilities in performing motor acts (posturability on slope, crossing over an obstacle), their perceptions of themselves by achieving of self-assessment questionnaires, particularly their perceptions of their age. We also examine the perceptions they have of others, especially those that have other seniors. The objective is to study the positive and negative impacts on their health perceptions of older correct or incorrect. Our first two studies showed the existence of a bias of overestimating postural abilities among older participants, which could be related to a positive vision of themselves. Then our research is concerned with the existence of this overestimation of motor skills in older people with cognitive impairment (Alzheimer's disease at a beginning stage). In the second part, our research turned to the estimate that seniors have of themselves, especially in student self-assessment and hetero-age estimation.Our studies showed that older people usually adopted an optimistic view of themselves and their motor skills do not match reality. This optimistic view, although to maintain morale may be related to the endangerment on the motor.

Orientador: Maria José D'Elboux / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-27T08:50:00Z (GMT). No. of bitstreams: 1 Silva_VanessaAbreuda_D.pdf: 2181192 bytes, checksum: f2b09456b1f7e48f3b035d252adb01da (MD5) Previous issue date: 2014 / Resumo: Este estudo teve como objetivo analisar os desfechos e fatores associados à síndrome da fragilidade de idosos atendidos em serviço de geriatria de um hospital escola. Trata-se de um estudo quantitativo, comparativo e com delineamento longitudinal, integrante da pesquisa maior intitulada "Qualidade de vida em idosos: indicadores de fragilidade e de bem-estar subjetivo", que compreende duas fases. Na Fase 1 (2005-2007), foram avaliados 150 idosos em acompanhamento no ambulatório de geriatria. Na Fase 2 (2013), os idosos foram novamente contatados, por telefone ou visita domiciliar, e submetidos, após o consentimento, a uma entrevista para a coleta de dados sociodemográficos, de saúde e funcionalidade. Foi adotado o fenótipo de fragilidade de Fried et al., 2001. Os desfechos estudados foram: queda, hospitalização, comorbidade e óbito. Na fase 2, dos 150 idosos participantes da primeira fase, 71 evoluíram a óbito e 25 foram excluídos. Assim, a amostra contou com 54 idosos respondentes, com predomínio do sexo feminino e idade igual ou superior a 80 anos. No que diz respeito à saúde e à funcionalidade, houve diferença estatisticamente significante entre todas as variáveis estudadas, com exceção do número de hospitalizações e do número de quedas. É notável o declínio da funcionalidade desses idosos, avaliada por meio dos instrumentos: SPPB, MIF e AIVD, cujas médias dos seus escores reduziram significativamente. O estado cognitivo também apresentou diferença estatística com redução da média do escore do MEEM na fase 2 (p<0,001). Quanto à fragilidade, houve aumento na média do número de critérios (3,83) quando comparados à fase 1 (2,43), e a maioria dos idosos pontuou para todos os critérios de fragilidade, com exceção para o critério "perda de peso não intencional". Houve aumento na proporção de idosos classificados como frágeis (50,0% fase 1 e 88,9% fase 2) e nenhum idoso foi considerado não frágil. O desfecho queda (fase 2) associou-se a hospitalização e com os critérios de fragilidade exaustão e perda de peso não-intencional na fase 1. O idoso que relatou hospitalização na fase 1 teve maior risco de hospitalização na fase 2. Do mesmo modo o desfecho comorbidade (Índice de Comorbidade de Charlson) foi associado a própria comorbidade na fase 1. Sobre o desfecho óbito verificou-se diferença significativa para a variável idade, níveis de fragilidade, comorbidade e o critério de fragilidade baixo nível de atividade física. Este estudo longitudinal proporcionou maior conhecimento sobre os eventos adversos da síndrome da fragilidade em idosos em acompanhamento ambulatorial / Abstract: This study aimed to analyze the outcomes and factors related to the frailty syndrome in a population of elderly patients treated in the outpatient geriatric service of a teaching hospital. This quantitative, comparative and longitudinal study is part of the larger research project "Quality of life in the elderly: frailty and subjective welfare indicators", conducted at the Geriatric Clinic of the Hospital of the State University of Campinas. This study used a convenience sample and had two phases (Phase 1 and 2). In Phase 1 (2005-2007),150 elderly patients followed up at the geriatric clinic were assessed. In Phase 2 (2013), the elderly were contacted again by phone or home visit and, after their consent, they were interviewed to collect sociodemographic and health data. Moreover, frailty was assessed according to the frailty criteria defined by Fried et al. (2001). The following events were considered as outcomes: fall, hospitalization, comorbidity and death. In Phase 2, of the 150 participants in Phase1, 71 died and 25 were excluded. Thus, Phase 2 sample had 54 respondents, predominantly women, and the rate of 80-year-old or older patients almost doubled (34% in Phase 1 and 64.4% in Phase 2). Concerning health and functionality, there was a statistically significant difference between all variables under study, except for number of hospitalizations and number of falls. The decline of functionalityis marked among these elderly and it was assessed using the tools SPPB, FIM and IADL, whose average scores decreased considerably. The cognitive state also showed a statistical difference, with a decrease in the average MMSE score in Phase 2 (p<0.001). As to frailty, the average number of criteria increased in Phase 2 (3.83) when compared to Phase 1 (2.43), and most of the elderly scored on all frailty criteria, except for "unintentional weight loss". The rate of the elderly classified as frail increased (50% in Phase1 and 88.9% in Phase 2) and none of the elderly was considered as non-frail. The outcome fall (Phase 2) was related to hospitalization and to the frailty criteria "exhaustion" and "unintentional weight loss" in Phase 1. Also was observed that the elderly who were hospitalized in Phase 1 were at a higher risk of hospitalization in Phase 2. As regards the outcome comorbidity (Charlson Comorbidity Index), the variable associated was comorbidity itself. Concerning the outcome death, we observed a significant difference in age, levels of frailty, comorbidity, and in the frailty criterion "low level of physical activity". This longitudinal study provided a more comprehensive knowledge of the adverse events of the frailty syndrome in the elderly followed up at an outpatient geriatric clinic. Therefore, we expect to contribute to more efficient public policies for the elderly population, considering the phenomenon of population aging and the magnitude of the frailty syndrome / Doutorado / Enfermagem e Trabalho / Doutora em Ciências da Saúde

BACKGROUND: Approximately one-third of community dwelling elderly people (age ≥65 years) falls each year contributing to over 2 million elderly emergency department (ED) visits for falls annually. The cost of care for fatal falls by elderly patients in the US was $179 million in 2000, and was $19 billion for non-fatal falls. The risk of falling increases with various risk factors including advancing age. Despite the frequency and costs associated with elderly falls, it is not clear what evaluation elderly fallers receive in the ED, after the ED, and the outcomes of the care provided. OBJECTIVES: We sought to examine the ED and post-ED workup of elderly fallers, and to compare this evaluation to that recommended by published ED fall evaluation and treatment guidelines. We also examined the disposition of these patients and the rate of adverse events which occurred within 1 year of discharge. METHODS: This study was a retrospective chart review of elderly ED fall patients from one urban teaching hospital with >90,000 visits per year. Patients aged ≥65 years who had an ED visit in 2012 with fall related ICD-9 codes E880-886, E888 and who had been seen by a primary care physician (PCP) within our hospital network during the past 3 years were included. We excluded patients who were transferred to our hospital and subsequent visits related to the original fall. We randomly selected 350 eligible patients for chart review. We adapted our data collection instrument from published fall evaluation recommendations including the American Geriatric Society. Categorical data were presented as percentages and continuous data were recorded as mean with standard deviation (SD) if normally distributed or medians with inter-quartile ranges (IQR) if non-normally distributed. RESULTS: A random sample of 450 charts were taken, 100 were subsequently excluded for erroneous identification. The average age was 80 (SD±9) years; 124 (35%) were male, with an average Charlson comorbidity index of 7.6 (SD 2.9). In terms of history, 251/350 (72%) took 5 or more medications, 144/350 (41%) had their visual acuity checked in the past 12 months, and 34/350 (10%) had fallen two or more times in the past 3 months. In the physical exam, only 43/350 (12%) had orthostatics done. 168/350 (48%) patients had their extremity strength recorded, of these 16/168 (10%) had decreased muscle strength. Only 128/350 (37%) patients had their gait recorded, of which 108/128 (84%) were noted to have an abnormal gait. Basic chemistry laboratory tests and hematology were sent on 199/350 (57%) of patients in the ED. X-rays were taken of 275/350 (79%) patients, and CTs were taken of 184/350 (53%) patients in the ED. 277/350 (79%) patients were discharged to their place of preadmission residence from the ED, ED observation unit, or hospital while 70/350 (20%) were discharged to a skilled rehab facility, all after being admitted to the hospital. 196/350 (56%) patients returned to the ED for any reason within 1 year of discharge, averaging 2.4 ± 1.9 visits. 161/350 (46%) patients were hospitalized within 1 year after discharge, averaging 2 ± 1.4 hospital admissions. 23 (7%) of patients died within 1 year after discharge. CONCLUSION: The comprehensive evaluation of falls for well-established risk factors and causes appears to be poor in this academic medical center ED. While results may not be generalizable to other EDs, the results suggest that standardized evaluation and treatment guidelines are needed.

The purpose of this thesis is to examine how the elderly people experience the food on a sheltered accommodation. We will examine nutrition in the food and if the elderly people have an influence on food they gets everyday. The aim of this study was to examine older persons’ everyday experiences of food within the context of homes for the elderly. More specifically, nutrition and the personal experiences of influence concerning choice of food were examined. The study was performed by means of a qualitative approach involving interviews with both personnel and elderly persons themselves within two homes for the elderly, both located in the same city in southern Sweden. The results of this study indicate that elderly persons tend to experience less influence on the everyday choice of food. However, this is partly contradicted by the personnel concerning their explicit involvement of the elderly when composing weekly menus.

The purpose of this study was to describe the experiences of elderly people caring for HIV positive orphans on antiretroviral treatment in Swaziland. An exploratory, descriptive and contextual qualitative study based on a phenomenological approach was conducted. Data was collected by means of semi structured interviews with twelve elderly people purposively selected at Mbabane Government Hospital antiretroviral treatment clinic. The findings of the study highlighted that the elderly people were giving care under compulsion with very little support from the government, the community or other organisations. Their care giving capacity was compromised by many challenges which included the heavy burden of caring for a number of dependents; economic constraints; poor infrastructure; food insecurity, and physical, psychological and social constraints. The elderly were employing a number of coping strategies to counteract the challenges that they were facing. The researcher concluded that the elderly people were vital in ensuring the survival of sick orphans under the paediatric antiretroviral treatment programme in Swaziland if afforded sufficient support and empowerment. / Health Studies / M.A. (Public Health)