The cognitive aging literature contains abundant evidence of the natural vulnerability of the frontal areas of the brain and the associated impact on higher-order cognition. Namely, Executive Functions (EFs) have been repeatedly shown to decline steadily after 60 (Schaie, 2013). These age-related changes are said to impact most aspects of everyday life including quality of life (QoL; Davis et al., 2010), a key variable with regards to health, social service interventions and evidence-based clinical practices. Deepening our understanding of potential moderators of cognitive aging such as QoL is crucial to promoting well-being in the growing older adult population. The overarching aim of this study was to investigate the moderating role of QoL over age-related EFs differences. A seminal taxonomy of EFs (Miyake et. al, 2000, 2012) and the work of the World Health Organization (WHO) on QoL (Power et al., 2005) inspired this endeavor. Six tasks of EFs related to Shifting, Updating, and Inhibiting and self-reported QoL based on the WHOQOL-BREF and -OLD were utilized with 102 community-dwelling, healthy older adults (M = 73.11 years; age range: 60 - 94). A moderation analysis was used to assess if QoL (moderator) buffers the relationship between age (IV) and EFs indicators (DV). Regression and MANCOVA analyses were conducted to evaluate age-related differences in EFs and the following prominent theories: the processing speed theory (Salthouse, 1996), inhibition deficit theory of cognitive aging (Hasher & Zacks, 1988), and dedifferentiation hypothesis (Garrett, 1946). As predicted, age significantly contributed to task performance for most EFs indicators, above and beyond processing speed. As expected, statistically significant moderation interactions were found for several executive indicators and QoL domains, illustrating the buffering role of QoL over age-related differences in EFs. Specifically, QoL items related to the environment, sensory abilities, and social engagement domains, and EFs indicators related to Inhibiting, showed the most notable moderating effects. Implications for these results and the role of covariates were discussed. An emphasis was placed throughout on the importance of investigating QoL variables and other moderating factors of cognitive aging, for the development of prevention and intervention endeavors with older adults. / Graduate

Dementia is a progressive condition that can profoundly affect the lives of individuals and their families. With no known cure for the disease, the focus has shifted towards promoting well-being and enabling individuals to maintain an optimum quality of life. Understanding of the perspectives of both people with dementia and their carers in this area will provide greater insight into to the provision of dementia care services. The first paper systematically reviewed the literature exploring the level of agreement between self and family-proxy ratings of patient quality of life. Twenty-six studies were identified for review. The overall level of agreement between ratings was low. Patients were found to consistently rate their quality of life as higher, compared to family-proxy ratings. A range of factors influencing this discrepancy were identified: neuropsychiatric symptoms, cognition, awareness of disease, caregiver burden and stress, relationship factors, activities of daily living and sociodemographic characteristics. The need for further interventions to address these factors is highlighted, as well as implications for future research. The second paper aimed to explore people with dementia and their carers lived experience of social interaction and communication after attending a Cognitive Stimulation Therapy (CST) group. Interpretative Phenomenological Analysis revealed six superordinate themes. These captured the difficulties faced by people with dementia in accessing social opportunities and the positive experience of being in the CST group. Several challenges experienced by carers were highlighted and the subsequent impact this had on their emotional well-being. Improvements for people with dementia were noticed in areas of social communication, confidence and emotional wellbeing, with no noticeable change in memory. Carers expressed a desire for on-going support and intervention following the group. These findings have important implications for future research, dementia care and increased carer support.

Magister Chirurgiae Dentium (MChD) / Introduction:Hereditary Epidermolysis bullosa (EB) is a group of rare mechanobullous dermatological disorders in which blisters develop following gene mutations. These genes encode structural proteins that anchor the epidermis to the underlying dermis.There are four main types of Epidermolysis bullosa, with more than 20 subtypes. The medical, physical and psychosocial aspects of Epidermolysis bullosa are well documented (Lucky et al, 2005; Mellerio et al, 2005). Many studies have documented case reports of associated oral lesions (Silva et al, 2004; Pacheco and de Sousa Araugio 2008; Siqueira et al, 2008). However, no assessment of the impact of these oral lesions on the affected person's everyday life has been made. The morbidity of the oral lesions associated with EB is expected to have an impact on the quality of life of these patients.Aim:To assess the prevalence and impact of oral lesions on daily activities in persons with Epidermolysis bullosa in Cape Town, South Africa, utilizing the Oral Impact on Daily Performance (OIDP) measure. Research Design and Methodology A case-controlled, descriptive analysis of the way in which oral lesions impact on quality of life in persons with Epidermolysis bullosa was carried out using semi-structured interviews. Fourteen persons with a confirmed diagnosis of hereditary Epidermolysis bullosa who attended the dermatology clinics at the Red Cross and Groote Schuur hospitals participated in the study. The control group comprised eighteen persons closely matched for gender, age, and dental status. Three persons with EB were unavailable for inclusion in the study.Results and Discussion Fourteen persons with Epidermolysis bullosa and eighteen controls were included in the study. Epidermolysis bullosa Simplex comprised the largest sub-group (n=9). Two persons had Junctional Epidermolysis bullosa, two had recessive Dystrophic Epidermolysis bullosa and one person had Kindler syndrome. The oral manifestations observed were consistent with those reported in the literature(Chimenos et al, 2003; Silva et al, 2004; Pekinar et al, 2005). No significant oral lesions (other than tooth decay) were seen in persons in the Epidermolysis bullosa Simplex group. Oral ulcers, atrophy of the dorsal surface of the tongue and gingival erythema were seen in persons with Junctional Epidermolysis Bullosa. The two individuals with Dystrophic Epidermolysis bullosa had a maximal oral opening of 15mm and 24mm. Ankyloglossia, depapillation of the dorsal tongue, absence of palatal rugae and poor oral hygiene was seen in these two persons. The patient with Kindler syndrome presented with erythematous and inflamed gingiva and cratering in the maxillary anterior interdental area. The gingiva appeared desquamative, fragile and bled with even the slightest provocation. Healing peri-oral blisters and angular cheilitis was also seen. His mouth opening was restricted to a maximal oral aperture of 13mm and his tongue extrusion was limited to only the tip of the tongue passing over the lower anterior incisor teeth.Defects in the tooth enamel was recorded in both participants with Junctional Epidermolysis bullosa and one person with dystrophic Epidermolysis bullosa, as well as excessive occlussal tooth wear (attrition), which may have been secondary to enamel hypoplasia. The dental caries status of the Epidermolysis bullosa and control groups varied according to age. The dmf for persons with Epidermolysis bullosa (all of whom had Epidermolysis bullosa Simplex), was lower than in the control group. The DMF in EB persons (15.3) was higher than in the control group (10.1).Toothache and tooth decay were the most common perceived complaints in both the Epidermolysis bullosa and control participants, accounting for the high overall OIDP score in both groups (87.5%). No statistically significant difference was found between the two groups (85.7% and 88.9% for Epidermolysis bullosa and control group persons respectively).Conclusion:The results of the study show that oral lesions (particularly tooth decay and toothache) in persons with Epidermolysis bullosa do affect their daily activities and the impact thereof is high. Other oral manifestations, irrespective of the subtype, had little impact on the OIDP score. This may be because the EB persons become tolerant of and “learn to cope” with them.Recommendations:Epidermolysis bullosa is a rare condition and not all persons with EB will present with lesions. However, all health personnel (including oral health profession) must be cognizant of this condition, in order to manage these persons safely, without incurring harm inadvertently. Thus, the overall management of persons with Epidermolysis bullosa must encompass ways to minimize and prevent trauma; provide an optimum wound healing environment; provide pain management and judicious checks for the development of premalignant lesions. This necessitates a multidisciplinary and holistic approach, with emphasis on patient involvement. To this end, an oral health care programme should form an integral part of their management because of the risk of dental disease. Periodic recall visits will enable the monitoring of home care and minimize the need for advanced restorative procedures. In this way, one may reduce the impact any oral problems may have, so that they do not further influence the patients well being.

Magister Artium - MA / In this thesis I present – from the perspective of the capability approach and within the context of South Africa – a conceptual analysis of the relationship between quality of life, education, poverty and inequality. The role of education within the South African context is of particular importance. The capability approach, which was pioneered by economist-philosopher Amartya Sen and significantly further developed by philosopher Martha Nussbaum and a growing number of other scholars across the humanities and social sciences, is a theoretical framework for the assessment and comparison of quality of life and social justice. The argument is made that when inquiring about the prosperity of a nation or region in the world, traditional economic approaches – such as gross domestic product (GDP), which is the most commonly used indicator of economic activity – are not, by themselves, accurate or adequate. When assessing individuals and societies‟ quality of life and sense of well-being, we need to know not only about their levels of income, wealth, or consumption; but also about the opportunities they have, or do not have, to choose and to act. The capability approach provides a more comprehensive conceptualisation of quality of life, because it takes into account broader and more encompassing measures of well-being. Conceptualising quality of life from the perspective of the capability approach, makes it clear that large numbers, if not the vast majority, of people experience many forms of unfreedom that impedes their development (i.e. their freedom to choose), and prevents them from leading lives they consider valuable and worthwhile. Many people lack capabilities. The capability approach asserts that the expansion of the real freedoms that people enjoy (i.e. what people are effectively able to be and to do) is both the primary end and the principle means of development. Expansion of freedom equates to enhanced individual agency as a result of an increase in capabilities. Furthermore, individual agency is central to addressing various deprivations (both individual and societal).

Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: Osteoarthritis (OA) is one of the prevalent debilitating diseases in South Africa, often leading to activity limitations, participation restrictions and a poor quality of life. Older people often lead more sedentary lifestyles, which may further aggravate their symptoms. Exercise therapy has demonstrated good outcomes in the OA population. Many dance interventions have become popular in OA treatment and results suggest their effects to be more successful than traditional physiotherapy exercises regimes. Ballet dance exercises have not yet been explored in the treatment of OA, even though it has been proposed to have positive effects on the body. Purpose: to determine the effect of a program of ballet dance exercise classes on BMI, perceived pain, physical function and quality of life in patients with osteoarthritis (OA) of the hip and knee, compared to the existing Midros Clinic program of exercise classes. Methods: The study used a randomized, cross-sectional, quantitative, experimental study using pre- and post-intervention as well as multiple time-point testing. A sample of 52 males and females were recruited in Midros, Middelburg Cape. The inclusion criteria of the study were persons aged 65 years and older, with OA of the hip and/or knee, clinically diagnosed according to the criteria of the American College of Rheumatology. The VAS, Timed Up and Go Test (TUGT), WOMAC and the SF-8 Index, respectively measured reported perceived pain, physical function, quality of life and health status in the study groups. BMI, pulse and blood pressure were also recorded to further monitor the effects of the interventions. A comparable number of scores were obtained over six weeks of bi-weekly ballet exercise classes (intervention group = IG), and nine weeks of two-weekly exercise classes at the Midros Clinic (comparison group = CG). Descriptive statistics were used to analyse the demographic information and inferential statistics were used to determine the associations for parametric data; a two tailed p-value was calculated; the 95% CI was calculated using the approximation of Katz. The p-value was classified as significant if p<0.05. Results: The demographics and baseline measurements of the IG and CG were comparable. A series of five exercise classes (over nine weeks) had a significantly beneficial effect on BMI and systolic BP, perceived and actual physical function, and QOL, whereas a series of 12 ballet exercise classes ( over six weeks) had a significant positive effect on BMI and diastolic BP, perceived pain, perceived physical function, and QOL. The comparison of responses to the outcome measures by male and female participants demonstrated that, contrary to findings in the reviewed literature, females held more positive perceptions than males on their perceived severity of joint pain and function, physical and mental health, and well being. A series of the existing exercise classes of Midros Clinic brought about more significant changes than a program of ballet exercise classes in the research parameters measured, despite exercise classes taking place much less frequently than the ballet classes. Conclusion: Although both interventions were found to both bring about positive changes in older persons with OA, a series of ballet exercises classes did not result in better outcomes than the currently existing Midros Clinic group exercise classes. The results of the current study demonstrate that exercise interventions are found to be the most beneficial in improving the quality of life of OA sufferers.

Magister Chirurgiae Dentium - MChD / Aim: To assess the change in the quality of life of patients while on the third molar surgery waiting list. Introduction: A large number of patients routinely present at the Tygerberg Oral Health Centre for removal of symptomatic impacted third molars. This results in many patients being placed on a surgical waiting list. In addition, many patients who have been placed on this waiting list return for adjunctive interventions, indicating a possible decrease in Quality of Life (QoL) over the waiting period. Numerous studies document post-surgery changes in QoL in patients that have had third molars removed. Many other studies detail QoL changes in patients awaiting orthopaedic and general surgery procedures. However, no study could be found that dealt with changes in QoL while awaiting third molar surgery. Materials and Methods: This is a prospective questionnaire-based study. It compares QoL at the beginning and the end of the waiting period for the removal of impacted third molars in order to determine whether a change in QoL occurs during the waiting period. The study sample was made up of 48 patients who met the inclusion criteria. Results: The present study shows that patients presenting with symptomatic impacted third molars have a decreased QoL at baseline, which further deteriorates over the waiting period. Although the overall change is negative, it is not statistically significant. This suggests that the null hypothesis cannot be excluded, and that it is therefore acceptable for patients to be managed on a waiting list. Conclusion: Third molar surgery results in a greater decrease in mental than physical wellbeing. The results in this study regarding a negative change in QoL was found not to be statistically significant. Only three out of 48 patients required emergency intervention. It can thus be concluded that placing patients on a waiting list for third molar surgery is acceptable.

Please read the abstract in the section 00front of this document / Thesis (DPhil)--University of Pretoria, 2010. / Medical Oncology / unrestricted

Background: Stroke is the disease that leads to most days of care in hospitals and which leads to the most disabilities in adults. With these disabilities, the patient often end up in a dependence to both relatives and healthcare professionals to cope with their daily lives. Previous research on family experience shows that they feel regret, stress and do not find time for relaxation. Describing how people experience their quality of life and their everyday life after stroke is important in order to give the nurse a better insight and understanding of the care of these patients.   Aim: To describe how people perceive their quality of life and their daily lives after a stroke and describe the study groups in the selected articles.   Method: A descriptive literature study. 13 scientific articles were used, with both quantitative and qualitative approaches.   Results: When the authors compiled the thirteen articles of this literature study, a continuous theme was seen on how stroke affected the quality of life of the participants and their everyday life. Stroke led to a changed life, both physically and mentally. Many suffered from speech disorders and disabilities, which meant isolating themselves from society. Quality of life was considered to be done by itself, having goals in life and having good social relations. To not have to rely on others and to be independent was a goal that the stroke sufferers constantly sought after.   Conclusion: Both physical and psychological problems arise that affected everyday life after a stroke. Finding new meaningful activities, establish goals, managing oneself and having good social relationships were important for a good quality of life after a stroke.

Due to the increasing healthcare costs and reduced length of hospital stay it is becoming increasingly important to identify individuals who are ‘at risk’ of experiencing long-term health issues. The purpose of the study was to: (1) determine if resilience, self efficacy and depression changed from inpatient to 3-month follow up; (2) examine the relationship between resilience, self efficacy, depression, and quality of life (social roles/activity limitations) at inpatient and 3-month follow up; and (3) identify if resilience at inpatient is related to change scores in selfefficacy and depression at 3-month follow up. Results from the paired sample t-test indicated that participants did not experience a significant change from inpatient to 3-month follow up in resilience or self-efficacy, but a significant decrease in depression was observed. Findings also indicated significant correlations between resilience, self-efficacy, and depression during inpatient stay and resilience, self-efficacy, depression, and quality of life at 3-month follow up. However, there was no relationship found between resilience and change scores in self-efficacy and depression. Future resilience research should continue to identify the variables that are most strongly related to resilience so effective interventions can be developed that improve rehabilitation outcomes, decrease secondary and chronic conditions as well as aid in the successful reintegration of individuals into their lives after a traumatic injury.

Abstract: En av de vanligaste folksjukdomarna i Sverige är demenssjukdomar. Personer med demenssjukdomar är i behov av vård och omsorg och ett hälsosamt liv med meningsfulla sysselsättningar. Syftet med denna litteraturstudie är att kartlägga vad aktuell forskning säger om aktiviteter för personer med demenssjukdomar och dess koppling till individens livskvalitet. Metoden som användes var en litteraturstudie med hjälp av scoping metoden som följer en sexstegsmodell som är framtagen av Arksey & O´Malley, (2005). Efter sökningen i databaserna Pubmed, Cinhal och Psykmed framkom det åtta artiklar som granskades. Resultaten visar att Gemenskaper, kunskaper om individens tidigare liv, individen i fokus och meningsfulla metoder har stor påverkan på personens livskvalitet. Det är genom personalens omvårdnad, respekt och professionellt bemötande den enskilde får uppleva trygghet och livskvalité. Individanpassade aktiviteter minskar ensamhet och isolering / Abstract: One of the most common public diseases in Sweden is dementia. People with dementia diseases need care and a healthy life with meaningful daily activity. The purpose of this literature review is to compile what current research says about activities for people with dementia diseases. Metod: A literature review was conducted using the scoping method following a six-step model developed by Arksey & O´Malley, (2005). Following the search in the databases Pubmed, Cinhal and Psykmed, the eight articles were examined. Results: shows that communities, knowledge of the past life of the individual, the individual in focus and meaningful methods greatly affect the person's quality of life. It is through the staff's nursing, respect and professional response, the individual's experience of safety and quality of life. Individual activities reduce loneliness and isolation.