This descriptive correlational study was designed to examine the relationship between situational control, and both psychological and physical well-being, in the institutionalized elderly. A convenience sample of 52 elderly institutionalized subjects was selected from two intermediate care facilities. The subjects completed the Perceived Weil-Being Scale, the Situational Control Of Daily Activities Scale, and the Subject Information Sheet. All residents were found to have an overall perception of situational control. However, residents perceived a lack of control for the daily activities of eating and grooming. The majority of residents obtained a moderately high score on the psychological well-being and physical well-being scales. No significant relationship was found between situational control and psychological well-being, or situational control and physical well-being. A significant positive relationship was found between psychological well-being and physical well-being. / Applied Science, Faculty of / Nursing, School of / Graduate

A trend toward non-institutionalization of the elderly, in conjunction with the increasing size of the elderly population has resulted in the development of a variety of community programs and services to help meet their complex and diverse health care needs in the community setting. Although there is substantial documentation pertaining to the needs of the elderly in the community and the available services (Lifton, 1989; Padula, 1983; Starrett, 1986; Wallace, 1987), this documentation has been generated primarily by health care professionals and agencies, rather than from the perspectives of the elderly themselves. Adult Day Care [ADC] programs were established in the late 1960s as one means of attempting to meet the needs of the frail elderly in the community (Padula, 1983). On the surface, these programs appear to be effective in meeting the needs of clients through the provision of nursing services and a wide variety of therapeutic programs and social activities. This exploratory descriptive study was based on the premise that there exists a need to gain insight into the clients' perspectives regarding the ways in which ADC services are instrumental in meeting their perceived needs. Data were collected and analyzed to identify the self-perceived needs of ADC clients and their perceptions of how the ADC nursing services were instrumental in assisting them to meet these needs. Two interviews were conducted with each of the 11 ADC participants comprising the sample, using a semi-structured interview guide developed by the researcher. The two needs most commonly identified by participants included the need to cope with a range of concurrent and/or successive losses, and the need to establish new support systems. Participants identified the most significant components of the nursing role as those of the provision of emotional support through counselling, and the provision of health monitoring services. Participants viewed the overall ADC program as important in assisting them to meet their needs by providing access to social outings, individualized care, emotional support, and the opportunity to enhance their self-esteem, confidence, and feelings of belongingness. / Applied Science, Faculty of / Nursing, School of / Graduate

The treatment of spontaneous pneumothorax in the civilian population can be influenced by the age of the patient and the presence of associated pulmonary disease. The medical records of 130 patients who presented with 168 occurrences of SP were reviewed during an 11-year period (1973 to 1984). Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). The therapeutic options included observation alone (40 occurrences), thoracentesis (6 occurrences), chest tube thoracostomy (102 occurrences), and thoracotomy (20 occurrences). Treatment of SP should be prompt with the objective of complete re-expansion of the lung and prevention of recurrent pneumothorax. This should be accomplished by the use of chest tube thoracostomy with early addition of thoracotomy as necessary. Selected use of thoracentesis can be effective. The use of observation alone can be dangerous and is associated with a higher recurrence rate.

No / PURPOSE: Epidemiologic research has shown that multifocal spectacle wearers (bifocal and progressive addition lenses [PALs]) are more than twice as likely to fall than are nonmultifocal spectacle wearers, with this risk further increasing when negotiating stairs. The present study investigated whether step and stair descent safety is improved by using single-vision distance lenses. METHODS: From a stationary standing position on top of a block, 20 long-term multifocal wearers stepped down (from different block heights) onto a lower level wearing bifocal, progressive addition, or single-vision distance lenses. RESULTS: Use of single-vision distance spectacles led to an increased single-limb support time, a reduced ankle and knee angle and vertical center-of-mass velocity at contact with the lower level, and a reduced ankle angular velocity and vertical center-of-mass velocity during initial landing (P < 0.03). These findings indicate that landing occurred in a more controlled manner when the subjects wore single-vision distance spectacles, rather than tending to "drop" onto the lower level as occurred when wearing bifocals or PALs. CONCLUSIONS: Use of single-vision distance spectacles led to improvements in landing control, consistent with individuals' being more certain regarding the precise height of the lower floor level. This enhanced control was attributed to having a view of the foot, step edge, and immediate floor area that was not blurred, magnified, or doubled and that did not suffer from image jump or peripheral distortions. These findings provide further evidence that use of single-vision distance lenses in everyday locomotion may be advantageous for elderly multifocal wearers who have a high risk of falling.

No / INTRODUCTION: Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK care homes, and to identify their causes. METHODS: A prospective study of a random sample of residents within a purposive sample of homes in three areas. Errors were identified by patient interview, note review, observation of practice and examination of dispensed items. Causes were understood by observation and from theoretically framed interviews with home staff, doctors and pharmacists. Potential harm from errors was assessed by expert judgement. RESULTS: The 256 residents recruited in 55 homes were taking a mean of 8.0 medicines. One hundred and seventy-eight (69.5%) of residents had one or more errors. The mean number per resident was 1.9 errors. The mean potential harm from prescribing, monitoring, administration and dispensing errors was 2.6, 3.7, 2.1 and 2.0 (0 = no harm, 10 = death), respectively. Contributing factors from the 89 interviews included doctors who were not accessible, did not know the residents and lacked information in homes when prescribing; home staff's high workload, lack of medicines training and drug round interruptions; lack of team work among home, practice and pharmacy; inefficient ordering systems; inaccurate medicine records and prevalence of verbal communication; and difficult to fill (and check) medication administration systems. CONCLUSIONS: That two thirds of residents were exposed to one or more medication errors is of concern. The will to improve exists, but there is a lack of overall responsibility. Action is required from all concerned.

Sarcopenia is a condition that is most common in aged animals, and is characterized by the loss of skeletal muscle mass and integrity, and can lead to physical disability and poor quality of life. Since skeletal muscle protein synthesis can be limited by the availability of amino acids, supplementation of limiting amino acids to ameliorate the progression of sarcopenia has become a topic of interest in companion animal research. Although there is some data to support the idea that amino acid supplementation improves maintenance of muscle mass in aged horses, the cellular mechanisms behind that improvement have yet to be elucidated. Therefore, the objective of this study was to examine the effect of amino acid supplementation in aged horses on markers of whole body and muscle protein metabolism. In a cross-over design, six old horses were studied while receiving each of three treatments in a replicated Latin square design. For all three treatments, horses received 1.8% BW/d of timothy hay cubes and 0.5% BW/d of experimental concentrate. The three treatments included a control (CON) treatment concentrate that was designed to meet all requirements of mature horses when fed in combination with the timothy hay cubes, and two supplemented concentrates, LYS/THR with additional lysine and threonine (40 mg/kg BW/d and 31 mg/kg BW/d, respectively), and LYS/THR/MET with additional lysine, threonine, and methionine (40 mg/kg BW/d, 31 mg/kg BW/d and 11mg/kg BW/d respectively). In each 15 d period, following a 9-day adaptation, horses were fitted with a collection harness, and total urine and feces were collected for 72 hours for assessment of nitrogen balance and creatinine output. Blood samples were taken directly before feeding and 30, 60, 90, 120, 150, 180, 210, and 240 minutes post-feeding for analysis of plasma urea nitrogen (PUN), glucose, insulin, and plasma amino acid concentrations. Muscle biopsy samples were taken for analysis of proteins in the mTOR pathway. Additionally, horses underwent stable isotope infusion procedures, and comparisons of phenylalanine kinetics were used to determine whole-body rates of protein synthesis and degradation. There was no significant effect of treatment on creatinine output (P=0.58), relative abundance of proteins in the mTOR pathway (P>0.05), nitrogen retention (P=0.70), or phenylalanine kinetics (P>0.05). PUN concentrations were significantly (P=0.0058) higher for LYS/THR and LYS/THR/MET than for CON. Atrogin-1 activation was significantly higher for the pre-feeding CON sample compared to the post-feeding CON sample. Lack of significant difference in creatinine output suggests that there were not significant differences in muscle mass between treatments. Lack of significant differences in mTOR protein activation suggests that amino acid supplementation did not result in improvements in protein synthesis. Lack of significant differences in nitrogen retention and phenylalanine kinetics suggests that whole-body protein metabolism was not improved. Additionally, higher PUN concentrations in the supplemented diets suggests that the supplemented amino acids being provided were catabolized. However, increased activation of Atrogin-1 in the pre-feeding CON samples, but not the pre-feeding samples of supplemented treatments, suggests amino acid supplementation may have reduced protein degradation in the post-absorptive state. Data from the present study suggests that amino acid availability may not have been limiting protein synthesis in the sedentary aged horses in the present study.

published_or_final_version / Sports Science / Master / Master of Science in Sports Science

The objective of this study was to compare the effects on eating behavior, lipids, lipoproteins, lipid peroxidation, and glycemic control in women with type 2 diabetes of a high-monounsaturated fat diet (HM) compared to a high-carbohydrate diet (HC). In an outpatient feeding study, ten hypertriglyceridemic postmenopausal type 2 diabetic women alternately for six weeks consumed the HM and HC diets. On the HM diet, 45% of total calories were consumed as carbohydrate and 40% as fat (27% monounsaturated) compared to 55% carbohydrate and 30% fat (10% monounsaturated) in the HC diet. At the beginning and end of each diet phase, total lipids, lipoproteins, lipid peroxidation, and glycemic variables were measured. For 8 days in each diet phase eating pattern frequency, palatability of foods, hunger and fullness were assessed. At the end of each diet phase, taste testing to determine preference for fat was conducted. Total cholesterol was significantly decreased on the HC diet. Serum triglyceride, very low density lipoprotein (VLDL) triglyceride and cholesterol, and apolipoproteins A-1 and B were not significantly different on the two diets. When comparing initial to final values, both diets lowered LDL-C; however, the change was greater on the HM diet. Lipid peroxidation variables improved when the HM diet was consumed. Glycemic variables improved on both diets. No significant differences between total number of eating episodes on the HM and HC diet phases were found. Both diets were rated as highly palatable. Hunger and fullness ratings varied within and between subjects. However, fullness was more commonly experienced than hunger on both HM and the HC diet. Preference for fat was not found at the end ofHM or HC diets. However, subjects differed significantly in ratings for liking of foods that were salty, sour, and bitter when compared to nondiabetic women. Consumption of the HM and HC diets did not result in deterioration of lipid status. The HM diet by virtue of less oxidation of the LDL particle and improvement of glycemic control provides an important advantage over the HC diet. A description of eating behavior of women with type 2 diabetes emerged. / Graduation date: 2000

Nutrition and health-related risk factors could be identified through the implementation of the nutrition preventive strategies, such as nutrition screening, for the Chinese elderly population who are at high risk of malnutrition. Efficacious culturally sensitive nutrition assessment tools and nutrition screening tools hold the most essential value to assess the nutritional health status among the Chinese elderly. A standardized nutrition screening tool, the DETERMINE Checklist, has been used to determine the nutritional health risk status among the elderly but not the Chinese elderly. Focus group research developed cultural appropriate dietary assessment tools, the food inventory list and Chinese food photos, to evaluate the adequacy of food consumption. A case study used the Nutrition and Health Related Questionnaire to evaluate the efficacy of the standardized DETERMINE Checklist. The Nutrition and Health Related Questionnaire included a dietary assessment method, the 24-hour dietary recall, and the modified DETERMINE Checklist was developed from the integrated questions of the standardized DETERMINE Checklist and Level I Screen. The efficacy of the standardized checklist, the sensitivity and specificity, among fifty-eight Chinese elderly age 70 or older, was evaluated through the comparison of the adequacy of food consumption and the identification of the nutritional health risk status. Results showed that the majority (95%) of the Chinese elderly participants had inadequate food consumption as measured by the U.S. Food Guide Pyramid. The standardized DETERMINE Checklist was not sensitive (40%-60%) or specific (63.6%-46.1%) in evaluating the nutritional health risk status among this population. The conclusion from this study was the modified DETERMINE Checklist designed for this study included questions with a single perspective in assessing the inadequacy of food consumption and the physical inability, to identify the level of severity on the nutritional health risk status better than the standardized DETERMINE Checklist. The research prototype model provided a base assessment process of the nutritional health risk status for the minority Chinese elderly. Complex interactions between acculturation, language competency, accessibility of cultural food, and socioeconomic factors related to the nutritional health risk status are needed for further qualitative research investigations. / Graduation date: 2000

The purpose of this study was to identify variables that facilitate lay caregivers in maintaining dependent elders in the home setting. Specifically, this study: (1) tested a deduced theory designed to explain home maintenance of a dependent elder; (2) examined the relationship between the following variables: Seriousness of an Elder's Illness, Caregiver Overload, Quality of Care, Learning State, Caregivers Maintenance Ability, Acceptance of the Maintenance Role and the Caregiver's Perception of Power; and (3) evaluated the reliability and validity of the instruments that measured the proposed variables. A descriptive correlational design with causal modeling methodology was used to assess a five stage theory. The convenience sample was comprised of 70 English speaking caregivers providing a minimum of five hours of direct care to a dependent elder in the home setting. Reliability and validity of the instruments used to evaluate the theoretical concepts were assessed by Cronbach's alpha, factor analysis and predictive model testing. Multiple regression statistics were used to evaluate the theory and residual analysis was used to assess violations of statistical and causal modeling assumptions. The findings supported two of the predicted relationships: Seriousness of Illness had a direct and positive relationship with Caregiver Overload (B =.60, R² =.35) and Learning State had a direct and positive influence on Acceptance of the Maintenance Role (B =.36, R² =.18). As the disabilities of the dependent elder became more acute, the caregivers' feelings of being overloaded with the burden of the caregiving responsibilities increased. However, when the caregivers had a positive perception of their abilities to implement prescribed health care instruction as well as felt positively about their caregiving role (Learning State), they spent a greater amount of time giving direct care to the dependent elder (Acceptance of Maintenance Role). Identification of learning needs as they relate to the caregivers' ability to understand and implement health care instruction as well as feel positively about their role, can assist nurses in developing appropriate teaching interventions. The expected outcome of these interventions is direct care provided by the caregiver to the dependent elder.