No description available.

The decline of physical ability that occurs with aging has been linked to reduced skeletal muscle function. It has been theorized that Ca2+ uptake and release by the sarcoplasmic reticulum (SR) is altered with aging. Data pertaining to the actual structural and functional changes of SR due to aging are limited; thus, this theory has not yet been fully proven. The purpose of this research was to determine if SR function is altered as a result of aging in the following muscles: soleus, plantaris, and diaphragm. The soleus is composed of slow twitch muscle fibers. The plantaris is composed of fast twitch muscle fibers, and the diaphragm is composed of both slow and fast twitch muscle fibers. Fisher 344 Brown x Norway Cross Rats were used as subjects for this project. A total of 12 animals were used: six in group 12 months and six in group 27 months. A Jasco CAF-110 Fluorometer and fura-2 were used to determine the rate of Ca2+ uptake and release by isolated SR vesicles. In the aged animals, mass of the soleus was reduced by 22%, while the plantaris was reduced by 23%, and the diaphragm by 15%. However, these differences were eliminated when masses were normalized by body mass. In all three muscles examined, the rates of Ca2+ uptake were not significantly different between the young and aged animals. Rates of Ca2+ release, however, were reduced by 30% in both the plantaris and diaphragm of the aged animals. These results suggest that SR function is altered in "fast" muscles of the rat. It is possible that changes in SR Ca release may contribute to diminished muscle function and also lead to the decline in physical ability of older adults. / Master of Science

While replacement of dietary saturated fat with unsaturated fat has been advocated to reduce cardiovascular disease risk, diets high in polyunsaturated fatty acids (PUFA) could increase low density lipoprotein (LDL) susceptibility to oxidation, potentially contributing to the pathology of atherosclerosis. To assess in vivo lipid peroxidation and susceptibility, of LDL surface and core lipids to ex vivo oxidation, in women consuming increased amounts of specific unsaturated fatty acids, 15 postmenopausal women took daily supplements of sunflower oil providing 12.3 g/day of oleate, safflower oil providing 10.5 g/day of linoleate, and fish oil providing 2.0 g/day of eicosapentaenoate (EPA) and 1.4 g/day of docosahexaenoate (DHA) during a crossover trial. Plasma F₂-isoprostanes (F₂-isoP), malondialdehyde (MDA), and thiobarbituric acid reacting substances (TEARS) were measured to assess lipid peroxidation in vivo. Ex vivo oxidation of LDL was monitored by measuring the formation of phosphatidylcholine hydroperoxides (PCOOH) and cholesteryl linoleate hydroperoxides (CE18:200H) during coppermediated oxidation. Plasma free F₂-isoP and MDA concentrations were lower after EPA/DHA supplementation than after oleate (P = 0.001, F₂-isoP and 0.02, MDA) and linoleate supplementation (P = 0.04 for both F₂-isoP and MDA). However, plasma TBARS concentrations were higher after EPA/DHA than after oleate (P = 0.001) and linoleate supplementation (P = 0.0004). During LDL oxidation, the lag phase for PCOOH formation was shorter in EPA/DHA- than oleate- (P = 0.0001) and linoleate-enriched LDL (P = 0.002), while the lag phase for CE18:200H was shorter in EPA/DHA- than oleate- (P = 0.01) but not linoleate-enriched LDL. The maximal rate of PCOOH formation was lower in EPA/ DHA- than linoleate- (P = 0.007) but not oleate-enriched LDL, while the maximal rate of CE18:200H formation was lower in EPA/DHA- than oleate- (P = 0.03) and linoleate-enriched LDL (P [less than or equal to] 0.0001). The maximal concentrations of PCOOH and CE18:200H were lower in EPA/DHA- than oleate- (P [less than or equal to] 0.05) and linoleate-enriched LDL (P [less than or equal to] 0.01). Oleate-enrichment generally decreased the oxidative susceptibility of LDL surface and core lipids, while EPA/DHA-enrichment did not increase LDL oxidative susceptibility compared to linoleate-enrichment. This study emphasizes the need for more than one relevant assay of in vivo lipid peroxidation. / Graduation date: 2000

No description available.

This study was an investigation of the complexities and challenges of change in a community-based aged care facility in Western Australia, to reveal the impact and influence of change on the community. It explored the impact of change on both the residents and the senior management team, as leaders of the organisation, and explored how change influenced the redevelopment process and future of the organisation. There is considerable literature on organisational change including the impact of change on the structure, function, process, workforce and leaders of the organisation. There is, however, little literature on organisational change within aged care communities, particularly with an emphasis on the complexities and challenges associated with change within an organisation that is both a business and a home for its residents. The study took the form of a participative action research study, occurring predominantly over two years (2002-2003) with some continuation into a third year (2004). The study had three phases and included two action research cycles and a critical reference group (CRG), comprising the senior management team (SMT) and researcher. It adopted a broadly qualitative methodology, using data from participatory observation and semi-structured interview; however, it did include quantitative and qualitative data from two 'quality of service' surveys for independent living residents and a staff satisfaction survey. The finding of this study are presented as a narrative account of the experiences of the participants. The study reveals that change associated with the redevelopment impacted on residents' wellbeing, described by them as quality of life. / The redevelopment process and associated change also emphasised the importance of communication and explanation with residents to understand elements of quality of life and to monitor and manage the impact of change. The findings of the study highlight the challenge faced by community-based aged care communities classified by government, the industry and the wider community as primarily not-for-profit, to balance financial accountability and social conscience. The perception of benevolence influenced the attitudes of residents and staff and made business accountability more difficult to explain and realise. The study reveals that change also impacted on the structure and function of the organisation as it built its capacity for change. It reshaped the relationship between the Board and senior management team (SMT), which was reported as an improvement in communication, work relations and leadership effectiveness. The development of the leadership team, being the senior management team, was influenced by change and the change process enabled this team to become a competent, confident, cohesive senior team, with a preferred leadership style. A further finding was the realisation of the value and appropriateness of the action research process. It provided tools and processes that were used to plan, act, analyse and reflect on the many aspects of organisational change and enabled the organisation, principally the SMT, to reflect on the impact and influence of change. The research process supported their development as leaders as well as the development of the team. The process of planning, collecting data, analysing data, reflection and action provided a structure and process that they continued to use in their management practices, as new situations continued to arise with the redevelopment process.

The need to address the issue of quality in aged care service provision in Australia has received increasing emphasis in recent decades. Particularly since the 1980s, the federal government has played a key role in ensuring that this is the case through the implementation of various reforms and regulatory strategies. In 1998, the national standards monitoring system which had been in place since the mid 1980s was replaced with a new system based on an accreditation model. In contrast to the former system which was wholly controlled by government and involved one-off inspections by government standards monitors, responsibility for managing the new system has been devolved to an independent body, the Aged Care Standards and Accreditation Agency. One of the Agency's primary functions is to assess compliance with the accreditation standards. A key component of the new system is its emphasis on continuous improvement which has been incorporated into the accreditation standards. As a consequence, the new system requires a much greater level of involvement and commitment by providers than previously. In order to continue receiving government funding all facilities had to be accredited by January 1st 2001. This study represents an evaluation of the accreditation system based on the views and experiences of service providers in Western Australia. It explored a number of issues relating to the basic philosophy and principles underlying the new system, the implementation process, the accreditation standards that are used as a basis for assessing service quality and the overall impact of the system on providers. It also sought providers' views about the strengths and limitations of the system and any areas in need of change or improvement. A descriptive design, using in-depth interviews as the method of data collection, was adopted for the study. / Participants from three levels of service provision, namely, facilities, organisations and peak bodies were selected on a stratified purposive basis. A total of 45 informants were interviewed. The findings indicated that, overall, as a regulatory approach the accreditation system was generally supported by providers and was regarded as having a number of positive features, particularly in comparison to the previous system. At the same time a number of concerns were identified. These related in particular to the assessment process, specifically the lack of consistency amongst assessors and the self assessment tool, and to the extent of information and guidance provided by the Agency. Concerns regarding the latter's role in relation to, and extent of independence from, the federal government were also identified. The study also found that the introduction of the system had impacted on providers in a variety of ways, both positive and negative, but particularly in terms of the demands on staff and financial resources. A number of 'broader' level factors, such as funding, nursing shortages and other often competing demands (e.g. assessing residents according to the Resident Classification Scale) were also felt to be impacting on providers' capacity to meet the requirements of the system. These concerns, along with concerns about the way in which the system would develop in the future, appear to have created a degree of uncertainty and in some cases apprehension amongst many providers. Although this study has focused on the experiences of Western Australian service providers, evidence from other reviews of the accreditation system where providers' views have been sought has indicated a widespread similarity in perceptions. This suggests, therefore, that there is a need for further review and refinement of certain aspects of the system as it moves into the second round.

This thesis explored the relationship between the discourses of nursing care, the nursing care provision, and the perceived nursing care needs of three highly dependent residents in a residential aged care facility in Australia. Residential aged care in this country has undergone major reforms since 1987 and the nursing profession has struggled with these changes because of the documentation, validation, and accreditation requirements; the inadequate determination of dependency on nursing care for funding; the Registered Nurse (RN) being removed from the bedside to a role of scribe and delegator; the increasing acuity and complexity of the residents' needs; an increase in the turnover of residents; a rise in the nursing staff attrition rate; the delivery of care by untrained and unqualified persons; the RN being accountable and responsible for the care given by 'non-nurses' from a distance; and, the inadequate skill mix and staff to resident ratios provided in these institutions. The interest of this thesis was to research gerontological nursing practice in the context of residential aged care. Residential Aged Care Facilities (RACFs) in Australia that care for the highly dependent elderly were identified in the thesis as disciplinary institutions that used 'subjectivation' as a means to control the efficiency and effectiveness of the labour force and the 'docile' bodies of the residents, whilst at the same time the government rhetoric is that of the quality of life standards and the rights of residents in these institutions. As well as the discourse analysis, an historical overview of the aged care reforms in Australia was undertaken for the period from 1975 to 2006 that demonstrated the effects the reforms have had on the voice of nurses and nursing care in these institutions. This analysis highlighted where nurses have been silenced and found the federal government determining what is nursing care and what is not nursing care, and also who is providing this nursing care. Using a case study approach and discourse analysis each of the three residents was studied using data from five sources namely the resident or relative, a RN, a careworker (CW), the current documentation pertaining to the resident's nursing care, and the non-participant observation of the nursing care provided. These discourses on the nursing care and perceived residents' nursing care needs were analysed using the theoretical base developed from the philosophy and research interest of Michel Foucault (1926-1984), who questioned the apparatus and institutions of Western cultures and searched for discontinuities in the practices of what he termed 'disciplines'. The results of the discourse analysis found nursing care practices that were alarming around the residents' perceived nursing care needs, the documentation of the nursing care provision, and the observed 'actual' nursing care provided. A questionable standard of nursing care was evidenced even though this facility had recently been accredited. A custodial level of mechanistic care was provided to residents in an extremely noisy and public environment within a culture of haste and bustle by unknowledgeable CWs, under the distant gaze of a RN, and the direction of the government documentation requirements. This resulted in unsafe, unethical, unprofessional, and negligent practices, as well as fraudulent, illegal, and dangerously out of date documentation practices. This was ultimately affecting each resident's quality of life, nursing care, and wellbeing and was an added burden on the residents' relatives. Many discontinuities, dissonances, conflicts, and contradictions in nursing practice were uncovered for these three highly dependent residents that may be transferable and similar to other highly dependent residents in this and other institutions. Indeed it may mirror other disciplines that provide care services, such as mental health care, acute care, and disability care provision. The concerns for the nursing profession have epistemological, ethical, and political ramifications for the residents and their relatives, the nurses, the non-nurses doing nursing work, the government, and the industry. Epistemologically new nursing 'knowledges' were being developed that were not resident focussed or based on evidence. Ethically, the legislated rights of residents were not being supported, despite the accreditation, funding, and complaint mechanisms in place - and this has the potential to have punitive ramifications for the industry. Professionally and politically, CWs were identified as non-nurses doing nursing work of a poor standard. This care was not based on accepted nursing practice, but developed through the documentation requirements of the federal government department, the applied constraints, and the CWs themselves. Furthermore, the documentation requirements were found to be a pretence in regard to funding through validation and accreditation, as well as a charade in nursing practice. There is presently a substantial third level of nurses who are identified legally and political as non-nurses doing non-nursing work (known as 'personal' care); but these non-nurses are doing nursing work and are identified by the nursing profession and the public as 'nurses' doing nursing work. These non-nurses who provided nursing care are not educated, licensed, or regulated, and are not accountable professionally to nurses or legally to the public. It is proposed that CWs are in need of licensing under nurses' boards requiring at the very least a minimum of training and education. It is further proposed that documentation requirements resort back to professional nursing documentation; funding be dependent on an predetermined minimum skill mix and staff/resident ratio; and the funding of residents be based on a minimum data set and untied from nursing practice. The professional nursing practice of assessment, planning, implementation, and evaluation of nursing care needs resorting to a nursing domain of knowledge, practice, accountability, responsibility, and documentation. If an acceptable quality of life is to be realised for residents in the residential aged care system, given that highly dependent residents are reliant on quality nursing care that is fundamentally imperative to their very quantity and quality of life, then changes in the residential aged care system and the nursing profession will be necessary. This thesis will contribute to opening up such dialogue between the government, the industry, and the nursing profession in Australia, and it also highlights areas of aged care nursing practice in need of further research.

The purpose of this study was to examine conditions under which functional ability predicts relocation of older persons. Data for this study came from a sample of 6,225 respondents aged 70 or older, who were interviewed both at Wave 1 (1993) and 2 (1995) of a longitudinal national survey of Asset and Health Dynamics Among the Oldest Old (AHEAD). Hierarchical logistic regression analyses were used to estimate the effects of functional ability, functional ability and assistance from human resources, and functional ability and built-environment features on the probability of relocation when socio-demographic variables were controlled. Important findings are, first, differences in functional ability differentially predict future relocation behavior of older persons and, second, the existence of built-environment features in a residence has a reducing effect on the probability of entrance into an institutional setting in conjunction with functional difficulty. Household ADL decline between 1993 and 1995, as well as advanced ADL (i.e., cognitive ADL) and lower body activity difficulty in 1993, were predictors of the increased probability of residential moves occurred over the same period. Basic, household, and advanced ADL decline between 1993 and 1995, as well as basic, household, advanced ADL, and lower body activity difficulty in 1993, were predictors of the increased probability of entrances into an institutional setting occurred over the same period. Older persons who lived in a residence with built-environment features in 1993 were less likely to enter an institutional setting when they experienced basic ADL or lower body activity declines between 1993 and 1995. The onset of LBA and/or AADL difficulty triggered residential moves. Efforts to enhance the independent living of older persons in the community setting should target the compensation of LBA and/or AADL difficulty. / Graduation date: 2001

The relationship between mothers and daughters has been shown to be generally positive and strong throughout the life cycle. The relationship may become strained, however, as mothers become dependent due to deteriorating health or chronic health conditions. It has long been recognized in both the gerontological and intergenerational literatures that caring for a dependent elderly parent can be burdensome and stressful for some caregiving adult daughters. Using the elaborated wear-and-tear hypothesis, this study examined longitudinally the impact of the amount of care given on 140 caregiving daughters' perception of the quality of their relationship with their elderly dependent mothers. It was hypothesized that increases in the amount of care given by caregiving daughters over time would lead to a corresponding decrease in relationship quality. It was also hypothesized that relationship quality and amount of care given would be stable over time. Results indicated that providing more care does decrease relationship quality between caregiving daughters and care-receiving mothers over time although it does not do so initially. Further, the results of study showed that relationship quality and amount of care given, on average, are stable over time. / Graduation date: 1997

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2008. / Directed by Heather Helms; submitted to the Dept. of Human Development and Family Studies. Title from PDF t.p. (viewed Jan. 28, 2010). Includes bibliographical references (p. 96-108).