Sub-Saharan African is experiencing major sociodemographic trends that include population aging, the proliferation of both Christianity and Islam, and the contribution of migration to the dynamics that exist between urban and rural areas. The need to better understand the health of older adults in a setting largely lacking the formal means to support them is essential. The purpose of this research is to examine various factors related to the health of older women and men in rural Malawi, using quantitative data from the Malawi Longitudinal Study of Families and Health (MLSFH). Analysis begins in the residential setting but extends to include social and religious spaces beyond the family, and how some of these factors influence the likelihood of migration for older respondents. The primary measures of health are the mental and physical health scores from the Short-Form 12 (SF-12). Overall, the findings of the three studies in this paper show that: (1) co-residence with offspring has a positive relationship with health for older women, while older men who live in a larger household or with a greater number of females have better health; (2) older adults affiliated with most Christian denominations are less healthy compared to Muslims; (3) participation in religious activities may be particularly important for the health of older women, especially at lower levels of wealth; and (4) the likelihood of migration for older women increases with age and with HIV-positive status, while for older men the likelihood of migration decreases with age but increases with physical health. Overall, these findings indicate that certain factors within and beyond the residential setting have an important relationship with health, and that these factors can serve as determinants of migration in older age in rural Malawi. / 1 / Jacob Evans Kendall

<p> In 2017, 5.5 million Americans were estimated to have Alzheimer&rsquo;s dementia, and it is expected to affect 13.8 million American&rsquo;s by 2050 (Alzheimer&rsquo;s Association, 2017, p. 24). The estimated lifetime risk of Alzheimer&rsquo;s disease at age 45 is 1 in 5 for women, and 1 in 10 for men (Alzheimer&rsquo;s Association, 2017, p. 23). Dementia is one of the costliest medical conditions; related costs are projected to increase from $259 billion annually in 2017 to more than $1.1 trillion in 2050 (in 2017 dollars; Alzheimer&rsquo;s Association, 2017, p. 60). No current pharmacological treatment has the capacity to stop, slow, or reverse neurological damage caused by this fatal disease (Alzheimer&rsquo;s Association, 2017). Nonpharmacological therapies might delay or prevent symptom expression. In the current study, research relevant to reserve, mindfulness meditation, and Alzheimer&rsquo;s disease is examined. Conferring the most up-to-date research by gathering and integrating interdisciplinary data helps to clarify the direction of future research that ultimately could influence the discovery of a successful prevention or treatment for this debilitating disease. An integrated literature review was conducted by searching multiple databases on ProQuest, for articles containing specific key words (Alzheimer, dementia, mindfulness, meditation, &amp; reserve). Reserve is the brains capacity to compensate for pathology, and the literature appears to indicate that mindfulness meditation may play a strong role in the prevention of Alzheimer&rsquo;s disease and in the delay of symptom expression by utilizing underlying neural mechanisms which increase reserve. These underlying mechanisms include increased attention, reduced cortisol production, reduced oxidation, increased emotional regulation, increased brain volume, and improved sleep.</p><p>

<p>ABSTRACT The current increase in the population of older adults has created a high demand for more informal caregivers. Informal caregivers complain of many problems in providing care including psychological stresses and anxieties, as well as physical, emotional, financial, and other social burdens. The purpose of this phenomenological study was to understand and describe the essence of the lived experiences of informal caregivers. The study was also intended to make health professionals and policy makers aware of such problems. The study adopted a qualitative methodology and a hermeneutical phenomenological design. Purposeful sampling was used in selecting participants with informal caregiving experience. Eleven informal caregivers were interviewed via telephone for data collection. Data was analyzed using Nvivo 11 for the identification and description of patterns and themes from the perspectives of participants. Eight themes that emerged from data analysis were: (a) Gender, many females engaging in caregiving, (b) Caregivers feeling stressful, (c) Love played a crucial role in caregiving, (d) Need for training for caregivers, (e) Being cared for by loved family members, (f) Impacts on job performance, (g) Living arrangements between caregiver and care receiver, and (h) Lack of support from family, community or state agencies. The conclusions focused on the need for support to informal caregivers such as caregiver training, adult day care services, care leave or respite care, increased access to services, care payments, and expansion in the informal caregiver workforce.

<p> <b>Purpose:</b> The purpose of the study was to determine the impact of the discharge education plan on the 30 day heart failure (HF) hospital readmission rates of elderly patients.</p><p> <b>Research Question:</b> What was the impact of the discharge education plan including medication adherence, dietary discretion, daily exercise tolerance, daily weight recording, recognition of any early symptoms of worsening HF and early follow-up plan with the physician in reducing the 30 day HF hospital readmission rates of the elderly patients? </p><p> Research Hypothesis: The discharge education plan including medication adherence, dietary discretion, daily activity tolerance, daily weight monitoring, recognition of any early symptoms of worsening heart failure, and early follow&ndash;up with the physician will reduce the 30 day heart failure hospital readmission rates of elderly patients. </p><p> <b>Background:</b> HF is one of the most common diagnoses and indications for hospitalization among adults over 65 years in United States (Pang, Komajda, and Gheorghiade, 2010). HF admission results in 6.5 million hospital days annually. In 2010, the total cost of care for patients with HF was 39.2 billion dollars (Gheorghiade, Vaduganathan, Fonarow, and Bonow, 2013). About two million Medicare beneficiaries are readmitted within 30 days of release from the hospital each year, costing Medicare 17.5 billion dollars in additional hospital bills. It is reported that elderly patients with HF are at increased risk for early readmission as a result of behavioral factors such as medication non&ndash;adherence, dietary indiscretion, exercise intolerance, drug and alcohol abuse, inadequate access to follow-up care, and poor transition of care (Gheorghiade, et al., 2013). </p><p> <b>Design and Methods:</b> A retrospective, non&ndash;experimental, and descriptive chart review was used in this study. The quantitative data, using convenience sampling, selected charts of patients with a diagnosis and readmission of HF within 30 days of discharge from the hospital between May 2012 and June 2013, was reviewed. </p><p> <b>Findings:</b> A chi square statistic was used to investigate whether distributions of categorical variables differ and also compare the tallies or counts of categorical responses between the six independent variables. The significant results of the Chi square test for goodness of fit was found only for daily weight monitoring (p=0.0372) and with activity intolerance (p=0.0123). The test compared theoretical (expected) values to experimental (observed) values to determine whether the differences between these values are due to chance (sampling error) alone. The components of the discharge education plan that could not be tested were early recognition of worsening symptoms, early follow&ndash;up with the physician and medication non-compliance because of the low frequency counts of &lt;5, and thus we cannot assume that the data follows a rough normal distribution. Therefore, the hypothesis was not supported.</p>

<p> The Filipino culture recognizes the elderly as part of its human resources. As a culture that considers family as a basic unit of society, the elderly play a central role. When elderly Filipinos, those that are 65 years of age and older, migrate to the United States, they expect that their families are able to take care of them. However, work demands and living situations among family members prevent them from receiving proper care.</p><p> With the increasing population of elderly Filipinos in Palm Springs, demand for a new Residential Care Facility for the Elderly (RCFE) is important. Agbayani's Residential Care Facility for Elderly Filipinos in Palm Springs, CA will offer supportive, quality, and long-term care for institutionalizing family in the facility. This business plan will show how Agbayani's RCFE intends on providing elderly Filipinos the quality of service and community they are accustomed to while maintaining a viable business.</p>

<p> Aging Well Day Care Center is a start-up company designed to offer an affordable alternative care for seniors living alone. The services offered will be equally beneficial for families caring for their aging parents. Recent legislation has emphasized the importance of developing daycare centers to handle the rapidly growing population of elder Americans that relies upon the federal insurance programs to help manage their long-lasting medical conditions which can be treated but not cured. The objective of this business plan is to illustrate the need for adult day care services within this region and that adequate resource are available to build and maintain a financially solvent organization.</p>

<p> The purpose of this project was to demonstrate whether a multifaceted quality improvement intervention program would improve hand hygiene compliance of healthcare providers (HCPs) in the Emergency Department (ED). A descriptive design with an observational approach was used with a convenience sample of ED healthcare personnel at a large, 500 bed community hospital. Seven hundred and fifty-eight hand hygiene compliance direct observations were collected during 3 time periods (baseline, pre-intervention and post-intervention observation periods). Descriptive and inferential statistics were used to analyze differences in hand hygiene compliance across the observation periods and by HCP job category. </p><p> The results indicated a statistically significant increase in hand hygiene compliance among all groups combined after a multifaceted intervention program was implemented. Efforts to change behavior, lifestyle and the environment must be varied and the target audience must be involved to be effective. This model can be applied to HCPs in other healthcare settings to improve compliance with hand hygiene, a fundamental infection prevention practice to prevent healthcare acquired infections.</p>

<p> Decisions near the end of life must be made at a time of great emotional upheaval and rely on knowledge that few people possess outside of healthcare. Complicating this is that choices appear to change as older adults become more ill and approach death. Thus, healthcare providers must help older patients navigate this complexity to make decisions that are consistent with patients' priorities and wishes. Research examining end-of-life decisions has been descriptive in nature, looked at decisions from among younger adults, or examined decision making among those with cancer diagnoses. In addition, the research often focused on prospective decisions among healthy elders. Much less is known about decision-making processes used by older adults with a limited prognosis. </p><p> The aim of this dissertation was to examine decision-making processes among older adults with a limited prognosis who were in the midst of making significant healthcare decisions. The goal was to explore the phenomenon from within the context of the end of life to bring forth the missing voice of these elders. </p><p> Twenty community-based adults (13 men, 7 women, ages 67-97) with a prognosis of less than 12 months were recruited through the San Francisco Veterans' Administration Medical Center and the University of California, San Francisco, Division of Geriatrics. One-on-one interviews were conducted in participants' homes using a semi-structured interview guide. Interviews were recorded and transcribed verbatim. Grounded theory was used to analyze the interviews to allow themes and concepts to emerge organically from the data. </p><p> Two main themes emerged: <i>maintaining a sense of control </i> and <i>decision making in the context of ambiguity.</i> Participants rarely discussed actual decisions and preferred to delegate end-of-life decisions. By using different approaches to express their priorities and goals, they maintained the <i>sense</i> of control without being <i> in</i> control. The actual context of decisions could not be understood a priori, which resulted in uncertainty and ambivalence that influenced how decisions were made. </p><p> By understanding how older adults approach late-life decisions, healthcare providers can better support their patients as they make different choices and help guide patients to choices that are consistent with their stated preferences and priorities.</p>

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration. / Includes bibliographical references. Also available on the Internet.

<p> Rural West Virginia has a very high percentage of older adults. The age-related disease of Alzheimer&rsquo;s threatens the health of older Appalachians, yet research on Alzheimer&rsquo;s disease (AD) in this population is scarce. In order to improve screening rates for cognitive impairment, Appalachians need to understand their vulnerability. The first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational descriptive study was conducted with 240 participants from four samples of older adults in south central rural Appalachian West Virginia using surveys and face-to-face interviews. Results from tests for stability, reliability including Rasch modeling, discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of education [<i>F</i>(2, 226) = 170.51, <i>p</i> = .001]. Using multiple regression, the predictors of AD knowledge included caregiver status, miles from a healthcare provider, gender, and education; (<i>R</i>²=.05, F(4,187) = 2.65, <i>p</i> =. 04). Only years of education accounted for a significant proportion of unique variance in predicting the total BKAD score (<i>t</i> = 2.14, <i>p</i> =. 03). Implications include the need for further tool refinement, testing for health literacy, coordination with recent statewide efforts to educate the public regarding AD, and community based participatory research in designing culturally effective education programs that will ultimately increase screening and detection of Alzheimer&rsquo;s disease in rural populations.</p>