<p><strong>ABSTRACT </strong></p> <p>In the current climate of downsizing and cost cutting within the health care system in Ontario, the Long Term Care (LTC) sector is faced with the present and future challenge of providing care for a growing population of people afflicted with dementia. LTC facilities are generally regarded as a suitable location for people with dementia experiencing behavioural disturbances to live out the last years of their lives. Critics, advocates and researchers are concerned with the capacity of facilities to meet the complex care needs of this vulnerable population. Confronted by barriers such as staff shortages, increased workloads and acuity of resident care facilities are struggling. The purpose of this study was to explore what characterizes a LTC facility that allows the staff to receive and respond well to the care needs of their residents experiencing behavioural disturbances, to better understand the organizational culture and practices that distinguish them from facilities that are not as successful in their efforts to provide resident-centred care.</p> <p>A small qualitative study of specialized geriatric outreach case managers working within a number of different LTC facilities was conducted using personal interviews to draw forward their experiences and observations. This group of professionals was uniquely positioned to witness the organizational cultures and practices within facilities associated with good and responsive care. Analysis of their accounts suggests that an organizational culture within a LTC facility that is able to create an environment that builds capacity among the staff to provide responsive care, was resident-centred, had an inclusive work culture, provided support and work flexibility was better able to be responsive to the needs of residents with dementia experiencing behavioural disturbances. The findings also revealed the importance of not losing sight of the impact front-line staff can have on making changes and pushing back against the current social policy agenda and constraints in LTC.</p> / Master of Social Work (MSW)

Falls and concomitant injuries are common problems among large groups of the elderly population, leading to immobility and mortality. These problems are even more pronounced among people suffering from dementia. This thesis targets fall risk factors for people with dementia in institutions. The overall aim of this thesis was to investigate risk factors for falls, predisposing as well as related to circumstances surrounding falls, and to do this as efficiently as possible. In a prospective cohort study including residents of residential care facilities with and without dementia, the fall rate was higher for those with dementia, the crude incidence rate ratio (IRR) was 2.55 (95% CI 1.60–4.08) and the adjusted IRR was 3.79 (95% CI 1.95–7.36). In the group of people suffering from dementia, including 103 residents, a total of 197 falls resulted in 11 fractures during the 6-months follow-up period. From the same baseline measurements 26% and 55%, respectively, of the variation in falls could be explained in the group of residents with and without dementia. Fall predictors significantly and independently associated with an increased risk of falls in the group of people suffering from dementia were the category “man walking with an aid” and the use of more than four drugs. In a prospective cohort study, including 204 patients in a psychogeriatric ward, a total of 244 falls resulted in 14 fractures. Fall predictors significantly and independently associated with an increased risk of falls were male sex, failure to copy a design, use of clomethiazole, and walking difficulties. Treatment with statins was associated with a reduced risk of falls. With these fall predictors in the negative binomial regression (Nbreg) model, 48% of the variation in falls was explained. The data from the psychogeriatric ward were also analysed with the use of partial least squares regression (PLS) and regression tree to be compared with the results of the Nbreg analysis. PLS and regression tree are techniques based on combinations of variables. They both showed similar patterns, that a combination of a more severe level of dementia, behavioral complications and medication related to these complications is associated with an increased fall rate. Thirty-two percent and 38%, respectively, of the variation in fall rate were explained in the PLS and regression tree analysis. The circumstances surrounding the falls in the psychogeriatric ward were analysed. It was found that the fall rate was equally high during the night and the day. A large proportion of the falls was sustained in the patients’ own room and a small proportion of the falls was witnessed by the staff. This pattern was even more pronounced during the night. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. The proportion of urinary tract infection was also higher in connection to falls sustained by women than to falls sustained by men. This thesis confirms that people suffering from dementia are prone to fall. Walking difficulties, male sex and impaired visual perception are factors that should be considered in the work of reducing falls among people suffering from dementia. Furthermore, falls at night, behavioral complications and medication related to these complications should also be considered in this work, especially as the dementia disease progresses. A larger portion of the variation of the outcome variable was explained by the Nbreg model than the regression tree and PLS. However, these statistical methods, based on combinations of variables, gave a complementary perspective on how the fall predictors were related to falls.

Subjective Defining of Life Goals of Pupils with Behavioural Disturbances Author: Jan Chaloupka Faculty of Education, Charles University in Prague - Department of Special Education Supervisor: Mgr. Jana Mottlová Based on studying literature on general pedagogy, special pedagogy and psychology as well as on the author's personal experience with working with pupils with behavioural disturbances, the author proposes a hypothesis, according to which the long-term goal seeking efforts of the majority of pupils concerning socialization and education are absent, distorted and ineffective. The objective of this paper is to confirm or refute the validity of the hypothesis as well as to theoretically formulate impulses for practice. The research was performed on a sample of 120 respondents and a contrastive control group of 30 grammar school students. It was effectuated by means of a questionnaire and complemented by interviews, which are not included in full form for space reasons. The research has shown that in a heterogeneous group of respondents, a majority of two thirds is either incapable of life goals definition or the definition is rather inadequate and unrealistic. The author, however, has identified the reasons for this neither in the faulty family or educational background nor in decreased...