Alzheimer's Disease is a progressive, irreversible neurodegenerative illness and the most common of the dementing disorders. Only few diseases disrupt patients and their relatives so completely or for so long a period of time as Alzheimer 's. Caring is held to be very demanding and emotionally involving. Caregiver burden has been defined as a multidimensional response to emotional, social, physical, psychological, and financial stressors associated with the caregiving experience. The objective of the 1st study was to assess the degree of burden and its possible change in family caregivers of the long-term sick family member with progressive Alzheimer's disease during eight-month monitoring. In addition to the common psychiatric examination the Mini- Mental State Examination (MMSE) was administered in patients to indicate the severity of the dementia and the Zarit Burden Interview was administered in caregivers to assessed degree of burden. The total of 60 people have been examined - 30 patients with AD and 30 their caregivers (24 females, 6 males) were recruited from the Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. At the beginning of the study there were 18 patients with mild stage of AD (60%), 11 patients suffered...

Given the stress involved in caring for elders, the propensity for abuse among the older adult population continues to be a problem, as the number of caregivers providing care in the home is increasing to meet the demand of an increasing population of older adults. One solution is to implement video surveillance in the home. The purpose of this phenomenological, retrospective and prospective study was to describe the perceptions and experiences of caregivers that affect stress in the home care setting and to describe participants' perceptions about the impact of video surveillance in the home environment on caregiver stress and elder abuse. Using a lens of critical ecological framework and privacy theory, the research questions inquired about the specific experiences of stress and the perceptions of the use of home surveillance of caregivers in the home. A sample of 9 older adult home caregivers were recruited from the United Jewish Council of the East Side Home Attendant Service Corp. Findings revealed that increased family, community, and agency involvement and support may offset the feelings of isolation of the home care environment and ensure the caregiver is given opportunities to engage in strategies designed to help cope with the inherent stressors of the job. In addition, video camera surveillance in the home care setting may provide social support through observation of the situation in the home, supporting both social control on the behavior of the caregiver and direct evidence of quality of care for the caregiver. The findings of the study help to highlight effective intervention strategies based on the specific stressors and stress relievers identified, serving to reduce the potential for older adult abuse and neglect in the home care setting.

Bakgrund Amyotrofisk lateralskleros är en dödlig sjukdom som påverkar såväl den drabbade som anhöriga. Anhöriga har en betydande roll då de ofta vårdar den närstående i hemmet, och på grund av sjukdomens progression kan det bli en omfattande livsförändring. Sjuksköterskor ska utgå ifrån ett palliativt personcentrerat förhållningssätt där anhöriga behöver praktiskt och emotionellt stöd. En anhörig som vårdar en person med långvarig sjukdom ska erbjudas stöd för att minska belastning och förbättra livssituationen. Syfte Syftet var att beskriva anhörigas erfarenheter av att ge stöd till en person med Amyotrofisk lateralskleros. Metod En litteraturöversikt med elva vetenskapliga artiklar användes. Artiklarna hämtades från databaserna Cinahl Complete och PubMed. Artiklarna analyserades med stöd av Fribergs analysmodell. Resultat Tre teman identifierades i resultatet: (1) Inre känslor, (2) Förändringar inom familjen och (3) Hälso- och sjukvårdspersonalens påverkan. Två underteman framkom: Förändrade familjerelationer och Förändrade roller. Sammanfattning Litteraturöversikten visade att det fanns ett behov av information och stöd från sjukvården och övriga anhöriga. Att vara anhörigvårdare medförde en känslomässig påverkan på grund av hög belastning och ansvarskänslor. Sjukdomen bidrog till förändringar inom familjen så som förändrade familjerelationer och nya roller och anhörigvårdare upplevde olika utmaningar som att bibehålla en normal vardag och åsidosätta sina egna behov. / Background Amyotrophic lateral sclerosis is a deadly disease that affects both the person affected by illness and their relatives. Relatives have a significant role as they often provide care for the person at home, and due to the progression of the disease there can be an extensive life change. Nurses shall focus on a palliative person-centered care where relatives need practical and emotional support. A relative who cares for a person with a long-term illness must be offered support to reduce the burden and improve the living situation. Aim The aim was to describe relatives’ experiences of providing support to a person with Amyotrophic Lateral Sclerosis Method Literatur review with eleven scientific articles were used. The articles were retrieved from the databases Cinahl Complete and PubMed. Friberg’s analysis model were used to analyze the articles. Results Three themes were identified in the result: (1) Inner feelings, (2) Changes within the family and (3) The impact of health care professionals. Two sub-themes emerged: Changed family relationships and Changed roles. Summary The literature review showed that there was a need of information and support from the healthcare system and other relatives. Family caregivers experienced an emotional impact due to high workload and feelings of responsibility. The disease contributed to changes such as changing family relationships and new roles, and family caregivers experienced various challenges such as maintaining a normal everyday life and overriding their own needs.

No description available.

Bakgrund: I Sverige beräknas att cirka 40% av personer med kognitiv sjukdom vårdas på särskilt boende och innan de flyttar dit är det ofta anhöriga som ger informell om­vårdnad i hemmet. Tidigare forskning har visat att vården av en person med kognitiv sjukdom och processen att flytta denne till särskilt boende är påfrest­ande för anhöriga, med stor risk för att utveckla egen ohälsa. Regeringen har under 2022 beslutat om en anhörig­strategi för att stärka anhörigas rätt till stöd, och Socialstyrelsen publicerade ett kunskapsunderlag för vårdgivare under 2023 i syfte att underlätta implementering av anhörigperspektivet. Därför är det intressant att studera hur sjuksköterskor idag stöttar anhöriga under denna process. Syfte: Studiens syfte är att utforska hur sjuksköterskor i kommunal verksamhet beskriver stödet de ger till anhöriga till personer med kognitiv sjukdom under transitionsprocessen från ordinärt boende till särskilt boende, samt om de upplever att det finns förbättringsmöjligheter.  Metod: En kvalitativ intervjustudie med induktiv ansats genomfördes. Det gjordes 13 semistrukturerade intervjuer med sjuksköterskor inom kommunal hemsjukvård och särskilt boende, med minst ett års erfarenhet från ena eller båda verksamheterna. En kvalitativ innehållsanalys med en manifest tolkning gjordes för att få fram ett resultat.  Resultat: Analysen resulterade i fyra huvudkategorier: 1. Att hjälpa anhöriga ur en ohållbar situation. 2. Att skapa en god relation. 3. Att samverka. 4. Att förhålla sig till brister i verksamheten. Resultatet visade att sjuksköterskorna börjar stötta anhöriga i processen långt tidigare än förväntat och är medvetna om de svåra känslor som anhöriga brottas med innan de fattar beslut om flytt. Sjuksköt­erskorna på särskilt boende arbetar ofta hårt med att öka tryggheten för anhöriga och göra dem delaktiga, och ett väl fungerande teamarbete är viktigt för ett gott samarbete med anhöriga, liksom att det finns anhörigstödjare att tillgå. De pekade också på att det finns brister i verksamheten, både av organisatorisk och kulturell art, som påverkar stödet till anhöriga negativt.  Slutsatser: Studien visade att sjuksköterskor i hög grad är medvetna om de problem och utmaningar som anhöriga står inför när de måste separera från en familje­medlem med kognitiv sjukdom. Studien pekar på förbättringsbehov avseende sjuksköterskors kompetensnivå, rutiner som verkar för ett mer jämlikt tillhanda­hållande av stöd för anhöriga, samt att sjuksköterskor får mer resurser för denna folkhälsofrämjande verksamhet. / Background: Some 40% of persons with dementia in Sweden live in care homes, and before they move there, are cared for by informal family caregivers in the home. Previous research has shown that the process of caring for a person with dementia and moving them to a care home is taxing for family caregivers, with increased risk of developing health problems of their own. The Swedish government has in 2022 presented a national next-of-kin strategy aiming to strengthen the right to support for family caregivers and Socialstyrelsen published a guide for healthcare providers to implement the next-of-kin perspective in 2023. In this light, it is of interest to study how registered nurses working in homes and care homes support family caregivers today.  Aim: The aim of the study is to investigate how registered nurses in the context of elder care, both in ordinary homes and in nursinghomes, describe the support they give to relatives of persons with dementia during the transitionprocess from ordinary living to care home living, and if they see possibilities for improvement.  Method: A qualitative interview study with inductive approach was made. There were 13 semistructured interviews made with registered nurses working in home care and care home settings, having at least one year of experience from one or both of the settings. A qualitative content analysis with a manifest interpretation was made to generate a result.  Results: The analysis resulted in four main categories: 1. Helping family caregivers in an untenable situation. 2. Creating a good relationship. 3. Cooperation. 4. Relating to the shortcomings of the area of care. The result showed that registered nurses support family caregivers long before expected and are aware of the difficult feelings relatives deal with before they decide on care home living. The nurses in care homes often work hard aiming to create a sense of security and participation for relatives. A well functioning team is a foundation for a good collaboration with relatives, and access to external support is an important resource. The nurses also identified organizational and cultural problems, affecting the support negatively.  Conclusions: The study shows that registered nurses are highly aware of the problems and challenges facing family caregivers when needing to separate from a family member with dementia. The study indicates areas of improvement concerning the nurses need for further education, routines that facilitate a higher degree of equal opportunities for relatives, and that the nurses have more resources allocated for this area of preventative public health care.

Interactions of children and adults in two child care groups were observed and examined. Each group was observed as a same-age multiple caregiver group and eight months later as a multi-age constant caregiver group. Twenty indicators were used to evaluate positive interactions. Analysis showed positive interactions occur in multi-age constant caregiver groups. Multi-age constant caregiver groups enhance the interest of caregivers in children and promote development and interaction of language between caregivers and peers. This study indicates a multi-age constant caregiver group is an alternative to meet the needs of young children by increasing and enhancing positive interactions with caregivers and peers.

The focus of this study was the exploration of parents and caregivers experiences of raising children with ADHD and their experiences of services at a public sector hospital. There is a paucity of scholarly studies conducted on this topic in South Africa. The context of the study is the public sector hospital where the researcher is employed as a social worker. Through her interactions with the parents and caregivers of ADHD affected children she became aware of the challenges that they were exposed to and this prompted her to undertake the study. This was a qualitative study and a purposive sample was used. Semi-structured interviews were conducted with 21 participants and one focus group was conducted as a method of triangulation, with six participants. This study was guided by two theoretical frameworks, namely the bio-psychosocial and ecosystems approaches. The main conclusions drawn from the findings of the study were that many participants experienced a lack of support from their families and from the hospital. Participants did not have sufficient knowledge of the comprehensive treatment plan available in the management of ADHD. Health care professionals failed to engage in mutual decision making with participants, related to ADHD treatment and they neglected to address the concerns of participants regarding their children. A further finding was that the referral process to allied health professionals was inconsistent. Participants also experienced difficulties with the hospital administrative processes. Based on the findings, the recommendations include the need for more comprehensive support which includes medical and psychosocial support for participants. The limited knowledge base of participants with regard to the nature, causes and the use of medication for ADHD should be addressed by the health care providers. This could be achieved through participant education on the disorder at the initial stages of diagnosis. ADHD should be managed in a more collaborative and co-ordinated manner at the health care facility through an actively interdependent team. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

Ny statistikk viser økende forekomst av aldersdemens blant eldre. Menn utgjør en økende gruppe omsorgsgivere. Disse mennene har fått relativt liten forskningsmessig oppmerksomhet, det finnes en begrenset mengde litteratur tilgjengelig om menn som omsorgsgivere for ektefeller med aldersdemens. Der er derfor viktig å gi dette feltet forskningsmessig oppmerksomhet, blant annet for å kunne gi helsepersonell kunnskap om denne gruppen. Med økt innsikt i mennenes opplevelse av sin situasjon vil de kunne gis bedre følelsesmessig og praktisk assistanse i omsorgsarbeidet sitt. Det ble gjennomført en studie med fokus på ektefeller av menn med demente ektefeller ved bruk av Grounded Theory som metode. Studien ble basert på opplevelsene til ni menn, seks av dem hadde omsorg for hjemmeboende ektefelle, de tre andre hadde flerårige erfaringer med å ha dement ektefelle hjemme men hadde nå sine ektefeller i sykehjem og fulgte dem opp der. Data ble samlet gjennom dybdeintervjuer tatt opp på bånd. Intervjuene ble analysert ved bruk av Grounded Theory. Det ble funnet fem hovedkategorier, mestring, ensomhet, lojalitet, sorg og tap av felleskap med ektefelle / Recent statistics reveal a growth in the incident of Alzheimer disease and related dementia amongst elderly. Males make up an increasing group of caregivers, yet little attention has been given to them as that, there is limited literature available on husbands as caregivers for wives with the disease. Therefore, the need to conduct research in the area of male caregivers is essential if nurses and other help personnel are to understand and provide appropriate support and care for male caregivers. A qualitative study which focused on the experience of husbands who are home caregivers of wives diagnosed with dementia was conducted using Grounded Theory as research method. The study was based on the experience of nine husbands, six of them were caregiving for their wives at home at the time of the interview, the others had their wives in an institutional setting after years of home caregiving. Data collected during in-dept tape recorded interviews with the participants was analysed using Grounded Theory. Five major categories themes emerged from the participants stories, coping methods, loneliness, grief, loyalty and loss of fellowship in relationship. / <p>ISBN 91-7997-140-7</p>

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-01-27T11:02:51Z No. of bitstreams: 1 arquivototal.pdf: 2610329 bytes, checksum: d03670d25be3305aefb5179c6e9ba299 (MD5) / Made available in DSpace on 2016-01-27T11:02:51Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2610329 bytes, checksum: d03670d25be3305aefb5179c6e9ba299 (MD5) Previous issue date: 2014-02-26 / The elderly population was “immune “to HIV/AIDS. However, With the emergence of drugs that return to the old man his sexual potency, Coupled with the concept of active aging, it was noted that sexual behavior had changed and with it the HIV/AIDS arrived in the elderly. Another aspect to be considered is the delay of formal caregivers to detect evidence that the elderly presents HIV/AIDS, and this diagnosis was made after discarded a list of other diseases that most affect this age group. Given the above, and with the theoretical and methodological contributions to social representations (SR) The aim of this study was to understand that SR seropositive elderly, Caregivers formal and informal caregivers have on the living, live and death in the context of HIV/AIDS. Method: We used non-probability sampling, accidental kind, where nine elderly people were analyzed, ten formal caregivers who deal directly with patients seropositive and finally, three informal caregivers. Data collection was performed using semi-structured interviews that were recorded. The analysis was performed with the software ALCEST. Results and discussion: The RS brought by seropositive elderly was an HIV/AIDS that brings a negative feeling, especially at the time of discovery, where the issue of death is raised as a possibility to conduct disease. Death is associated with the diagnosis and also brings a feeling of sadness and strangeness. For the caregiver RS HIV/AIDS is linked to current scientific knowledge. Already on death formal caregivers to portray as an event of intense and difficult to accept suffering, she even doing this in his life almost daily. Informal caregivers bring HIV/AIDS as a framework for elderly care and care that a change in their lives that now needs to be divided between care and other activities. Death is feared and to be considered as a bad thing, nor is spoken by informal caregivers. In the analysis performed with the formal and informal caregivers emerged related to the path of prevailing professional – class – formal caregivers, HIV/AIDS, which was once again portrayed the scientific knowledge presented today on the disease, the relationship between classes HIV/AIDS and the elderly were portrayed by their form of contagion and the difficulty of talking about it – sex. The care that was present in the representation was a predominance of informal carers. And death once again comes through the speech of formal caregivers. Final thoughts: with the research you realize that there is a very great prejudice to speak of sexuality and death in the elderly. This makes their vulnerability increases considerably, even by the formal caregivers neglect the fact that the elderly still keep themselves sexually active. The death was not widely spoken by older people and their formal caregivers showing that it is a taboo and evil that surround people who are older and more when they are afflicted with such a stigmatizing illness like HIV/AIDS. In this sense, we see the importance of broadening our understanding of the issues presented in order to provide a better life for the portion of the population studied. / A população idosa encontrava-se “imune” ao HIV/AIDS. No entanto, com o surgimento de medicamentos que devolvem ao homem idoso sua potência sexual, aliado ao conceito de envelhecimento ativo, notou-se que o comportamento sexual havia se alterado e com isso a HIV/AIDS chegou à terceira idade. Outro aspecto a ser considerado é a demora dos cuidadores formais em detectar indícios de que o idoso apresenta HIV/AIDS, sendo este diagnóstico realizado depois de descartada uma lista de outras enfermidades que mais acometem essa faixa etária. Diante do exposto, e tendo como aporte teórico-metodológico as Representações Sociais (RS), o objetivo deste estudo foi apreender as RS que pessoas idosas soropositivas, cuidadores formais e cuidadores informais produzem sobre o viver, o conviver e a morte no contexto do HIV/AIDS. Método: Utilizou-se amostragem não probabilística, tipo acidental, na qual foram analisadas nove pessoas idosas; dez cuidadores formais que lidam diretamente com pacientes soropositivos e, por fim, três cuidadores informais. A coleta dos dados foi realizada utilizando-se entrevistas semiestruturadas que foram gravadas. A análise foi realizada com o software ALCEST. Resultados e discussão: A RS trazida pelas pessoas idosas soropositivas foi de um HIV/AIDS que traz um sentimento negativo, principalmente no momento da descoberta, onde a questão da morte é levantada como uma possibilidade de desenrolar da doença. A morte é associada ao diagnóstico e também traz um sentimento de tristeza e de estranhamento. Para o cuidador formal a RS do HIV/AIDS está atrelada ao conhecimento científico vigente. Já sobre a morte os cuidadores formais a retratam como um evento de sofrimento intenso e difícil de se aceitar, mesmo ela se fazendo presente em sua vida quase diariamente. Os cuidadores informais trazem o HIV/AIDS como marco para o cuidado ao idoso e com esse cuidado uma mudança em suas vidas que agora precisa se dividir entre o cuidado e as outras atividades. A morte é temida e por ser considerada como algo ruim, nem é falada pelos cuidadores informais. Na análise realizada com os cuidadores formais e informais surgiram classes relacionadas à trajetória profissional – classe predominante dos cuidadores formais –, sobre o HIV/AIDS, onde foi mais uma vez retratado o conhecimento científico apresentado nos dias de hoje sobre a doença. A relação entre o HIV/AIDS e os idosos foi retratada por sua forma de contágio e a dificuldade de falar sobre ela – o sexo. O cuidado que fez presente na representação foi uma predominância dos cuidadores informais. E a morte que mais uma vez chega através da fala dos cuidadores formais. Considerações finais: Com a pesquisa percebe-se que ainda existe um preconceito muito grande em se falar de sexualidade e morte com os idosos. Isso faz com que a vulnerabilidade deles aumente de forma considerável, até mesmo porque os cuidadores formais negligenciam o fato de os idosos ainda se manterem sexualmente ativos. A morte não foi muito falada pelos idosos e seus cuidadores formais, mostrando que ela é um tabu e um mal que ronda as pessoas que são idosas, muito mais quando são acometidas de uma doença tão estigmatizante como o HIV/AIDS. Nesse sentido verifica-se a importância de se ampliar o conhecimento sobre as temáticas A população idosa encontrava-se “imune” ao HIV/AIDS. No entanto, com o surgimento de medicamentos que devolvem ao homem idoso sua potência sexual, aliado ao conceito de envelhecimento ativo, notou-se que o comportamento sexual havia se alterado e com isso a HIV/AIDS chegou à terceira idade. Outro aspecto a ser considerado é a demora dos cuidadores formais em detectar indícios de que o idoso apresenta HIV/AIDS, sendo este diagnóstico realizado depois de descartada uma lista de outras enfermidades que mais acometem essa faixa etária. Diante do exposto, e tendo como aporte teórico-metodológico as Representações Sociais (RS), o objetivo deste estudo foi apreender as RS que pessoas idosas soropositivas, cuidadores formais e cuidadores informais produzem sobre o viver, o conviver e a morte no contexto do HIV/AIDS. Método: Utilizou-se amostragem não probabilística, tipo acidental, na qual foram analisadas nove pessoas idosas; dez cuidadores formais que lidam diretamente com pacientes soropositivos e, por fim, três cuidadores informais. A coleta dos dados foi realizada utilizando-se entrevistas semiestruturadas que foram gravadas. A análise foi realizada com o software ALCEST. Resultados e discussão: A RS trazida pelas pessoas idosas soropositivas foi de um HIV/AIDS que traz um sentimento negativo, principalmente no momento da descoberta, onde a questão da morte é levantada como uma possibilidade de desenrolar da doença. A morte é associada ao diagnóstico e também traz um sentimento de tristeza e de estranhamento. Para o cuidador formal a RS do HIV/AIDS está atrelada ao conhecimento científico vigente. Já sobre a morte os cuidadores formais a retratam como um evento de sofrimento intenso e difícil de se aceitar, mesmo ela se fazendo presente em sua vida quase diariamente. Os cuidadores informais trazem o HIV/AIDS como marco para o cuidado ao idoso e com esse cuidado uma mudança em suas vidas que agora precisa se dividir entre o cuidado e as outras atividades. A morte é temida e por ser considerada como algo ruim, nem é falada pelos cuidadores informais. Na análise realizada com os cuidadores formais e informais surgiram classes relacionadas à trajetória profissional – classe predominante dos cuidadores formais –, sobre o HIV/AIDS, onde foi mais uma vez retratado o conhecimento científico apresentado nos dias de hoje sobre a doença. A relação entre o HIV/AIDS e os idosos foi retratada por sua forma de contágio e a dificuldade de falar sobre ela – o sexo. O cuidado que fez presente na representação foi uma predominância dos cuidadores informais. E a morte que mais uma vez chega através da fala dos cuidadores formais. Considerações finais: Com a pesquisa percebe-se que ainda existe um preconceito muito grande em se falar de sexualidade e morte com os idosos. Isso faz com que a vulnerabilidade deles aumente de forma considerável, até mesmo porque os cuidadores formais negligenciam o fato de os idosos ainda se manterem sexualmente ativos. A morte não foi muito falada pelos idosos e seus cuidadores formais, mostrando que ela é um tabu e um mal que ronda as pessoas que são idosas, muito mais quando são acometidas de uma doença tão estigmatizante como o HIV/AIDS. Nesse sentido verifica-se a importância de se ampliar o conhecimento sobre as temáticas apresentadas no sentido de proporcionar uma melhor condição de vida para a parcela da população estudada.

[pt] O envelhecimento populacional é uma realidade que acarreta consequências como o aumento de doenças crônico degenerativas e síndromes demenciais. Neste contexto são necessários cuidadores informais, familiares e formais que podem atuar tanto na residência do idoso como também nas Instituições de Longa Permanência para Idosos (ILPI). O presente trabalho tem por objetivo estudar o papel e particularidades de cada um dos agentes do cuidado - idosos e cuidadores, além de apresentar ideias que visam melhorar a qualidade de vida, o funcionamento cognitivo e aliviar os sintomas de depressão e ansiedade para ambos os grupos. Para tanto, quatro estudos desenvolveram este objetivo com diferentes ferramentas. Como resultados, é possível destacar o impacto da sobrecarga do cuidador no funcionamento cognitivo de cuidadores familiares, a influência da renda média e da escolaridade no funcionamento cognitivo de cuidadores contratados, além da investigação sobre os idosos receptores de cuidado, que demonstraram desempenho cognitivo abaixo do esperado. Por fim, são propostas ações que visam melhorar a qualidade de vida e a saúde mental, como um todo, dentro do ambiente institucional. É importante ressaltar a necessidade de mais estudos e implementação de práticas que visem melhorar as condições de vida e trabalho dentro das Instituições de Longa Permanência para Idosos. / [en] Population aging is a reality that has consequences such as the increase in chronic degenerative diseases and dementia syndromes. In this context, informal, family and formal caregivers are needed who can work both in the elderly s residence as well as in Long Stay Institutions for the Elderly (ILPI). The present work aims to study the role and particularities of each of the care agents - the elderly and caregivers, in addition to presenting ideas that aim to improve quality of life, cognitive functioning and relieve symptoms of depression and anxiety for both groups. To this end, four studies developed this objective with different tools. As a result, it is possible to highlight the impact of caregiver burden on the cognitive functioning of family caregivers, the influence of average income and schooling on the cognitive functioning of hired caregivers, in addition to the investigation of elderly care recipients, who demonstrated cognitive performance below expected. Finally, actions are proposed that aim to improve the quality of life and mental health, as a whole, within the institutional environment. It is important to emphasize the need for further studies and implementation of practices that aim to improve living and working conditions within Long Stay Institutions for the Elderly.