Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

Objective: To assess the efficacy of personal support worker (PSW) mouth care education to improve the oral health of residents of long term care homes. Methodology: Experimental PSWs received mouth care education at baseline before taking the knowledge test. PSWs‟ mouth care knowledge was measured using a 20-item knowledge test at baseline, post-test (supervised); 6-months (un-supervised). Residents‟ oral health outcomes assessed at baseline and 6-months using the modified Plaque Index and modified Gingival Index. Results: Experimental PSWs‟ post-test knowledge (n=32;M=17.59;SD=1.43) significantly increased from pre-test (M=15.34;SD=2.10), F(2,72)=4.90;p<.05. 39 control residents and 41 experimental residents participated. Experimental residents‟ PI significantly decreased at 6-months compared to baseline, F(1,156)=5.52;p<.05, there was no significant difference in their GI between baseline and 6-months, F(1,156)=3.29;p=.07. Conclusion: PSWs‟ mouth care knowledge significantly increased after receiving mouth care education and was sustained over six months. Only experimental residents‟ PI significantly improved after 6 months.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

No description available.

Despite a large prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on understanding how this population adapts to perform tasks of daily living. Past research has focused on the analysis of upper limb kinematics of young healthy individuals while performing these essential tasks (Magermans, 2004, Murray and Johnson., 2004). The purpose of this thesis was to identify kinematic and shoulder loading differences between elderly mobile individuals and elderly individuals with rotator cuff impingements during specific activities of daily living. Motion capture techniques were used in combination with the Shoulder Loading Analysis Modules (Dickerson, 2005, Dickerson et al., 2007) to estimate thoracohumeral kinematics and calculate external joint moments. Two-tailed t-tests with injury status as the factor determined that differences in active range of motion in flexion/extension and humeral rotations existed between the two populations. Results of the ADL analysis showed that the impinged population tended to have decreased plane of elevation and humeral rotations during ADLs. Task was also a main factor for most variables examined. Perineal care, hair-combing and reaching tasks were the most demanding in terms of range of motion necessary to complete the task. The reaching tasks resulted in the highest shoulder moment. K-means clustering techniques proved to be unsuccessful in identifying different motion strategies between the two study groups. This investigation showed that developing adaptations for perineal care, hair-combing and reaching tasks should be considered a priority when working with patients with rotator cuff impingements, as these tasks demanded the largest ranges of motion as well as high shoulder moments.

Bakgrund Mat- och måltidsituationen på äldreboenden är ett område som ofta diskuteras. Det är viktigt att inhämta kunskap om de äldres näringsintag, upplevelse av matsituationen och åsikter om smaken på maten för att bättre kunna möta deras behov och genomföra förbättringar på detta område. Syfte Syftet med studien var att undersöka mat och måltid på äldreboende. Fokus lades på de äldres smakupplevelse, måltidssituation samt näringsintag. Metod Dels en kvalitativ studie där halvstrukturerade intervjuer användes som datainsamlingsmetod och analyserades med kvalitativ innehållsanalys, dels en kvantitativ studie där den kvantitativa analysen genomfördes med hjälp av Dietist XP samt bilddokumentering. Resultat Den kvalitativa analysen resulterade i två kategorier: uppfattningen om maten och upplevelsen av måltidsmiljön. Nutritionsscreeningen visade att anpassning hade gjorts för dem som hade ätproblem. Näringsintaget visade att de äldre, med vissa undantag, uppnådde det rekommenderade intaget för måltiderna. Slutsats Genom att tänka på hur maten serveras kan aptiten påverkas, vilket i sin tur kan göra att de äldre får ett bra näringsintag. Det är även viktigt att vara lyhörd för vad de äldre anser om maten som serveras på särskilda boenden för att kunna ge de äldre måltider som skapar glädje. / Background Food and meal situation in residential care facilities is an area that is often discussed. It is important to learn about older people's nutritional intake, experience of eating habits and opinions about the taste of food in order to better meet their needs and implement improvements in this area. Aim The aim of the study was to examine food and meal at residential care facility. The focus was on older people's taste, mealtime situation and nutrition. Method First, a qualitative study in which semi-structured interviews were used as data collection method and was analyzed using qualitative content analysis, and a quantitative study in which quantitative analysis was performed using Dietist XP and photo documentation. Results The experiences could be interpreted as a comprehensive conception of the food and the experience of the meal environment. Nutrition screening showed that adjustment had been made for those who had eating problems. Nutrient intake showed that the elderly, with some exclusion, achieved the recommended intake for meals. Conclusion By thinking about how the food is served the appetite is affected, which in turn may cause the elderly to receive good nutrition. It is also important to be sensitive to what the elderly think about the food served in residential care facilities in order to give the elderly meals creativity

The purpose of this study has been to examine the unit manager’s perspective on making Lex Sarah-notifications. The study has been carries out by six semi structured interviews with persons in leading positions of the elderly from three different municipalities. They were asked about different circumstances that affects the problems with Lex Sarah. The results indicates that the unit manager’s act on elder abuse from the complex mechanisms that exist within the organization. The study results shows that the unit manager’s in the daily tasks are doing their work and solve problems regarding the risk of elder abuse that occur over time, but circumstances will determine if its documented prescribed by a Lex Sarah. The conclusion is that the unit manager’s of the elderly is limited by the circumstances and processes within the organization and that it affects them to lift up and report abuse among the elderly.

Bakgrund: Gruppen äldre icke-heterosexuella i Sverige beräknas omfatta 80 000 personer. I sjuksköterskeutbildningen existerar begränsad kunskap om äldre HBT-personer. Syfte: Syftet med denna litteraturstudie var att beskriva upplevelsen av att vara äldre och icke-heterosexuell. Metod: I litteraturstudien sammanställdes åtta kvalitativa artiklar publicerade mellan 2001 och 2009. Litteratursökningar genomfördes i databaserna CINAHL, PsychINFO och PubMed. Efter genomläsning, kvalitetsbestämning och analys av innehållet sammanställdes artiklarna i fem kategorier och 16 subkategorier. Resultat: Äldre icke-heterosexuella såg på och hanterade sin sexuella identitet på olika sätt. Överlag tyckte många deltagare att de hade ett gott självförtroende samt kände att de var nöjda med livet. Många upplevde dock ålderism och kände sig dåligt bemötta i vården samt upplevde att de inte hade samma lagliga rättigheter som heterosexuella. Vissa icke-heterosexuella valde att medvetet dölja sin sexuella läggning exempelvis av rädsla för negativa attityder. Andra levde öppet med sin sexuella identitet. Slutsats: Ett synliggörande av äldre icke-heterosexuella är nödvändigt. Ökad kunskap och attitydförändringar är viktiga för att äldre homo- och bisexuella ska känna sig likvärdigt behandlade och trygga i vården. Resultaten kommer förhoppningsvis att leda till en ökad kunskap om och större förståelse för äldre icke-heterosexuella personer i vården. Vidare forskning om äldre HBT-personer behövs. / Background: The group of elderly non-heterosexuals in Sweden is estimated to include 80,000 people. Within the nursing programme, there is limited knowledge about older LGBT people. Aim: The aim of this study was to describe the experience of being elderly and non-heterosexual. Method: In this literature study eight qualitative articles, published between 2001 and 2009, were compiled. Literature searches were performed in the databases CINAHL, PsychINFO and PubMed. After perusal, determination of the quality and analysis of the content, the articles were compiled into five categories and 16 subcategories. Results: Older non-heterosexuals viewed and dealt with their sexual identity in different ways. Overall, many participants in the studies experienced a high level of confidence and satisfaction with their lives but many experienced ageism and felt discriminated within nursing contexts. Several of the participants felt that they did not have the same legal rights as heterosexuals do. Some non-heterosexuals chose to deliberately conceal their sexual orientation due to fear of negative attitudes while others lived openly with their sexual identity. Conclusion: It is necessary to make the older non-heterosexuals visible. In order to make elderly non-heterosexuals feel secure and equally treated in health care, increased awareness and changes in attitudes are important. Hopefully, the findings will result in better knowledge and greater understanding of elderly non-heterosexuals in the nursing context. Further research is needed on older LGBT persons.