京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19276号 / 社医博第67号 / 新制||社医||9(附属図書館) / 32278 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 川上 浩司, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Undernäring är ett av de vanligaste hoten mot en god ålderdom. God nutritionsvård är en mänsklig rättighet. Kroppssammansättningen hos den äldre människan förändras genom att muskelmassa och andelen kroppsvatten minskar samtidigt som fettvävnaden ökar. Detta medför att äldre är mer känsliga än yngre för ett bristande nutritionsintag. En kombination av hög ålder, läkemedel samt flera kroniska sjukdomar medverkar till en förhöjd risk för undernäring. Idag finns många riktlinjer och hjälpmedel för att bedöma och behandla undernäring, trots detta är undernäring ett underdiagnostiserat problem. För att få rätt behandling vid sjukhus är det av centralt värde att identifiera patienter med nedsatt nutritionsstatus.   Syftet med studien var att identifiera hinder och åtgärder för att förebygga undernäring hos äldre personer inlagda vid sjukhus eller vård- och omsorgsboende. Metoden som valdes var en kvalitativ litteraturstudie. Arton vetenskapliga artiklar från olika delar av världen valdes och granskades. Sökningar gjordes i databaserna Cinahl, PubMed och SveMed+ samt fria sökningar utifrån intressanta artiklars referenslista.    Resultatet i denna studie visade att sjukvården på senare tid har fått upp ögonen på näringsproblem och åtgärder som förbättrad kunskap kring nutrition. Forskare och vårdutvecklare har utvecklat riktlinjer som ska underlätta nutritionsarbetet. Det finns numera en mängd olika bedömningsinstrument för riskbedömning av undernäring inom vård- och omsorg. Studier visar att sjuksköterskorna behöver mer kunskap och stöd för att kunna identifiera och behandla undernäring. Fortfarande finns det många hinder för att förbättra nutritionen för de äldre. Ett förslag är att förkorta nattfastan så att den understiger 11 timmar. Måltidstillfällena bör spridas över dagen genom att äta fler, mindre mål mat med mellanmål dessemellan. Möjlighet att få en lugn och stillsam måltidsmiljö är dessutom mycket viktigt. Genom att rasterna ändras maximeras antalet personal under måltidstillfällena så att fler blir tillgängliga. Hjälp av volontärer som utbildas i nutrition är ytterligare en åtgärd för att minska stressen vid måltiderna.     Slutsatsen visar att än idag är undernäring ett stort problem för äldre personer vid sjukhus eller vård- och omsorgsboende. Det är av yttersta vikt att i ett tidigt stadium finna undernärda patienter eller de som har risk för undernäring genom att använda något av de bedömningsinstrument som finns. Identifiera, åtgärda samt följa upp är tre viktiga åtgärder för att förebygga och förhindra undernäring hos äldre vid sjukhus eller vård- och omsorgsboende. När undernäring väl har uppstått är det mycket svårt att vända den negativa spiralen. / Malnutrition is one of the most common threats to age in a respectable way. Good nutrition care is a human right. As you get older the body composition changes. The muscle mass and percentage of body water decreases while the fat tissue increases. The elderly are more susceptible than younger for a lack of nutrition intake. A combination of old age, drugs and several chronic diseases contributes to an increased risk of malnutrition. Today, there are many guidelines and resources to assess and treat malnutrition. Despite this, malnutrition is an underdiagnosed problem. To get the right treatment at the hospital it is of vital importance to identify patients with impaired nutritional status. The purpose of the study was to identify barriers and measures to prevent malnutrition in elderly people hospitalized at the medical facility. The method chosen was a literature study based on qualitative research studies. Eighteen research studies from different parts of the world were selected and reviewed. Searches were made in the databases CINAHL, PubMed and SveMed +.  Articles found in the reference list of interesting science studies were also picked.   Nutritional problems and measures to improve knowledge about nutrition has lately been an eyes opener in healthcare. Scientists and healthcare developers have composed guidelines to facilitate the nutrition work. Different assessment instruments to identify malnutrition in elderly people hospitalized at the medical facility, have been developed.Studies show that nurses need more knowledge and support to identify and treat malnutrition. There are still many obstacles to improve nutrition for the elderly.  A recommendation is to shorten the night fasting so that it is less than 11 hours. Meal's sessions should be spread over the day by eating more often, smaller meals, with snacks in between. Having the meals in a calm, harmonious environment free from stress can make the elders eat more. By changing the breaks of the staff you can maximize the number of personal working during the elders’ meal session. Support from volunteers who have received training in nutrition can be of great help during meals.   Malnutrition is still a great problem for the elderly in institutions. It is of utmost importance to as early as possible find patients at risk of malnutrition using any of the assessment tools available. Identify, address, and monitoring are three important steps to forestall and prevent malnutrition in the elderly at the institutions. Once malnutrition has arisen, it is very difficult to reverse.

Background: Elderly people are vulnerable and belong to the high-risk groups of becoming seriously ill from COVID-19. Because of this, they also become more vulnerable in society due to COVID-19 restrictions. The government has used social distancing as a restriction to prevent the spread of COVID-19. People in general, and more specifically elderly people, were asked to stay at home to minimize the risk of becoming seriously ill for their own sake, and as not to overload the healthcare system. Social distancing had a negative impact on their health and well-being. Aim: To explore elderly's experience of social distancing during the COVID-19 pandemic. Method: The method used was a literature review, using qualitative and quantitative research.Results: Two overarching themes emerged: Psychological strain and facing a new reality, with four sub-themes: Increased loneliness, Negative emotions, New challenges and Coping strategies. Conclusions: The social distancing, related to the COVID-19 pandemic, has had a negative impact on the health of older people. Elderly people have suffered from loneliness, lack of well-being and have become isolated from society during the pandemic. They were encouraged not to burden the healthcare system and all their health promotion activities had been suspended due to the pandemic. Many elderly people have multiple illnesses and have previously experienced loneliness, which also worsened during the pandemic. The results showed an increased experience of loneliness and psychological burden. To cope with their new reality and challenges within, some older people found digital ways of socializing with each other and their relatives. It is important that society targets these high-risk groups to minimize their loneliness, depression, and subsequent increased morbidity. Keywords: COVID-19, elderly, loneliness, mental health, social distancing.

The combination of declining birth rates and an aging Swedish population presents challenges for the government in terms of accommodating and providing for the needs of a larger and older population. This demographic shift will exert significant pressure on the public sector, particularly the healthcare system. The potential of digitized healthcare to address the challenges posed by the aging population is significant, and mHealth technologies may be part of the solution to addressing these challenges. This study seeks to examine and quantify the key factors that influence the attitudes of young elderly (ages 45-60) individuals in Sweden towards the adoption of mHealth technologies. Specifically, the research aims to assess the factors that impact willingness to adopt technologies for managing primary healthcare needs. By identifying and measuring these influencing factors, the study strives to contribute to a better understanding of the drivers behind the adoption of mHealth solutions among this demographic. The study employs a single-method research design with a deductive empirical approach, using an online survey to collect quantitative data through a snowballing sampling technique. The study introduced three new variables (General Technology Experience, Healthcare Technology Experience, and Security and Privacy) and three new moderators (Being a Parent, Highest Level of Education, and Frequency of Primary Care Visits) to the widely recognized UTAUT framework. The results were analyzed using Excel and SPSS to identify patterns, relationships, and trends that emerged from the empirical data. Via analysis of the collected survey data, it was found that Performance Expectancy strongly influences the adoption of mHealth technologies among young elderly Swedes. Social Influence and Security and Privacy have minimal impact on adoption decisions. Security and Privacy show a negative correlation to willingness to adopt, indicating mistrust. Higher education levels are associated with digital literacy and belief in technology's job performance benefits. Lower education levels correlate with higher social influence. Individuals visiting primary care 2-3 times a year exhibit higher technology experience and social influence.

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Background Elderly persons need to be physical active for an opportunity to a healthy aging. It is important for the nurse and other healthcare professionals to understand significance of thepreventive care and health promotion for an older population that are growing in our society. This to promote elderly persons wellbeing and health. The elderly person has right to the opportunity for a healthy aging process. Aim The aim of this literature review was to illuminate the elderly person´s experiences of physical activity and how it can contribute to health. Method A method of a five-step model were used. An analysis of qualitative results of 12 scientific articles was preformed, which focused on the elderly person´s experiences of physical activity. Results Two main themes and four subthemes emerged. The result present two main theme:“Personal dimensions that affect the possibility of physical activity” and “Surrounding dimensions that affect the possibility of physical activity”. The subthemes where “Motivation” and “Social interaction”, “Outdoor environment” and “Obstacles”. Conclusion Elderly person´s experience of being physical active has an important link to the feeling of well-being and perceived health. Being physical inactive has consequences such as negative effect on elderly person´s health. This literature study contributes to knowledge about the importance of physical activity for elderly persons, which highlight the importance of offering health promoting efforts in both nursing care and society for elderly persons.

According to the United Nations, by the year of 2050, 16% ofthe world’s population will be over the age of 65, that is one in six people.¹ Considering this, there is more need than ever to bridge the generation gap. Prior research on the theme of different kinds of domestic efficiency, led me to a comparative study between mass produced housing and collective living. I spoke in favour of the values of social sustainability at the price of economically superior construction methods. Departing then from the subject of social isolation and involuntary loneliness versus togetherness, I landed on the topic of elderly care and intergenerational interdependence. This paper proposes the need of intergenerational housing and therefore my method for approaching this theme is through designing a combined elderly care home, student housing and preschool. My findings suggest that the environment which surrounds us impacts us in a number of ways, as does the ambiance, the people, and the relationships we have with them. Therefore, I aim to create a space with a warm and familiar feel as opposed to an impersonal and institutional one and a place where relationships between different age groups can naturally blossom.

China is moving into an aging society, and the quality of life of the elderly has become a topic of public concern. With the development of ICT technology, China’s digital level is increasing, and there is a digital literacy gap between the young and the elderly, and the intergenerational digital divide is widening. This paper combines the unique Chinese social context with smartphones as a representative digital tool aiming to analyze the dig- ital dilemmas experienced by the elderly living in Dongying, a fourth-tier city in China. Two research questions guide this study in the digital dilemmas of the elderly: 1)the role of smartphones in the lives of older people, and 2)the specific manifestations of digital dilemmas of older people and the influencing factors. The two theories UTAUT model and Cultural reverse form a theoretical framework to enhance our understanding of the digital dilemma.This study employed qualitative methods to collect (semi-structured interviews) and ana- lyze (substantive coding) data. Six elderly people over 65 years old living in Dongying participated in the study as interviewees. The results show that using smartphones is a re- quirement for the elderly from society and their children, therefore most of them no longer have difficulties in acquiring smartphones. However, smartphones still play an entertain- ment role in seniors’ lives, and most seniors only use their smartphones to make video calls with their children and watch short videos. They still lack an understanding of digital technology and are unable to apply it in a meaningful way. Such a dilemma is caused by a combination of technological limitations and psychological factors. They were born in an era when the country was still poor, their families were unable to support them in school, most of them did not graduate from elementary school, and their poor literacy skills would create obstacles for them to use smartphones. In addition, they did not have adequate learning access and had to rely on their children to help them learn smartphones, and their learning was entirely dependent on the cultural reverse ability of their children. In addition, they have resistance to learning smartphones, repeated learning due to memory loss, and a lack of confidence in themselves prevent them from further learning of digital skills.

Indiana University-Purdue University Indianapolis (IUPUI) / Half of those who are diagnosed with cancer in any given year are over age 65. Approximately 3.1 million males and 2.3 million females over age 65 became ill with cancer in 2000. The purpose of this study was to investigate the psychosocial experience of the older adult with cancer to enable social workers to better serve this population. It is not clear from previous research whether their lived experience in adapting to cancer is different from that of younger persons. Thirteen older adults with cancer were interviewed in-depth along with a focus group of three oncology social workers.