Structural equation modeling was utilized in studying the voluntariness of the assumption of caregiving status. A model hypothesizing the stress flow that occurs when assuming a new life schema was presented. Utilizing three groups of caregiving populations, Home Caregivers, Intermediate Care Facility Aides, and Intensive Care Units and Emergency Room Nurses (N = 66), measures were administered to determine the voluntariness of the assumption of the role of caregiver. Path analysis and causal interpretation were utilized to determine outcomes. The involuntary assumption of the role of caretaker was shown to significantly affect depression and burnout rates negatively when perceived feelings of burden were high. When caretaker age was greater upon assumption of the role, self-esteem was low and family support was perceived to be lacking. When the role of caretaker is assumed on a voluntary basis and support from outside sources is perceived as helpful (i.e., social or financial support from the family), job stress and the subjective manageability of the symptoms were viewed as manageable. Implications for those assuming the role of caretaker with the elderly were examined, and recommendations for further training and interventions within the caretaker population were offered.

- 5 - SUMMARY This thesis is dedicated to the assessment of the current state of education and care for the elderly, and outlines ways to improve care through education and, ultimately, to achieve life satisfaction of seniors. The thesis is written in the form of a comparison of scholarly sources dealing with the education and care of the elderly, and the current legislation of the Czech Republic. The thesis also includes an empirical study which draws on a quantitative questionnaire survey in a selected nursing home. This investigation aims at further education of the elderly and its effect on life satisfaction of population in this age group. Key words: Old age, aging, older adult, elderly education, social services for the elderly.

Objetivo: Compreender a inserção dos idosos no Centro Dia para Idosos (CDI) sob a óptica de seus familiares. Método: Pesquisa qualitativa realizada em dois Centros Dia para Idosos particulares, um localizado na cidade de São Paulo e o outro no município de Suzano, e ambos possuem idosos com o perfil independentes até semidependentes. A coleta de dados foi realizada entre setembro e novembro de 2018, por meio de entrevistas com onze participantes, todas mulheres e cuidadoras familiares. A análise dos significados foi norteada pelo referencial teórico filosófico de Alfred Schütz. Resultados: A análise dos dados possibilitou-nos desvelar doze categorias motivacionais que traduzem a percepção do familiar sobre a inserção do idoso no CDI. As categorias concretas do vivido das motivações foram: a promoção de atividades que preservam a cognição e memória; a promoção do alívio da sobrecarga do cuidador e ao mesmo tempo o estímulo da socialização e a melhora na saúde; o sentimento de acolhimento do familiar e do idoso; a percepção da melhora no comportamento do idoso. Considerações finais: Os resultados deste estudo permitem ajudar outros cuidadores familiares que estão vivenciando a mesma situação com o seu idoso. O CDI auxilia no compartilhamento dos cuidados do idoso e consequentemente alivia os conflitos e a sobrecarga do cuidador familiar, além de melhorar as relações intra-familiares. É importante a atuação de profissionais preparados, como o Gerontólogo, com uma visão humanizada nos atendimentos e acompanhamentos aos cuidadores familiares no CDI. Ao longo da realização da pesquisa ficou evidente importância do CDI como um serviço de acolhimento ao idoso e a família, evitando a institucionalização / Objective: To understand the insertion of the elderly in the Senior Day Care Center (SDCC) from the perspective of their relatives. Method: Qualitative research carried out in two particular Senior Day Care Centers, one located in São Paulo and the other in Suzano, and both have elders with profiles from independent to semi-dependent. Data collection was performed between September and November of 2018, through interviews with eleven participants, all women and family caregivers. The analysis of the results was guided by Alfred Schütz philosophical theoretical framework. Results: Data analysis allowed us to unveil twelve motivational categories that reflect the perception of the relatives about the insertion of the elderly in the SDCC. The motivations concrete categories of what was experienced were: the promotion of activities that preserve cognition and memory; the reduction of the caregiver\'s amount of work and at the same time the stimulation of socialization and improvement in health; the family and the elders feeling of welcome; the perception of the improvement in the behavior of the elders. Final considerations: The results of this study may support other family caregivers who are experiencing the same situation. The SDCC helps to share the care of the elderly and consequently relieves the conflicts and the workload of family caregiving and also improves inner family relations. The performance of prepared professionals, such as the Gerontologist, is important, with a humanized view of care and follow-ups to the family caregivers in the SDCC. Throughout the research, the importance of SDCC as a welcoming service for the elderly was evident, avoiding institutionalization

O presente trabalho consistiu em investigar e refletir, sob o ponto de vista clínico, a respeito do processo de implantação de um serviço de Psicologia clínica voltada à saúde da pessoa idosa, num centro de referência do idoso da cidade de São Paulo, contemplado no Sistema Único de Saúde, o SUS. O interesse por esta pesquisa foi despertado pela necessidade de se compreender as demandas específicas desse tipo de população, para buscar manejos adequados ao atendimento clínico do idoso. Empregamos como método de investigação a pesquisa-ação, que serviu para apresentação e análise das ações propostas ao longo da criação do serviço de Psicologia frente às problemáticas e necessidades clínicas dessa população. A fim de tecer considerações teóricas e clínicas sobre o processo de implantação e a especificidade dessa clínica, partimos da teoria psicanalítica winnicottiana sobre o processo maturacional, das contribuições de Safra e da noção do conceito de perdão em Arendt. Assim, a partir da experiência de implantação e da reflexão desse processo, chegamos a uma concepção de clínica do envelhecimento, a qual contempla alguns eixos clínicos, tais como: 1) a necessidade de a pessoa idosa, na velhice, contar com um ambiente de alteridade que oferte e sustente um lugar ético de interlocução para revisão do sentido da vida; 2) uma clínica oriunda do diálogo contínuo acerca da desconstrução do self e da elaboração dos lutos, aspectos estes que favorecem a possibilidade de o idoso acolher a velhice e a sua própria morte como respostas ao percurso de vida; 3) a necessidade de se viver as várias facetas do perdão, como oportunidade de abrir novos espaços, a fim de sonhar um fim último possível e destinar a continuidade da vida para as futuras gerações; 4) a urgência de reflexões clínicas quando as necessidades acima descritas não são possíveis e se instauram situações de adoecimento e intensas agonias; 5) a presença do clínico como testemunho da vida e da morte / This work investigated and reflected, in light of a clinical view, about the implementation process of a Psychological Clinic Service that focused on the health of the elderly, in a reference centre for the aged in the city of São Paulo, contemplated by Sistema Único de Saúde (SUS). The interest for this specific research arose due to the need to understand the specific demands of this population, in order to search for proper management for the elderly therapy setting. Action research was the investigation method chosen to present and analyze the actions proposed throughout the design of the Psychology Service, considering the problems and the needs of this particular population. For the theoretical and clinical considerations about the implementation process and the setting specificity, we addressed the Winnicottian Psychoanalytic Theory about the maturational process, the contributions of Safra and the concept of forgiveness from Arendt. Therefore, having as starting points the implementation experience and the reflection on the process, we conceive the concept of the ageing clinic that addresses some clinical axis, such as: 1) the necessity of the elderly, at the old age, to rely on an environment of alterity that provides and supports an ethical space of interaction to revisit the meaning of life; 2) a clinic that continuously establishes a dialogue with the deconstruction of the self and the elaboration of mournings, aspects that create room for the elderly to welcome old age and their own death as part of the life course; 3) the need to live the various aspects of forgiveness, as an opportunity to open new spaces, in order to dream with a possible end and ensure life continuity to the future generations; 4) the call for clinical reflections when the needs previously described are not possible, and when we have situations of illnesses and intense agony; 5) the presence of the clinician as a testimony of life and death

Avaliar a qualidade de vida vem assumindo importância cada vez mais relevante nos últimos anos, particularmente no que diz respeito a sua mensuração, quer individual quer coletivamente. Quando constatamos que a população idosa no mundo está aumentando significativamente, assim como as políticas públicas internacionais construídas para atender às necessidades de saúde dessa população, fica evidente a importância de se realizarem estudos sobre a saúde e a qualidade de vida dos idosos, que envolvam diferentes países e, mais ainda, do ponto de vista deles próprios. Nesse contexto, esta investigação teve como objetivo avaliar e comparar a qualidade de vida dos idosos brasileiros e portugueses. Trata-se de um estudo quantitativo, exploratório, descritivo, comparativo e com delineamento transversal, em dois diferentes cenários: o município de Marília (Brasil) e o município do Porto (Portugal). Foram sujeitos deste estudo 349 idosos brasileiros e 100 idosos portugueses, usuários do serviço público de atenção básica, com autonomia física e psicológica e com idade igual ou superior a 60 anos. A coleta de dados foi realizada por meio de entrevistas, com os instrumentos de qualidade de vida denominados WHOQOL-BREF e WHOQOL-OLD da Organização Mundial da Saúde. A qualidade de vida geral, medida pelo WHOQOL-BREF, mostrou-nos que o escore médio dos idosos do Brasil foi 63,32 e dos idosos de Portugal foi 51,13. As médias dos escores melhor avaliados por domínios e por ordem crescente, no Brasil e em Portugal, respectivamente, foram: Brasil: meio ambiente (56,30), físico (63,46), psicológico (66,07) e relações sociais (66,52). Portugal: físico (47,71), psicológico (57,13), meio ambiente (60,03) e relações sociais (61,17). A qualidade de vida dos idosos brasileiros também foi avaliada por meio do instrumento WHOQOL-OLD e os escores avaliativos por faceta, em ordem crescente foram: autonomia (58,66), participação social (59,68), atividades passadas, presentes e futuras (64,40), intimidade (67,51), funcionamento dos sentidos (73,81) e morte e morrer (75,37). Os idosos, tanto no Brasil quanto em Portugal, avaliaram positivamente a qualidade de vida em todos os domínios e facetas do WHOQOL e as variáveis que mais contribuíram para esta avaliação positiva foram relações pessoais, apoio que recebem dos amigos, ambiente físico onde moram, cuidados de saúde que recebem e o meio de transporte que utilizam. Concluímos que, comparativamente, a qualidade de vida foi mais bem avaliada pelos idosos do Brasil do que pelos idosos de Portugal. Tendo em vista que o WHOQOL é um instrumento cuja avaliação é feita segundo a percepção do participante sobre sua posição na vida, no contexto da cultura e sistemas de valores nos quais vive, ou seja, a partir da sua subjetividade, o fator subjetivo presente nesta avaliação, exige que se considerem os fatores sociais, culturais e econômicos que caracterizam cada população e consequentemente influenciam a percepção sobre a qualidade de vida. Desse modo, as diferenças sociais e demográficas encontradas nesse estudo, entre os idosos do Brasil e Portugal, podem ajudar a compreender as diferentes avaliações de qualidade de vida. Entende-se que o intercâmbio de conhecimento e de práticas de saúde, desenvolvido em diferentes países e voltado para os idosos, pode contribuir para a melhoria da qualidade de vida dessa população específica. / Assessing the quality of life is becoming an increasingly relevant topic in recent years, particularly with regard to its measurement, both individually and collectively. When it was verified that the elderly population in the world is increasing significantly as well as international public policies built to meet the health needs of this population, it became evident the importance of further studies on the health and life quality of the elderly, involving different countries and, more, from their own standpoint. In this context, this investigation aimed to evaluate and compare the quality of life of Brazilian and Portuguese elderly people. This is a quantitative, exploratory, descriptive, comparative and cross-sectional study, in two different scenarios: the city of Marília (Brazil) and the city of Porto (Portugal). Study participants were 349 Brazilian elderly people and 100 Portuguese elderly people, users of basic public service, with physical and psychological autonomy and aged 60 or over 60. Data collection was conducted through interviews, with tools of life quality named WHOQOL-BREF and WHOQOL-OLD from the World Health Organization. The quality of general life, measured by WHOQIL-BREF, showed that the average score of elderly people in Brazil was 63.32 and in Portugal it was 51.13. The average of the best evaluated scores, by fields and in an ascending order, in Brazil and in Portugal was, respectively: Brazil: environment (56.30), physical (63.46), psychological (66.07) and social relations (66.52). Portugal: physical (47.71), psychological (57.13), environment (60.03), and social relations (61.17). Life quality of elderly Brazilian people was also assessed using WHOQOL-OLD and the evaluative scores for facet, in ascending order were: autonomy (58.66), social participation (59.68), past, present and future activities (64.40), intimacy (67.51), functioning of senses (73.81) and death and dying (75.37). The elderly, both in Brazil and in Portugal, evaluated positively the life quality in all areas and facets of WHOQOL and the variables that contributed most to this positive assessment were personal relations, support from friends, physical environment where they live, health care they receive, and means of transportation they use. It was concluded that, in comparison, life quality was better assessed by the elderly in Brazil than by the elderly in Portugal. Considering that WHOQOL is a tool whose evaluation is done according to participants perception on their position in life, on the context of culture, and on the lived value systems, that is, from its subjectivity, the subjective factor present in this evaluation requires consideration of social, cultural and economic factors that characterize each population and consequently influence the perception of life quality. Thus, the social and demographic differences found in this study, between the elderly in Brazil and in Portugal, can help to understand the different assessments of life quality. It is understood that the exchange of knowledge and health practices, developed in different countries and aimed at the elderly, can contribute to improving quality of life in this specific population.

INTRODUÇÃO: As quedas envolvendo idosos são problemas que trazem sobrecarga tanto de ordem sócio-econômica quanto de saúde pública e são transtornos, para essa população e para seus familiares, além de trazer aumento no risco de morte para esse grupo. A falta de equilíbrio nessa faixa etária é uma das principais causas das quedas e o fisioterapeuta encontra, em sua prática clínica, grandes desafios para gerenciar esse problema, pois há falta de dados científicos que definam qual o programa de treinamento mais adequado, principalmente em termos de prescrição de exercícios. OBJETIVO: Investigar as correlações entre os efeitos de um programa de exercícios cinesioterapêuticos gerais para idosos saudáveis previamente sedentários, com o equilíbrio estático e dinâmico desses indivíduos. MÉTODOS: O estudo foi desenvolvido no Laboratório de Fisioterapia e Reatividade Comportamental do Centro de Docência e Pesquisa em Fisioterapia da Faculdade de Medicina da USP. Participaram do estudo, 32 mulheres, com idade média de 68,6 anos, ativas na comunidade, livres de disfunções (cardiopulmonar, neurológica ou muscular) ou de doenças crônicas que afetassem a habilidade de exercitar-se. Após uma série de testes de avaliação do desempenho funcional (pré-teste), as participantes foram distribuídas, por sorteio, em dois grupos com dezesseis integrantes cada: o grupo A submeteu-se ao programa de exercícios gerais, e o grupo B foi o grupo-controle. As participantes do grupo A submeteram-se ao treinamento por quatro meses, duas vezes por semana, em sessões de uma hora de exercícios, atingindo entre 40% e 70% da freqüência cardíaca máxima estimada. O grupo controle participou de atividades recreativas de coordenação motora manual. No final dos treinamentos, os participantes dos dois grupos submeteram-se a uma nova avaliação de desempenho funcional (pós-teste imediato), utilizando o mesmo protocolo do pré-teste. A análise dos dados constou de identificação das características dos participantes por grupos no pré-teste, o estudo dos efeitos do treinamento no desempenho físico dos participantes, por grupos (pós-teste imediato) e, finalmente, o estudo das correlações encontradas entre as variações das variáveis testadas e as variações dos índices de equilíbrio estático e dinâmico. RESULTADOS: Houve aumento da correlação entre equilíbrio estático e equilíbrio dinâmico após a aplicação do programa dos exercícios, houve uma tendência de haver maior impacto da melhora da flexibilidade dos indivíduos sobre o equilíbrio estático, a força dos músculos flexores dos quadris parece ter influência na performance do equilíbrio estático e dinâmico, sendo mais importante para o equilíbrio estático e tendência a favor de haver relação entre um melhor equilíbrio estático quando há fortalecimento associado dos músculos extensores do joelho. CONCLUSÃO: Este estudo demonstrou que o treinamento de exercícios gerais teve efeito benéfico para a população idosa estudada e trouxe indícios de que há efeitos das várias modalidades de treinamento, embutidas nos exercícios gerais, sobre a melhora do seu equilíbrio e que tais modalidades podem ser incluídas em um programa para idosos visando à melhora do equilíbrio / Introduction: Falls involving elderly people are problems that brings both economics and public health overload and are a disturbance for them and their relatives, besides it brings a mortality enhance for the group. Unbalance at this age is the main cause of falls, and the physicaltherapist finds, on his clinic, a big challenge to deal, because there´s no cientific datas which explain the best training program, especially to physical activity prescriptions. Objective: To investigate the correlations between a general kinesiotherapeutic exercise program effect on healthy elders who once used to be sedentary and their static and dynamic balance. Method: This study was developed at Laboratorio de Fisioterapia e Comportamento da Faculdade de Medicina da Universidade de São Paulo-USP. It was 32 women, 68,6 years average, active, without any disfunctions (cardiopulmonary, neurological or muscleskeletical) or any chronic disease which could affected their exercise ability. After carring out functional evaluation tests (pretest), the participants were shared out, by raffle, in two groups with sixteen people each: the A group underwent a general exercise program, and the B group was the control group. The A group participants underwent a four months training, two times a week, one hour exercise each appointment, reaching between 40% and 70% of the maximum heart rate. The control group attended recreational motor coordination activities. At the end of the training, all participants underwent a new functional evaluation (postest), using the same pretest protocol. The data analysis found the participant caracteristics at the pretest, the study of effects at the physical performance training by group (postest), and the study of the correlations between variation factors tested and variations of the static and dynamic balance. Results: There was a positive correlations between static and dynamic balance after the program application, there was a tendencis of flexibility improvement over static balance, the hip flexors muscle has na influence at the static and dynamic balance, and it was important to help the static balance when there is a knee extensors strength. Conclusion: This study showed that general exercises training had a positive effect for the elderly group and brought signs that exist others modalities of training that can help the balance and those modatlities could be included on a elderly program looking for a balance enhance

This thesis is focused on frailty in old age. The frailty syndrome is the newest geriatric syndrome and can be aptly called the ultimate geriatric syndrome due to the complexity of its causes and the wide range of adverse outcomes it may lead to in older persons. Several of the important correlates of frailty, namely falls, underweight and sarcopenia, are discussed in the context of their relationship with frailty. These entities are geriatric syndromes in their own rights, sharing many common risk factors and arriving at adverse health outcomes either directly or via the pathway of frailty. In the publications that arose from this work, the risk factors of falls, in particular the relationship between medications and chronic diseases in causing falls; risk factors and outcomes of sarcopenia, in particular its relation to diabetes mellitus and other chronic diseases; and how underweight poses survival risks in both community-living and institutionalized older people, are discussed. The final publication of this series of studies demonstrated the reversibility of the frailty syndrome, showing that not all who were in the pre-frailty stage will decline. Risk factors associated with improvement or decline in the pre-frail stage were identified in the local population, and a period of relative stability opened for possible interventions was observed. This thesis thus examines the complex interplay of these syndromes in old age. It is hoped that these publications will enable further research into the underlying mechanisms of frailty and to elucidate modifiable risk factors, hence enabling older people, in particular those in the pre-frail stage, to live healthier and longer lives. / Lee Shun Wah Jenny. / Thesis (M.D.)--Chinese University of Hong Kong, 2015. / Includes bibliographical references. / Title from PDF title page (viewed on 15, September, 2016).

<p>This paper studies, from a client perspective, how three Swedish municipalities work with information about a voucher system in homecare. The paper is a qualitative study using structured informant interviews and analysis of documents. The interviewees are responsible of information about the voucher system in the municipalities. The studied documents describe and clarify the voucher system of the municipality. Neo-institutional organization theory is used to analyse the result. Existing research has showed how pensioners find information on the voucher systems lacking. The research also shows how care managers have difficulties relating to their new roles as information coordinators on the voucher system. With this background, the study focuses on examining how the municipalities work with and organises the information on the voucher system as well as how the responsibiliy of the information is handled. The result shows that the studied municipalities mainly deal with the issue from a market point of view, where the care providers are to be presented in a neutral way. However, one of the municipalities has reconsidered the principle of neutrality and works to clarify the information to the elders. All three municipalities place the responsibility of information on the care managers in their interaction with the elder. There is no further communication between the municipality and the elderly people in the form of client studies or fora of discussion and review of the information on the voucher system.</p>

This paper studies, from a client perspective, how three Swedish municipalities work with information about a voucher system in homecare. The paper is a qualitative study using structured informant interviews and analysis of documents. The interviewees are responsible of information about the voucher system in the municipalities. The studied documents describe and clarify the voucher system of the municipality. Neo-institutional organization theory is used to analyse the result. Existing research has showed how pensioners find information on the voucher systems lacking. The research also shows how care managers have difficulties relating to their new roles as information coordinators on the voucher system. With this background, the study focuses on examining how the municipalities work with and organises the information on the voucher system as well as how the responsibiliy of the information is handled. The result shows that the studied municipalities mainly deal with the issue from a market point of view, where the care providers are to be presented in a neutral way. However, one of the municipalities has reconsidered the principle of neutrality and works to clarify the information to the elders. All three municipalities place the responsibility of information on the care managers in their interaction with the elder. There is no further communication between the municipality and the elderly people in the form of client studies or fora of discussion and review of the information on the voucher system.

The group of elderly people in Sweden will increase significantly in the future and science point out that the future elderly people will not accept today’s standards and offers of assistance in today’s public elderly care. Therefore public elderly care stands before a significant challenge in terms of development that has to be sustainable. New research also points out that middle managers can be a great strategic resource, and a founder of success, in the challenge of sustainable development. The aim of the report was to increase the knowledge about what middle managers in public elderly care think sustainable development has to embrace, when it comes to quality and personnel administration, in order to meet the needs of the future elderly people. The aim was also to deepen the knowledge of how formal and informal organizational factors facilitate or limit middle managers possibilities to work with development in general and sustainable development in specific in their units. Interviews, as a qualitative method, were used to gather empirical data and the result was analyzed with theories as Domain theory, New Public Management and Situational leadership. Our findings showed that middle managers have little possibilities to work with sustainable development in their units and that formal factors as budget had a great impact of the middle managers overall possibilities in their work. According to the result it seemed that development and long term planning in this particular organization were tasks mainly for the management and political domain. According to our findings it seemed as if the introduction of New Public Management increased the underlying initial problems of human service organizations. According to Domain theory these problems consists of disjunction, discordance and conflicts due to the differences between the three domains when it comes to principles, success measures, structure and work modes.