A total of 58 percent of elderly individuals receiving elderly care report experiencing loneliness, as indicated by the National Board of Health and Welfare's annual survey focused on this demographic. Regardless of the adverse effects of loneliness on health, addressing and acknowledging involuntary loneliness is crucial, given its potential to cause discomfort and diminish the wellbeing of the elderly. The objective of this study is to explore how aid officers, through conversations with the elderly, identify and address loneliness among this population. Additionally, the study aims to understand the actions aid workers take upon recognizing loneliness. The goal is to determine whether aid officers' perceptions of loneliness in the elderly are linked to various interventions provided by social services for this demographic. The research questions focus on how aid officers observe and address feelings of involuntary loneliness in the elderly, the nature of the needs assessment conducted by aid officers regarding these feelings, and the types of interventions offered to address loneliness among the elderly. The study adopts a qualitative approach, involving interviews with four aid officers from the Health Care and Care Administration. These aid officers are responsible for approving interventions, including social care for the elderly. The theoretical framework for interpreting the findings encompasses the activity theory and continuity theory. The results and analysis indicate that aid officers individually recognize and address loneliness in the elderly. However, they operate within common guidelines and templates, particularly in the context of social interventions where loneliness plays a role in the assessment for granting social interventions.

Bakgrund Den åldrande befolkningen i Sverige ställer idag högre krav på kvaliteten inom äldreomsorgen. Delaktighet har identifierats som en nyckelfaktor för att förbättra vårdkvaliteten, arbeta personcentrerat och främja de äldres välbefinnande. Syfte Syftet med studien var att beskriva sjuksköterskors och äldre personers erfarenheter av delaktighet i omvårdnaden inom äldreomsorgen. Metod Studien baserades på en systematisk litteraturöversikt där befintlig forskning om ämnet analyserats och ett nytt resultat framställts. Resultat Resultatet visade på att både sjuksköterskor och de äldre värderade delaktighet högt inom vårdandet. Det framkom två huvudkategorier vilket var; vårdmöte och individanpassad omvårdnad. Dessa huvudkategorier indikerar på att resultatet både innehöll hinder som exempelvis brist på tid och resurser men även förhållningssätt som främjade delaktighet, exempelvis individanpassad vård. Slutsats Sammanfattningsvis visade arbetet på att det finns ett ytterligare behov av utbildning hos sjuksköterskor inom området delaktighet och organisatoriska förändringar som kan främja delaktighet i den individanpassade vården hos de äldre. Där utveckling inom området kan ge möjlighet för sjuksköterskan att kunna arbeta utifrån ett personcentrerat förhållningssätt där de äldres önskemål och preferenser står i centrum för att förbättra deras livskvalitet och välbefinnande. / Background The aging population in Sweden currently imposes higher demands on the quality of elderly care. Participation has been recognized as a crucial factor for enhancing the quality of care, working in a person-centered manner, and promoting the well-being of the elderly. Aim The aim of the study was to describe the experiences of nurses and elderly individuals regarding participation in nursing care within elderly care services. Method The study is based on a systematic literature review where existing research on the subjectis analyzed, and new findings are produced. Results The findings indicated that both nurses and the elderly highly valued participation in care. Two main categories emerged: care meetings and individualized care. These main categories suggest that the results included both barriers, such as a lack of time and resources, and approaches that promoted participation, such as individualized care. Conclusions In summary, the work demonstrated that there is an additional need for education among healthcare personnel in the field of participation and organizational changes that can promote individualized care for the elderly. Development in the field can provide the opportunity for nurses to work from a person-centered approach where the elderly's wishes and preferences are central to improving their quality of life and well-being.

研究背景: 居住於安老院舍的長者通常患有多種不可逆轉的慢性疾病或未期病症。相對其他組群，他們將更快面對臨終與死亡的問題。因此，了解他們對「臨終問題」的態度、臨終地方的選擇意向及其預測因素是非常重要的。研究所得資將有助提供優質的“善終“服務予這群弱勢的長者。 / 研究目的: 本研究旨在探討有關居於香港安老院舍的長者對「臨終問題」的態度、臨終地方的選擇意向、是否視安老院舍如同自己的家及其預測因素。 / 研究方法: 本研究採用橫斷面量性研究的方法，以便利抽樣方式在香港不同地區的安老院舍進行研究。研究對象為年齡65歲或以上，及簡短智能測試達6分或以上，並能以廣東話溝通的安老院舍長者。研究採用結構性問卷以面對面訪談形式進行，作者把「對臨終問題的態度調查問卷」翻譯成中文版本用作調查長者對臨終問題的態度。並採用EQ-5D和Barthel Index (20) 以評估長者的自我健康評估及日常生活自我照顧能的狀況。調查問卷亦包括探討長者對安老院視為自己的家的看法和死亡地點的選擇。收集之數據採用了二分類邏輯回歸進行各因素與結果變量之間的單因關聯分析，那些p值<0.25的因素被選定為候選自變量，然後利用逐步多因素邏輯回歸分析來劃定結果變量的獨立相關因素。 / 研究結果: 合共317名來自20間安老院舍的長者參與了此項研究，包括248名女性(78.2%)和69名男性(21.8%)，年齡介乎65至99歲，平均年齡為84歲(標準差6.6)。多因素分析顯示多種預測因素與「臨終問題」的態度有著相關性；對於有家庭財政支持的長者來說，他們較傾向不同意由醫生作出所有有關照顧上的決定；有接受教育和患有較多慢性病的長者較傾向同意訂立預前指示；那些在安老院舍居住時間較長的長者較傾向不同意使用藥物讓他們可以隨時選擇結束生命；但患有糖尿病者較傾向同意安樂死；有宗教信仰者較傾向同意靈性或宗教的支持對他們是重要的。此外，310名安老院舍長者(97.8%)認為安老院舍如同自己的家。有261名長者 (68.1%) 表示希望在目前的安老院去世。那些認為安老院舍如同自己的家、有獨立經濟支持、及同意安樂死的院舍長者，較傾向希望在目前的安老院去世。 / 研究結論: 本研究譂述了居於香港安老院舍的長者對「臨終問題」的態度及其相關因素的實證結果。研究發現幾乎所有安老院舍的長者視安老院舍如同自己的家，明顯地相當多的長者表示如果條件允許下，希望在目前的安老院舍去世。這種強烈的聲音指出我們需要發展院舍的臨終照顧以滿足院舍長者的需要及期望。而從獲悉長者對「臨終問題」的態度及臨終地方的選擇意向，可讓醫護專業人員在安老院舍裡更有效地規劃臨終照顧服務，並能讓長者善終與好死。 / Background: Older people living in residential care homes for the elderly (RCHEs) have high incidences of irreversible chronic illnesses and terminal diseases. They are the most significant group facing impending death and dying. It is vital to understand their attitudes toward end of life (EOL) issues and their preference for EOL care in order to promote their quality of life. / Objective: This study aims to examine the attitudes toward EOL issues, the preference for place of death, the perception of RCHE as a resident’s own home and their predictors amongst older RCHE residents in Hong Kong. / Method: A cross-sectional quantitative study with convenience sampling was conducted in RCHE in different regions of Hong Kong. RCHE residents aged ≥65 achieving abbreviated mental test score ≥6 and who were able to communicate in Cantonese were recruited. Face-to-face interviews were conducted with the aid of a structured questionnaire. Demographic and clinical characteristics were collected. Health and functional status were measured by Euroqol-5D and Barthel Index (20). The “Attitudes of older people to end of life issues questionnaire“ was translated from the English version into a Chinese version and employed to examine the attitudes toward EOL issues. The perception of RCHE as own home and the preference for place of death were examined. Univariate analysis on the association between the outcome variables was performed. Factors with a p value <0.25 in univariate analyses were selected for multivariable logistic regression to delineate factors independently associated with the outcome. / Results: A total of 317 participants including 248 (78.2%) women and 69 (21.8%) men from 20 RCHE participated in the study. Their mean age was 84 ± 6.6 (mean ± SD). As showed in multivariate analysis, respondents financially supported by their family were less likely to allow doctors to make all the decisions about their care. Those respondents with higher number of morbidities and had higher education were more likely to agree with making a living will. Those who lived longer in RCHE were less likely to agree to having a drug at their disposal to end their life. Respondents with diabetic mellitus were more likely to agree with euthanasia. Respondents who followed a religion were more likely to agree on the importance of spiritual or religious support. Furthermore, 310 (97.8%) respondents perceived RCHE as their own home. Two hundred and sixteen (68.1%) residents wished to die in their present RCHE. Residents with the means to support themselves financially, agreed with euthanasia and who perceived RCHE as their own home were more likely to wish to die in RCHEs. / Conclusion: Nearly all residents perceived RCHEs as their own home and a significant proportion wished to die there if conditions allowed. This asserts that EOL care in RCHE should be developed to meet the wishes of the older residents. This study delineated significant factors associated with the attitudes of older people toward EOL issues. Knowing those factors allows health care professionals to plan for quality EOL care services in RCHEs more effectively and foster good death for this vulnerable population. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Law, Po Ka. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 160-173). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter 1. --- CHAPTER ONE: INTRODUCTION AND BACKGROUND / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Epidemiology data of ageing in Hong Kong --- p.3 / Chapter 1.3 --- Impact of ageing population --- p.4 / Chapter 1.4 --- Residential care services in Hong Kong --- p.5 / Chapter 1.5 --- Quality of residential care homes for the elderly (RCHEs) in Hong Kong --- p.7 / Chapter 1.6 --- Definition of end of life care, palliative care and hospice care --- p.9 / Chapter 1.7 --- End of life care in residential care homes in Hong Kong --- p.11 / Chapter 1.8 --- Dying in place --- p.14 / Chapter 1.9 --- Perception of RCHEs as own home --- p.15 / Chapter 1.10 --- Factors influencing attitudes to end of life issues --- p.15 / Chapter 1.11 --- The proposed framework --- p.18 / Chapter 1.12 --- Aim of the study --- p.20 / Chapter 1.13 --- Operational definitions of key terms --- p.20 / Chapter 1.14 --- Significance of the study and its impact on the society and future service development --- p.22 / Chapter 1.15 --- Overview of each chapter of the thesis --- p.24 / Chapter 2. --- CHAPTER TWO: LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.25 / Chapter 2.2 --- Literature search --- p.26 / Chapter 2.3 --- Search results --- p.27 / Chapter 2.4 --- Unmet need for end of life care in RCHEs in Hong Kong --- p.28 / Chapter 2.5 --- EOL care in RCHEs of other Western and Asian countries --- p.33 / Chapter 2.6 --- Preference for place of death --- p.34 / Chapter 2.7 --- Attitudes toward end of life issues --- p.38 / Chapter 2.8 --- Factors affecting older residents when choosing to die in RCHEs --- p.41 / Chapter 2.9 --- Barriers to EOL care in RCHEs --- p.43 / Chapter 2.10 --- Conclusion --- p.45 / Chapter 3. --- CHAPTER THREE: RESEARCH DESIGN AND METHOD / Chapter 3.1 --- Introduction --- p.47 / Chapter 3.2 --- Aim of the study --- p.47 / Chapter 3.3 --- Objectives of the study --- p.47 / Chapter 3.4 --- Research questions --- p.48 / Chapter 3.5 --- Research design --- p.50 / Chapter 3.6 --- Sample size --- p.51 / Chapter 3.7 --- Study setting --- p.52 / Chapter 3.8 --- Sampling method --- p.52 / Chapter 3.9 --- Data collection --- p.54 / Chapter 3.10 --- Study instruments --- p.55 / Chapter 3.11 --- Translation process for the AEOLI questionnaire --- p.60 / Chapter 3.11.1 --- Establishing the semantic equivalence --- p.64 / Chapter 3.11.2 --- Establishing the content and face validity --- p.66 / Chapter 3.12 --- Pilot study --- p.67 / Chapter 3.12.1 --- Testing the feasibility --- p.67 / Chapter 3.12.2 --- Test-retest --- p.68 / Chapter 3.13 --- Data cleaning --- p.70 / Chapter 3.14 --- Data analysis --- p.70 / Chapter 3.15 --- issues and consent Ethical --- p.72 / Chapter 4. --- CHPATER FOUR: RESULTS / Chapter 4.1 --- Introduction --- p.74 / Chapter 4.2 --- Recruitment of participants --- p.74 / Chapter 4.3 --- Characteristics of the study sample / Chapter 4.3.1 --- Socio-demographic characteristics --- p.76 / Chapter 4.3.2 --- Clinical characteristics --- p.79 / Chapter 4.3.3 --- Functional and health status --- p.81 / Chapter 4.4 --- Descriptive statistics of AEOLI-C, preference for place of death and perception of RCHEs as residents’ own home / Chapter 4.4.1 --- Descriptive statistics of AEOLI-C --- p.83 / Chapter 4.4.1.1 --- Decision making (Attitude 1) --- p.83 / Chapter 4.4.1.2 --- Pain (Attitude 5, 9, 20) --- p.83 / Chapter 4.4.1.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.84 / Chapter 4.4.1.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.84 / Chapter 4.4.1.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.85 / Chapter 4.4.1.6 --- Ageism (Attitude 13, 16, 23) --- p.85 / Chapter 4.4.1.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.85 / Chapter 4.4.1.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.85 / Chapter 4.4.1.9 --- Societal awareness (Attitude 12) --- p.86 / Chapter 4.4.2 --- Descriptive statistics of the perception of RCHEs as residents’ own home --- p.86 / Chapter 4.4.3 --- Descriptive statistics of the preference for place of death --- p.86 / Chapter 4.5 --- Correlational and logistic regression results / Chapter 4.5.1 --- Correlational and regression results of the predictive factors associated with AEOLI-C --- p.89 / Chapter 4.5.1.1 --- Decision making (Attitude 1) --- p.89 / Chapter 4.5.1.2 --- Pain (Attitude 5, 9, 20) --- p.90 / Chapter 4.5.1.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.91 / Chapter 4.5.1.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.93 / Chapter 4.5.1.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.95 / Chapter 4.5.1.6 --- Ageism (Attitude 13, 16, 23) --- p.97 / Chapter 4.5.1.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.99 / Chapter 4.5.1.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.100 / Chapter 4.5.1.9 --- Societal awareness (Attitude 12) --- p.101 / Chapter 4.5.2 --- Correlational and regression results of the predictive factors associated with the perception of RCHEs as residents’ own home --- p.104 / Chapter 4.5.2.1 --- Relationship with socio-demographic characteristics, clinical characteristics, health and functional status --- p.104 / Chapter 4.5.2.2 --- Relationship with AEOLI-C --- p.108 / Chapter 4.5.3 --- Correlational and regression results of the predictive factors associated with preference for place of death --- p.110 / Chapter 4.5.3.1 --- Relationship with socio-demographic characteristics, clinical characteristics, functional and health status --- p.110 / Chapter 4.5.3.2 --- Relationship with AEOLI-C --- p.114 / Chapter 4.6. --- Summary of the results --- p.116 / Chapter 5. --- CHAPTER FIVE: DISCUSSION / Chapter 5.1 --- Introduction --- p.117 / Chapter 5.2 --- Characteristic of the participants --- p.118 / Chapter 5.3 --- The attitudes toward end of life issues --- p.120 / Chapter 5.3.1 --- Decision making (Attitude 1) --- p.121 / Chapter 5.3.2 --- Pain (Attitude 5, 9, 20) --- p.123 / Chapter 5.3.3 --- Care environment (Attitude 3, 6, 10, 15, 27) --- p.125 / Chapter 5.3.4 --- Living wills (Attitude 8, 14, 19, 24) --- p.128 / Chapter 5.3.5 --- Euthanasia / Physician assisted suicide (Attitude 4, 17, 18, 26) --- p.131 / Chapter 5.3.6 --- Ageism (Attitude 13, 16, 23) --- p.133 / Chapter 5.3.7 --- Psychological needs including religious/spiritual (Attitude 11, 25) --- p.135 / Chapter 5.3.8 --- Quality versus quantity of life (Attitude 2, 7, 21, 22) --- p.136 / Chapter 5.3.9 --- Societal awareness (Attitude 12) --- p.137 / Chapter 5.4 --- The perception of RCHEs as residents’ own home --- p.138 / Chapter 5.5 --- The preference for place of death --- p.140 / Chapter 5.6 --- Summary --- p.143 / Chapter 6. --- CHAPTER SIX: CONCLUSION / Chapter 6.1. --- Introduction --- p.145 / Chapter 6.2 --- Limitations of the study --- p.145 / Chapter 6.2.1 --- Generalization of the results --- p.145 / Chapter 6.2.2 --- Lack of theoretical construct of the translated questionnaire --- p.147 / Chapter 6.2.3 --- Limitations of quantitative study and cross-sectional design --- p.149 / Chapter 6.3 --- Contributions of the study --- p.150 / Chapter 6.4 --- Recommendations and implications to nursing practice --- p.152 / Chapter 6.5 --- Implications to the EOL Care Practice in Residential Care Setting --- p.154 / Chapter 6.6 --- Implications to residential care policy --- p.155 / Chapter 6.7 --- Recommendations for further studies --- p.156 / Chapter 6.8 --- Conclusion --- p.158 / Chapter 7. --- REFERENCES --- p.160 / Chapter 8. --- APPENDICES --- p.174

Submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Background An increase in the world's population of ageing people is occurring not only in developed countries but also in developing countries. In South Africa, the proportion of the population aged 50 and over increased from 14.8% in 2006 to 15% in 2009 and is predicted to be 19% by 2030. This means that the supply of services for the elderly people should match the demand at all times, otherwise the quality of life of these senior citizens will be compromised. This study aimed at developing a model that would improve the quality of life for elderly people living in the uMhlathuze and uMlalazi sub-districts of the uThungulu district, KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive design was applied for this study. A semi-structured interview guide based on the Health Related Quality of Life Theory and Maslow’s hierarchy of needs was used. Random sampling was used to select the elderly participants. Purposive sampling was used for the selection of the chairpersons of non-governmental organisations, and the District Programme Manager. Audits were conducted in the clubs that elderly people with chronic disease participate in. Data analysis followed Tesch’s steps after which themes and categories were formulated. Results Three major themes that emerged from the data analysis were social well-being of elderly people, physiological factors and psychological factors. The results revealed that elderly people experience poor living conditions and suffer poverty due to a number of factors which including the high unemployment rate of their children. Often the children are involved in substance abuse using the elderly person’s money pension money, which leaves them without any food items in the household. According to the District Programme Manager, there was a project on integrated chronic disease management that was conducted at uThungulu district by the Department of Health. The integrated chronic disease management focused on the population in general of all ages, yet in this study the focus has been on elderly people, which is why the researcher developed a model to improve the QoL of elderly people, due to their unique needs. Conclusion This research study gathered information regarding social, economic, health and environmental factors in rural areas which will help in bringing issues of elderly people’s quality of life to awareness. This research will deepen the knowledge and skills of professionals on ageing issues, especially in rural areas/communities. / D

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-03-28T21:55:12Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Janaína_Amorim_de_Avila.pdf: 3116845 bytes, checksum: 79a50ae79fa8d1ad309cf1b4154c62ce (MD5) / Made available in DSpace on 2018-03-28T21:55:12Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese_Janaína_Amorim_de_Avila.pdf: 3116845 bytes, checksum: 79a50ae79fa8d1ad309cf1b4154c62ce (MD5) Previous issue date: 2017-10-26 / Sem bolsa / O presente estudo enfocou os profissionais que trabalham em rede pública de atendimento aos idosos negligenciados ou socialmente vulneráveis. O aumento expressivo de pessoas idosas, na sociedade brasileira, e a previsão de um contingente ainda maior nas décadas futuras remetem os profissionais e a sociedade, como um todo, a criar estratégias para diminuir ou acabar com a negligência e a vulnerabilidade social praticada contra a pessoa idosa. O estudo teve como objetivo geral: compreender o significado do atendimento aos idosos negligenciados ou socialmente vulneráveis para os profissionais da rede pública. E quanto aos específicos: Conhecer a organização da rede pública de serviços no atendimento prestado aos idosos negligenciados ou socialmente vulneráveis; Identificar as ações prestadas pelos profissionais que promovem assistência aos idosos negligenciados ou socialmente vulneráveis. Esta pesquisa foi fundamentada na linha do interacionismo simbólico, devido contemplar não só a complexa relação entre a sociedade, indivíduo e rede de serviços de atendimento, mas, também, o desenvolvimento de símbolos significantes e o processo de comportamento da mente, a partir de uma orientação filosófica e de fatos da existência real. A metodologia proposta nessa tese foi de cunho qualitativo, caráter exploratório e de análise de conteúdo somativa. A pesquisa foi aprovada pelo Comitê de ética da Faculdade de Medicina da Universidade Federal de Pelotas sob o parecer de número 2000.242, obedecendo aos preceitos éticos que direcionam a pesquisa com seres humanos no Brasil. A investigação transcorreu no município de Rio Grande/RS, cidade portuária, em que a população idosa apresenta uma estatística superior aos índices nacionais, sendo de 13,81%. A coleta de dados dessa averiguação transcursou por meio de entrevista semiestruturada, no período de abril a maio de 2017, com 21 participantes, sendo que 17 eram do sexo feminino, quatro masculino e na faixa etária entre 25 a 61anos. Quanto ao tempo de vinculação ao serviço variava entre 3 a 20 anos e com relação à formação profissional, 14 dos profissionais possuíam pós-graduação, nas áreas de Saúde Coletiva e Saúde da Família. A técnica de análise de conteúdo somativa ocorreu em três etapas: a pré-análise; a exploração do material que se repetia; a inferência e interpretação. Resultados: as entrevistas com os profissionais permitiram compreender que o profissional é o elo entre os dois mundos no atendimento ao idoso vulnerável e negligenciado, uma vez que ao atuar nesses universos, o profissional manifesta sentimentos diferenciados, ou seja, de satisfação com as resoluções dos casos e de frustração pela falta de apoio e sensibilidade dos gestores públicos em ofertar recursos suficientes para manutenção de um serviço proativo. Acredita-se que a vulnerabilidade e a negligência para o idoso só acabará ou minimizará se houver a mobilização dos profissionais e dos próprios idosos numa parceria de cidadania participativa. / The present study focused on professionals working in a public network of care for the neglected or socially vulnerable elderly. The significant increase in the number of elderly people in Brazilian society and the prediction of an even larger contingent in the coming decades remind professionals and society as a whole to create strategies to reduce or eliminate the neglect and social vulnerability practiced against elderly. The objective of the study was to understand the meaning of care for neglected or socially vulnerable elderly people in the public network. And as for the specific ones: To know the organization of the public network of services in the care provided to the neglected or socially vulnerable elderly; Identify the actions provided by professionals who provide care to the neglected or socially vulnerable elderly. This research was founded on the line of symbolic interactionism, due to not only the complex relationship between society, individual and the service network, but also the development of significant symbols and the process of behavior of the mind, from a philosophical orientation and facts of real existence. The methodology proposed in this thesis was qualitative, exploratory and analysis of summative content. The investigation was carried out in the city of Rio Grande / RS, a port city, where the elderly population has a statistic higher than the national indexes, being 13.81%. As far as the time of connection to the service varied between 3 to 20 years and in relation to the professional formation, 14 of the professionals had postgraduate, in the areas of Collective Health and Family Health. The technique of summative content analysis occurred in three stages: pre-analysis; the exploitation of the material that was repeated; the inference and interpretation. Results: interviews with professionals allowed us to understand that the professional is the link between the two worlds in the care of the vulnerable and neglected elderly, since when working in these universes, the professional expresses different feelings, that is, satisfaction with the resolutions of the cases and frustration due to the lack of support and sensitivity of the public managers in offering sufficient resources to maintain a proactive service. It is believed that vulnerability and neglect for the elderly will only end or be minimized if the professionals and the elderly themselves are mobilized in a participatory citizenship partnership.

Made available in DSpace on 2014-07-29T15:25:23Z (GMT). No. of bitstreams: 1 Tese de Doutorado Ruth Losada de Menezes.pdf: 1628232 bytes, checksum: 32727cccd739311e518bee0f3aab6bcf (MD5) Previous issue date: 2009-04-27 / Abstract xvii ABSTRACT Falling is a geriatric syndrome with multifactorial causes. Several studies confirm that fallings are frequent among institutionalized elders. The main objective of this study was to analyze the multidimensional factors associated with the falling episodes among elderly living at long-term care institutions in Goiania (GO) during the time of 2005-2007. A prospective longitudinal clinical trial was carried out at five philanthropic long-term care institutions for the elderly (LTCEI) in the city of Goiânia. The sample of the investigation included 59 elderly that met the inclusion and exclusion criteria. It was used a questionnaire containing socio-demographic data; information about falling episodes in the previous twelve months before the study and during may/august 2005 and may/august 2007 and the context of their occurrence; clinical data related to health/disease conditions; psycho-emotional data depression; assessment of the ability to perform Basic Activities of Daily Living (BADL) and the assessment of balance and gait. Simple frequencies of all the variables of the study were used for the data analysis. The comparisons among the variables were carried out using the McNemar test, the test of Marginal Homogeneity and the Chi-square test. Multi and univariate logistic regression analysis were performed in order to estimate the relative weight of each factor on the occurrence of fallings. The level of significance used for the statistic tests was 5%. The findings showed that there was a statistically significant increase of stroke (p=0,031) and other diseases (p=0,031) among the study population. There was an unfavorable evolution of the health for both groups (falling and non-falling elderly). The variable number of chronic diseases referred presented statistically significant difference among falling elderly, evidencing the unfavorable evolution (p=0,048). The variable other diseases presented statistically significant unfavorable evolution (p=0,021) for the non-falling elderly. Considering the study population, 54,2% of the elderly referred falling episodes, 22 (68,8%) elderly referred one episode, 06 (18,8%) referred two episodes and 04 (12,5%) referred three episodes. The context of occurrence of the falling episodes demonstrates that theses incidents took place mainly during day time, out of the indoor institution environment, during walking, on concrete floors, on dry surfaces, when they stumbled on something and when they were wearing flip-flops. The falls related for the study population were statistically associated to the female sex (p=0,015); cataract (p=0,007); lower score on the POMABrazil (p=0,038); altered performance of POMA-Balance on the following maneuvers 5th maneuver balance with eyes closed (p=0,024) and 10th maneuver perform spine extension (p=0,026); abnormal performance of POMA-Gait on the following maneuvers 15th maneuver step height Abstract xviii (p=0,047) and the 21st maneuver base of support during gait (p=0,047). The following variables were indicated as protection factors for falls by means of the univariate logistic regression analysis: male sex (OR 0,26), having cataract (OR 0,22), higher total score on POMA-Brazil (OR 0,04), normal performance on the 5th maneuver POMA-Brazil balance with closed eyes (OR 0,11), normal performance on the 6th maneuver POMA-Brazil balance when turning 360° (OR 0,29) and normal performance on the 10th maneuver POMA-Brazil spine extension (OR 0,19). By means of the multivariate logistic regression analysis, the following factors associated to falls were identified: protection variables associated to falls - male sex (OR 0,028) and the presence of cataract (OR 0,158); variable associated to risk of falls worse self-perception of health when compared to other people (OR 23,25). Because of this study it was possible to verify the decline of the elderly health during the two years investigated, characterizing the situation of functional vulnerability. Fallings cannot be underestimated and through this study it was possible to verify that the incident is present at the LTCEI of the city of Goiânia. With the dada obtained, we are able to point out the need of interventions directed to the health of the elderly, starting with a multidimensional approach that is only possible with the existence of an interdisciplinary health professional team, focusing on health promotion and health maintenance. / A queda é uma síndrome geriátrica que apresenta causas multifatoriais. Vários estudos apontam que em idosos institucionalizados as quedas são frequentes. O objetivo geral deste estudo foi analisar os fatores multidimensionais associados com o evento queda em idosos residentes em instituições de longa permanência em Goiânia (GO) no seguimento de 2005- 2007. Foi realizado um estudo clínico observacional longitudinal prospectivo em cinco instituições filantrópicas de longa permanência para idosos (ILPIs) no município de Goiânia. A amostra da investigação constou de 59 idosos que atenderam aos critérios de inclusão e exclusão. Utilizou-se um formulário contendo: dados sociodemográficos; informações sobre episódios de queda nos doze meses anteriores ao estudo e entre maio/agosto de 2005 e maio/agosto de 2007 e seu contexto de ocorrência; dados clínicos relacionados às condições de saúde-doença; dados psicoemocionais depressão; avaliação da capacidade para as Atividades Básicas de Vida Diária (ABVDs) e a avaliação do equilíbrio e marcha. Para análise dos dados foram utilizadas freqüências simples de todas as variáveis estudadas. Para as comparações entre as variáveis foram utilizados o teste de McNemar, o teste de Homogeneidade Marginal e o teste de Qui-quadrado. Para estimar o peso relativo de cada fator na ocorrência das quedas foram realizadas análises de regressão logística univariada e multivariada. O nível de significância adotado para os testes estatísticos foi de 5%. Os achados mostraram que no seguimento estudado houve incremento estatisticamente significativo de ocorrência de AVC (p=0,031) e de outras doenças (p=0,031). Observou-se evolução desfavorável da saúde para os dois grupos (idosos caidores e não-caidores). A variável número de doenças crônicas referidas apresentou diferença estatisticamente significativa entre os idosos caidores, mostrando evolução desfavorável (p=0,048). A variável outras doenças apresentou evolução desfavorável estatisticamente significativa (p=0,021) para os idosos não-caidores. Considerando o seguimento estudado, 54,2% dos idosos relataram ter sofrido queda, 22 (68,8%) idosos sofreram um episódio, 06 (18,8%) dois e 04 (12,5%) três. O contexto de ocorrência dos episódios de queda revela que estes incidentes ocorreram predominantemente no período do dia, fora do ambiente interno da instituição, quando os idosos estavam deambulando em piso de cimento, em superfície seca, quando tropeçaram em algo e quando estavam calçados com chinelos. A queda relatada no seguimento esteve associada estatisticamente com o sexo feminino (p=0,015), catarata (p=0,007), menor pontuação total no POMA-Brasil (p=0,038), desempenho alterado do POMA-Equilíbrio nas seguintes manobras 5ª manobra - equilíbrio com os olhos fechados Resumo xvi (p=0,024) e 10ª manobra - realizar extensão da coluna (p=0,026), desempenho anormal no POMA-Marcha nas seguintes manobras 15ª manobra - altura do passo (p=0,047) e 21ª manobra - sustentação durante a marcha (p=0,047). Por meio da análise univariada de regressão logística, foram identificados como fatores de proteção para quedas as seguintes variáveis: sexo masculino (OR 0,26), presença de catarata (OR 0,22), maior pontuação total POMA-Brasil (OR 0,04), desempenho normal na 5ª manobra POMA-Brasil equilíbrio com os olhos fechados (OR 0,11), desempenho normal na 6ª Manobra POMA-Brasil Equilíbrio ao girar (360º) (OR 0,29) e desempenho normal na 10ª manobra POMA-Brasil Extensão da coluna (OR 0,19). Mediante análise de regressão logística multivariada, foram identificados os seguintes fatores associados às quedas: variáveis protetoras associadas às quedas sexo masculino (OR 0,028) e presença de catarata (OR 0,158); variável associada ao risco para quedas pior autopercepção de saúde quando comparada a outras pessoas (OR 23,25). Por meio deste estudo foi possível verificar o declínio da saúde dos idosos ao longo dos dois anos investigados, caracterizando a situação de vulnerabilidade funcional. A queda não deve ser negligenciada e mediante este estudo foi possível verificar que o incidente fazse presente nas ILPIs do município de Goiânia. A partir dos dados obtidos, podemos indicar a necessidade de intervenções voltadas para a saúde do idoso, a começar por uma abordagem multidimensional que somente é possível mediante a presença de uma equipe profissional de saúde interdisciplinar, com foco na promoção e manutenção da saúde

<p>This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power.</p><p>This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals.</p><p>One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.</p>

This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power. This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals. One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.

Older people can be defined in different ways depending on the country’s social policies and also their health status. The health interventions overlook the vulnerability of older people regarding their individual health needs and their general susceptibility to chronic illnesses. Increasing economic disparities between races and inequalities in access to health services despite a large expansion in government social grants is another growing challenge. The major socio-economic changes has also contributed and enhanced the health challenges of older people in rural areas. This study aims to investigate the health perceptions and experiences of older people in rural areas and explore the factors that influence the quality of health of older people in South Africa. The study relied on focus group interviews (FGIs) and in-depth interviews (IDIs) to acquire an in-depth assessment and overall understanding of the life course and health perceptions of older people. Results reveal that even though health has evolved in South Africa over time, more challenges continue to affect the health of older people in rural areas where there are constant issues of low socio-economic status, poverty, migration and poor education attainment. The findings also suggest that, under the new political power there has been a change in the management of health care systems. Older people in KwaDumisa also face challenges with access to health care facilities.

Made available in DSpace on 2016-08-03T16:34:39Z (GMT). No. of bitstreams: 1 SAMANTHA RIBEIRO ULTRAMARI1.pdf: 1584078 bytes, checksum: 011cbc9e75c666c83cef25c8d4ba5163 (MD5) Previous issue date: 2007-03-21 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This research verifies through drawing the children&#146;s opinion on the Long Stay Home for the Elderly, before and after ludic contact with the resident elderly. So as to better characterize the elderly population, a neuropsychological profile is outlined. This work was developed with 21 resident elderly and 61 children aged between 7 and 12, from public Primary and Secondary schools. It begins with verification trough drawing of the children&#146;s opinion on Home for the Elderly. Then a ludic intervention with the participation of children and the elderly takes place: there are 10 encounters with symbolic games and rule games. Afterwards, the children&#146;s opinion is re-evaluated and a neuropsychological evaluation of the elderly is done, making use of the Mini Mental State Exam, of the Scale of Geriatric Depression, of the Short-Form Health Survey (SF-36) and of the Katz Rate. In order to verify the children&#146;s opinion expressed through drawing, the open title &#147;Home for the Elderly is&#133;&#148; is suggested to be completed. The drawings are analysed based on the projective, based on the projective House-Tree-Person (HTP) test. The results show that from one application of the test to the other there was a change in the opinion of 67% of the children, manifested a more positive opinion, perceiving the elderly as more interactive and the Home for Elderly as more humanised, as expressed in more colourful drawings of houses with doors and windows, people smiling and moving, and affectionate messages. The negative aspects found consist of an increased number of bars and people drawn faceless, which way 0,19, on a scale of 0 to 1, on which the maximum positive value is 1. On the neuropsychological evaluation of the elderly, during MMSE, 50% have showed cognitive preservation. The other instruments indicate that most of the subjects present no depressive symptoms, emit positive opinions on their on health, take part of ludic activities and are dependant. This study, however, points out that the particularities of the researched institution, together with the realization of ludic activities, may have favoured the changes on children&#146;s opinions after their contact with the home for the elderly. The study indicates the need of new research on the interaction of children and elderly people resident at nursing homes / Esta pesquisa verifica a opinião da criança por meio do desenho sobre o Lar de Longa Permanência para Idosos, antes e depois de contato lúdico com idosos institucionalizados. Para melhor caracterizar a população idosa, traça seu perfil neuropsicológico. Desenvolve-se junto a 21 idosos institucionalizados e 61 crianças com idades entre 7 e 12 anos, do Ensino Fundamental público. Inicia-se por verificar a opinião destas crianças sobre Asilo, por meio de desenho. Em seguida, realiza intervenção lúdica com crianças e idosos, de 10 encontros com brincadeiras simbólicas e jogos de regras. A seguir, reavalia a opinião das crianças e faz avaliação neuropsicológica dos idosos, por meio de Mini-Exame do Estado Mental, da Escala de Depressão Geriátrica, do Short-Form Health Survey (SF-36) e do Índice de Katz. Para verificar a opinião das crianças expressa por meio do desenho, utiliza de um título em aberto &#147;Asilo é...&#148;, a ser completado. Eles são analisados com subsídios do teste projetivo House-Tree-Person (HTP). Os resultados demonstram que houve, de uma aplicação para outra, alteração na opinião de 67% das crianças, que manifestaram opinião mais positiva relativa a perceber os idosos mais interativos e o Asilo mais humanizado, por meio de desenhos mais coloridas, de casas com portas e janelas, de pessoas sorrindo e em movimento e de mensagens afetuosas. Como aspectos negativos, encontram-se maior número de grades e de pessoas desenhadas sem face, o que pode representar a percepção da criança da dificuldade de contato do idoso com o mundo externo. Na análise estatística, encontrou-se média geral de 0,34 e desvio padrão de 0,16, no primeiro desenho e, no segundo, média de 0,42 e desvio padrão de 0,19, com médias obtidas numa escala de 0 a 1, em que se considera positivo o valor próximo a 1. Na avaliação neuropsicológica dos idosos, no MEEM, 50% demonstram preservação cognitiva. Os demais instrumentos indicam que a maior parte deles não apresenta sintomas depressivos, emite opinião positiva com relação à própria saúde, participa das atividades lúdicas e é dependente. Este estudo ressalta contudo que as características da instituição pesquisada, juntamente com a realização de atividades lúdicas, podem ter favorecido a opinião das crianças após seu contato com o Asilo. O estudo indica a necessidade de novas pesquisas sobre interação criança-idoso institucionalizado