Thesis (M.S.)--University of Michigan, 1999. / Running title: Nurse practitioners' perception on functional decline. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Objectives: The aim of this non-interventional observational study was to determine the prevalence of frailty in a cohort of 200 elderly patients and its correlation and dependence in relation to nutritional status and to evaluate the correlation of the items in the MNA - SF and SPPB test batteries and determine whether the weight loss is related to poor results in the evaluation of geriatric frailty, and to evaluate whether cognitive function affects nutritional status and if nutritional status in such circumstances affects subjects' self- sufficiency. Methods: Data was sourced from the results of standardized tests in Comprehensive Geriatric, Assessment, CGA at the 1. LF UK Geriatric Clinic, which include the assessment of selfsufficiency (ADL) and condition (SPPB), cognitive functions (MMSE) and the assessment of nutritional status (MNA - SF). Patients were also measured for bodyweight, height and BMI. Results: The study included a total of 200 patients, of whom 46 (23%) were men and 154 women (77%). Geriatric frailty was diagnosed in 59.5% of patients, with 21.5% of patients being classified as "pre-frailty" and 19 % of good physical condition. In this group 15.5% of patients were malnourished, 37.5% were at risk of malnutrition and 47 % were in a good nutritional condition. A statistically...

Introducción: Los adultos mayores institucionalizados (AMI), constituyen una población vulnerable porque pierden autonomía al adaptarse a un nuevo ambiente lo cual predispone la aparición de síntomas depresivos y dependencia funcional. El objetivo del estudio es determinar la asociación entre síntomas depresivos y funcionalidad en esta población. Materiales y Métodos: Estudio transversal analítico con la aplicación de instrumentos estandarizados para evaluar síntomas depresivos (Escala de depresión geriátrica de Yesavage) y dependencia funcional para actividades básicas de la vida diaria (Índice de Barthel) y la extracción de datos de historias clínicas en un Centro Geronto-Geriátrico en Lima- Perú durante Febrero- Abril del 2013. Resultados: 153 AMI fueron enrolados con una media de 80,8 ±7,3 años a predominio masculino, solteros, y de bajo nivel educativo. El 47,1% tenía algún grado dependencia funcional y el 62,1% algún síntoma depresivo. El coeficiente de Spearman entre los puntajes de Yesavage y Barthel mostró con una correlación negativa no significativa (-0,14, p=0,08). En el análisis de regresión lineal multivariado las covariables educación secundaria (p<0,01), hipertensión arterial (p<0,01), y dependencia funcional escasa (p=0,01) estuvieron asociadas a un mayor puntaje de sintomatología depresiva. Conclusiones: Existe asociación significativa entre los síntomas depresivos y dependencia funcional. Por ello, la identificación precoz de la dependencia funcional escasa en los AMI debe ser considerada como un indicador evitar la aparición de síntomas depresivos. / Introduction: Institutionalized Elderly (IE) constitute a vulnerable population because they lose their autonomy to adapt to a new environment which predisposes the onset of depressive symptoms and functional dependency. The aim of the study is determine the relationship between depressive symptoms and functional dependency in public old age homes. Materials and Methods: Analytical cross- sectional study using standardized scales to evaluate depressive symptoms (Yesavague’s Geriatric Depression Scale) and functional dependency on activities of daily living (Barthel Scale) and extracting data manually from medical records in a Gerontological- Geriatric Center in Lima Peru from February to April, 2013. Results: 153 IE were enrolled in the study with a mean age of 80.8, +/- 7.3 years. They were predominantly men, single and with low educational level, 47.1% had some degree of functional dependency and 62.09% some symptom of depression. The Spearman coefficient between Yesavage and Barthel illustrated non-significant negative correlation (-0.14, p=0.08). In the multivariate linear regression analysis, the covariates secondary education (<0.01), arterial hypertension (p<0.01) and functional dependency (p=0.01) were associated with a higher score of depressive symptoms. Conclusions: There is a significant association between depressive symptoms and functional dependency. Thus, the early identification of low functional dependency in IE should be considered as an early indicator to avoid depressive symptoms. / Tesis

Syftet var att granska sjuksköterskans dokumentation avseende intagningsorsak, andra identifierade problem/behov utefter CGA och vilka åtgärder det ledde till samt beskriva sjuksköterskans erfarenheter av att använda instrumentet CGA. Metod: Studien har en beskrivande design med kvantitativ och kvalitativ ansats. Totalt granskades 50 bedömningsinstrument och datajournaler. Frågeformulär utformades och 13 sjuksköterskor valde att delta. Journalgranskningarna utfördes med kvantitativ retrospektiv analys och frågeformulären analyserades enligt kvalitativ manifest innehållsanalys. Resultat: Under journalgranskningen framkom 11 olika intagningsorsaker där försämrat allmäntillstånd var den största gruppen. Totalt identifierades 205 problem/behov och 186 initierade åtgärder varav 7 åtgärder/person var högsta antal. Flest initierade åtgärder fanns inom nutrition, social bakgrund och fallrisk. Sjuksköterskornas erfarenheter av att använda CGA var att det fanns behov av tydliga arbetsrutiner gällande CGA, att CGA fungerade bra som checklista men var tidskrävande. De upplevde att CGA gav dubbelarbete men viljan fanns att använda CGA men däremot svårt att få det att fungera i arbetet samt att sjuksköterskorna identifierade problem/behov utan att använda CGA. Sjuksköterskorna upplevde inte att omhändertagandet förändrades men däremot fick teamet helhetsperspektiv på patientens livssituation. Samverkan med anhöriga och kommunen var viktigt. Slutsats: Studiens resultat visade att förutom inskrivningsorsak fanns även andra identifierade problem/behov utefter CGA som hade stor betydelse för att den äldre skulle uppleva hälsa. Sjuksköterskorna upplevde brister inom rutinen runt CGA samt erfor att sjuksköterskornas omhändertagande av den geriatriska patienten inte förändrades efter implementeringen av CGA. / Aim was to examine nurses documentation regarding admission cause, other identified problems/needs by the CGA and the actions that led to and describe nurses experiences of using the instrument CGA. Method: The study has a descriptive design with quantitative and qualitative approach. Total audited 50 assessment instruments and data records. Questionnaires were designed and 13 nurses chose to participate. Journal audits performed by quantitative retrospective analysis and the questionnaires were analyzed by the inspiration of qualitative manifest content analysis. Results: In the journal audit identified 11 different admission causes which reduced general condition was the largest group. Total identified 205 problems/needs and 186 initiated measures which 7 action/person was the highest number. Most measures were initiated in nutrition, social background and risk of falling. Nurses experiences of using the CGA was that there was a need for clear work procedures regarding the CGA, the CGA worked well as a checklist but was time consuming. They felt that the CGA gave duplication but the desire was to use the CGA but hard to make it work at work and the nurses identified problems / needs without using the CGA. The nurses did not feel that the care was changed but got the team holistic view of the patients life situation. Collaboration with families and the municipality was important. Conclusion: The study results showed that in addition the cause enrollment were other identified problems/needs along the CGA that had great importance for the elderly would experience health. The nurses experienced deficiencies in routine around the CGA and required that the nurses taking care of the geriatric patient did not change after the implementation of CGA.

Master of Regional and Community Planning / Department of Architecture/Regional and Community Planning / John W. Keller / The aging demographic of the United States is growing at an alarming rate. Each day, there are more than 10,000 people turning 65 years old. The majority of these individuals prefer to live in their home, called aging in place. Aging in place requires the resident to be relatively independent and capable of accessing necessary services. The emergent demographic shift will compel every community across the country to focus community planning efforts toward older adults. The amenities and structures in a community are, most of the time, not favorable for the older demographic. People in their later years develop various medical and physical conditions and subsequently, find difficulty when adapting to the environment. These individuals definitely need extra care and consideration from all sectors of the community. Creating an environment that promotes aging in place for older adults is confronted with multiple barriers that a community must work past.

The purposes of this secondary study were to explore the case detection phenomena of elder abuse by determining the congruence between nurses' assessments of abuse and elders' self-reports of abuse; to identify factors that may account for differences between abusive situations and nonabusive situations; then to describe differences between abused elders correctly identified and abused elders incorrectly identified by nurses. Both quantitative and qualitative data were used. The theory of attribution directed this research. The conceptual framework consisted of four concepts: structural factors, relationship factors, elder factors, and caregiver factors. A descriptive-comparison design was used to address the research questions. The sample included 48 elder-caregiver dyads, of whom 24 were self-reported abused elders and 24 self-reported nonabused elders. Descriptive analysis was used, including chi-square and t-tests. Results indicated that the nurses' assessments of elder abuse and elders' self reports of abuse were congruent in only one-fifth (N = 5) of the abused cases (N = 24). The findings confirmed allegations that nurses have difficulty identifying elder abuse unless outright battering is observed. Five variables were significant between abused and nonabused elders, and 10 variables were significant between abused elders correctly identified by nurses and abused elders incorrectly identified by nurses.

Class of 2012 Abstract / Specific Aims: To review overall quality of life (QOL) in active geriatric patients and to observe different attitudes toward aging in the student comparison groups. Subjects: Current students, regardless of academic year, attending the University of Arizona College of Pharmacy with a university email account. Methods: Data was collected using an electronic questionnaire. A link to the questionnaire was sent out via email to all University of Arizona, College of Pharmacy students. Another email containing the link to the questionnaire was sent two weeks after the initial notification. The questionnaire consisted of 36 questions requesting students to express their perspective on the health status, mental status and physical abilities of the elderly. Main Results: Geriatric patients tended to have a more positive view on their overall health when compared to students' perceptions of geriatric QOL (86.7% versus 35.7%, P <0.05). Students were also more likely to have the perception that geriatric patients had limitations in regular activities due to physical health and emotional problems when compared to the actual responses of older adults (72.6% versus 40.0%, P <0.05; and 60.0% versus 16.7%, P <0.05; respectively). There was a significant difference (P<0.05) between responses from students and geriatric patients to every question. Conclusions: There appears to be a noteworthy difference between pharmacy student perceptions of geriatric QOL and actual older adult QOL responses that may warrant an educational intervention.

The purpose of this study was to determine if aging attitudes, informal knowledge and formal education impact Master of Social Work (MSW) student interest in geriatric social work. A total of 70 MSW students participated in this study. The students were recruited from several metropolitan Atlanta MSW programs. A quantitative research design was employed, and surveys were used to gather the data. This study was designed to document the characteristics of MSW students and to predict interest based on perceptions using Ordinal Regression analysis. There was statistical significance identified with the aging attitudes and formal education variables and no statistical significance identified with the informal knowledge variable. The conclusions from this study suggest continued research regarding the factors influencing interest in geriatric social work.

Resumo: Sentir-se saudável ou doente é uma condição subjetiva. Mensurar o grau ou o significado de uma enfermidade para um determinado indivíduo é, portanto, uma atividade complexa. A subjetividade inerente ao processo saúde-doença resulta em grande variação na identificação de diagnósticos clínicos e, nesse sentido, a utilização de instrumentos padronizados aumenta a concordância entre os profissionais de saúde. Aferir e validar a coerência e consistência de instrumentos utilizados para a avaliação clínica de idosos. Estudo epidemiológico do tipo transversal. A base de dados provém de uma pesquisa de 2002. Foram entrevistados em domicílio 353 idosos com os questionários: Atividades Básicas da Vida Diária (AVD), Atividades Instrumentais de Vida Diária (AIVD), Escala de Depressão Geriátrica (EDG), Mini Exame do Estado Mental (MEEM), Avaliação de Suporte Social do Medical Outcomes Study, Avaliação de Adesão Medicamentosa, Escala de Dependência de Nicotina, Escala de Avaliação de Problemas com Álcool (questionário CAGE) e uma Avaliação Sócio-econômica. Foram realizados cálculos da consistência interna das variáveis através do Coeficiente α de Cronbach e a técnica Split-Half nos instrumentos completos para avaliar reprodutibilidade. As escalas que podem ser utilizadas sem modificações ou ressalvas são: a AIVDs; o MEEM; o questionário CAGE e a Avaliação do Suporte Social do Medical Outcomes Study. A Escala de Atividades Básicas da Vida Diária (AVD) apresenta uma questão incoerente com o constructo. Quando esta é excluída das análises, ocorre melhora da coerência da escala. / Abstract: Feeling healthy or ill is a subjective condition. To measure the level or meaning of a disease is, therefore, a complex activity. The subjectivity inherent to the health-disease process results in a large variation in the identification of clinical diagnoses and, in this sense, the use of standardized instruments increases agreement among healthcare professionals. To analyze and validate the coherence and consistency of instruments used for clinical evaluation of elderly. This is a transversal-type epidemiological study. The database was obtained from a study conducted in 2002. Three hundred and fifty-three elderly individuals were inquired at home by trained interviewers using the following questionnaires: Daily-Life Basic Activities Scale (ADL), Daily-life Instrumental Activities (IADL), Geriatric Depression Scale, Mini Mental State Examination (MMSE), Social Support Survey from the Medical Outcomes Study (MOS), Medication adherence Evaluation, Nicotine Dependence Scale, Scale for Alcohol-Related Problems (the CAGE questionnaire) and a Socio-economic Evaluation. Calculations of the internal consistency of variables were performed by using the Cronbach's α Coefficient and the Split-Half technique for the complete instruments in order to evaluate reproducibility. The scales that can be used without modifications or restrictions are: the IADL; the MEEM; the Social Support Survey from the MOS; the CAGE questionnaire. The ADL has a question which was incoherent with the scale was observed. / Orientador: José Eduardo Corrente / Coorientador: Tania Ruiz / Banca: João de Castilho Cação / Banca: Beatriz Funayama Alvarenga Freire / Banca: Silvia Cristina Mangini Bocchi / Mestre

O presente trabalho se propôs a fazer uma avaliação da higiene e saúde orais de pacientes geriátricos portadores de próteses totais. Devido ao crescimento da população idosa houve um aumento do número de pacientes que passaram a usar algum tipo de prótese (total, removível ou implantes). Espera-se que as próteses totais restituam as funções estéticas, mastigatórias e fonéticas, no entanto sua instalação não representa o final da reabilitação protética, existindo a necessidade da realização de controles periódicos. Um dos fatores essenciais para o sucesso do tratamento odontológico é a higienização eficiente, capaz de remover o biofilme das próteses. Em casos de estomatite protética associada à Cândida ssp, as medidas terapêuticas mais eficientes são os controles efetivos da higiene oral, assim como das próteses (HEARTWELL; RAHN, 1993). Partindo desse raciocínio, o índice de placa nas faces interna e externa das próteses totais maxilares foi avaliado, neste trabalho, através do uso de evidenciadores. Esse procedimento foi realizado em próteses novas tendo-se a preocupação de orientar, no momento da instalação, os portadores das mesmas sobre cuidados de higienização da cavidade oral e das próteses. Foi realizado ainda exame citológico do palato desses mesmos pacientes a fim de verificar a presença de Cândida albicans. Os resultados encontrados não mostraram diminuição dos índices de biofilme depositados nas próteses totais maxilares tanto dos pacientes do grupo experimental como dos pacientes do grupo controle, sendo que se procurou avaliar também distúrbios cognitivos. Estes resultados sugerem que o método de motivação não foi eficiente e que fatores psicológicos, sociais e culturais influenciam a motivação dos pacientes em relação a hábitos de saúde oral. / This research intended to evaluate hygiene and oral health in geriatric patients using complete dentures. Because the elderly population has increased fast much more people uses today some kind of prostheses (complete, removable or implants). It’s expected that complete dentures should replace facial expression, mastigatory function and speech as well. However this is not always possible because patients are supposed to accept the inconvenience and responsibility of taking care of their own prostheses. A very important step is to perform a good hygiene intending to control biofilm development on tooth surface as well as over the prostheses. In Candida-associated denture stomatites the most important therapeutic measure is institution of effective oral and denture hygiene (HEARTWELL; RAHN, 1993). Based on what was mentioned before it was analyzed by means of staining, the biofilm index in the internal and external faces of complete dentures. Such procedures were performed in the new prostheses after instructing the patient how to clean them. It was also performed a cytologic exam of the palatal mucosa to verify if Candida albicans were present, or not. The results did not show any diminution of the biofilm index accumulate in the maxillary prostheses of both groups: control and experimental with or without deficit of cognition. Such results suggest that the motivation method was not efficient and also that psychologic, social and cultural factors do influence the patient’s motivation when we deal with oral health.